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BK doffing problem....responses
Posted By: martha matthews on October 29, 2012
Orginal Post: I have a young active BK amputee with a large gastroc, but significantly smaller at the MTP and the distal end. Donning the Socket is a snap, but doffing is a bear due to this bulbous mid section. We are currently in a hard socket with a flexible inner liner and gel liner with pin. Any suggestions too help me with this young lady would be truly appreciated. Thank you
Use the same set up but before you laminate add pelite to the inner flexible socket at the undercut area. Build up enough so the dimensions gradually get smaller proximal to distal and there is not that huge difference in that area. Then laminate over that. Hope this helps
Can you window the narrow area in the posterior?
In the past I've incorporated a supercondylar build-up on a pelite insert/liner for use with locking liners and pin suspension; we simply have a hole in the distal end for the pin. The same could be done in this situation. If the flexible inner liner was removable, you could add a build-up to the MTP level and have the patient don this as she would a pelite liner. As long as there is enough of the pin sticking out of the flexible liner to engage into the lock in the socket, you should be good.
Consider adding a medial window with a strap in your hard outer socket.
P.S. Of course you'll want to fabricate a "door" to cover the "window" before you cut the opening. If you cut the opening carefully you can attach the original socket piece to the " window/door" covering.
I would suggest making a door with a clasp like a ski boot.
You need to make her a p-lite liner and contour the exterior to the shape of a cylinder. A laminated socket over that will slip right on.
You can put a hole in the bottom of the p-lite liner and use the silicone liner with pin for suspension.
They would don the silicone, then the p-lite liner, then slide right into the cylindrical socket.
You could fit her with a soft socket insert and build up the popliteal in thickness to allow for the larger gastric.
If you rememer the old bk's with the medial wedge of gondil for suspention with peite liner may do you good or some kind of wedge that can be pulled before duffing. this is just a thought
Try pelite type liner with build up to make cylindrical to be removable and flexible. May need to make a slit in liner to ease donning and doffing. Use coyote EOVC lock to allow both hands to doff devicePut medial compressible pad in. You'll have to remake the socket though. Usually it's medial side that has to compress.
Put medial compressible pad in. You'll have to remake the socket though. Usually it's medial side that has to compress.
If she contracts that gastroc when struggling to doff prosth its like physiological suspension. I usually find that donning is the problem and not doffing. It seems obvious but she must relax her leg when doffing and hopefully it will make a difference..
Try a Limb Logic vacuum system from OWW and change your socket shape for ease of exit. The vacuum will pull her in. It works well.
Usually patients with this configuration have to use a pelite insert with additional pads on the OUTSIDE of the insert to create a more cylindrical shape in the socket. Attaching 1/2 inch dacron straps with loops to the outside assists with donning. A gel liner with locking pin can be donned under the insert. Another complication that frequently accompanies the doffing problem you mention is excessive distal pressure which is worth monitoring with a pressure device during fitting.As a footnote, you cannot use a rigid frame/flexible socket with this configuration,a hard socket is necessary.
It might be a little late on a reply but we have the same problem once in a while and we put a one way valve in the bottom of the socket. This allows air to enter the socket when doffing and solves the problem.
A retrofit Lynn valve would be a good choice. Esp also has a nice slider valve that prevents the wearer from having to push the button the whole time he/she is doffs the socket. Not sure if it's a retrofit valve. I don't think it is.
clam shell/bi-valve socket.
Thanks to all that responded!!
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