Sunday, November 27, 2022

PART 2 RESPONSES TO ” difficult short bk fit”

Jeff Zeller

THANK YOU ALL FOR YOUR PROMPT REPLIES. I AM GOING TO TRY A VARIETY OF THESE
IDEAS. I AM GOING TO CAST WITH THE INTENTION OF DOING A THIGH LACER. THIS IS
WHAT I ORIGINALLY WANTED TO DO. BUT HE DID NOT LIKE THE IDEA. BUT I THINK
ULTIMATELY THAT WOULD ALLOW HIM THE EASE OF DONN AND DOFFING AS WELL AS
PROVIDE A WAY TO ONLOAD THE SOFT TISSUE AND BONY PROMINANCES OF HIS SHORT
LIMB.

I WILL KEEP YOU UPDATED.

SINCERELY,

JEFF A. ZELLER, CP

The Alps sleeves will allow the prosthesis to piston some, especially it it
is not a suction socket. If he cannot get the sleeve up, you may be able to
use a waist belt with maybe a fork strap.

Try elongating the stump when you cast it and then have him pull his tissue
in (or have a family member or caregiver do it) to the liner and then don
the socket, or whatever type of socket you make.

Have you tried the Medi liners? It is what our office has found works the
best for controling redundant tissue.

Have you tried casting for a custom liner? Then it can be made conical
enough for his thigh (if that is part of the problem). Alpha can do custom
liners from a cast and you can request gel stays to prevent it from rolling
down. (But again, then the Alpha liners don’t control redundant tissue
well.)

Another practitioner here mentioned having the patient wear a Comfort
shrinker underneath the pelite insert (but make sure you cast over the
shrinker as well). And make sure the seam is in the back.

Or use a suction socket with a PTS wedge as well. Multiple suspension may
reduce the pistoning.

Hope these suggestions help.

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Hi Jeff.

Sounds like a tough one. If he can manage it, try a pull-in fitting
using a slot cut in the end of the pelite liner. Use a section of
stocking(cosmetic hose or similar) long enough to pull over his socks, pass
through the slot, and be reflected back over the liner. It’s odd, but
we’ve had good results with patients who have redundant tissue and
residual limb sensitivity. Elongating the soft tissue appears to be the
key as it reduces stress from pushing the soft tissue and allows more
accurate proximal weightbearing.

Good luck.

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I think I would be tempted to consider joints and thigh lacer. It is not
ideal – it would be bulky and hot -although not much hotter than the sealing
sleeve but your patient would be able to don consistently. Consider keeping
the pelite liner and treat fit with socks and gel dots. Maintain suspension
over the condyles with the thigh lacer. Put the buckles medial to make it
easier to fasten with just the right hand. Just a thought – I am sure
someone will come up with somehting spectacular for you.

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