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Prosthetics > Transtibial Prosthetics > Flashcards

Transtibial Prosthetics Flashcards

1
Q

What are the 4 main components of transtibial prosthetics

A
  1. Socket and interface (socks, liners)
  2. Suspension mechanism
  3. Shank or pylon
  4. Foot
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2
Q

What does the socket do

A

Contacts and dispenses pressure around the patient’s residual limb, supports residual limb during weight bearing, transmits forces from the limb to control placement of foot

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3
Q

What are the 3 socket types for transtibial amputations

A
  1. Patellar tendon bearing
  2. Total surface bearing used with soft liner
  3. Flexible socket/rigid frame
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4
Q

Where are the weight bearing surfaces of the PTB socket

A

Patella tendon and counter force from popliteal fossa

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5
Q

What is the most effective residual limb shape

A

Conical

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6
Q

What is a conical shaped limb

A

Circumference of distal aspect of limb is smaller than proximal limb

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7
Q

What is a cylindrical shaped limb

A

Circumference of the limb is the same at all points

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8
Q

What is a bulbous shaped limb

A

Circumference of distal aspect of limb is larger than proximal aspect

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9
Q

True or False:

With a longer residual limb you can make a smaller socket and prosthesis

A

True`

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10
Q

What are the pressure tolerant areas around the knee with a transtibial amputation (6)

A
  1. Medial tibial flare
  2. Fibular shaft
  3. Patellar tendon
  4. Posterior compartment
  5. Femoral condyles
  6. Anterior compartment
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11
Q

What are the pressure intolerant areas around the knee with a transtibial amputation (4)

A
  1. Fibular head
  2. Tibial crest
  3. Hamstring tendons
  4. Distal tibia
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12
Q

How long does a patient with an amputation need to be in compression

A

23 hours of the day

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13
Q

True or False:

Total surface bearing sockets distribute weight more evenly throughout the limb with assistance of the liner

A

True

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14
Q

True or False:

Total surface bearing sockets are primarily used with pin/shuttle suspension

A

True

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15
Q

What happens if you have someone with a large fibular head or tibial crest

A

You can cut out a hole for those areas and put in a soft liner to help provide contact

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16
Q

What are the 2 goals of prosthetic socks

A
  1. Cushion forces applied to residual limb

2. Accommodate for the change in volume of residual limb

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17
Q

Socks are made of what typically

A

Wool or cotton

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18
Q

What are the types of ply layers you can have with a sock

A

1, 3, or 5

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19
Q

Where does the heaviest ply go

A

Closest to the skin

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20
Q

What is the baseline ply for all amputation patients

A

3 ply

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21
Q

What happens when you get 10-15 plys

A

You need a new socket

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22
Q

When would you use a half sock

A

When you need to increase the ply of the distal limb if an extra ply is needed but can’t wear prosthesis with a full 1 ply sock so get rid of proximal half of sock

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23
Q

What is worn directly against the skin

A

Sheaths

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24
Q

What do sheathes do

A

Wick moisture, decrease shear, and improve hygiene

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25
Q

Why do you need to change the socket when you get to 10-15 ply worth of socks

A

Due to increased temperature and shearing of prosthetic

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26
Q

True or False:

With a hard socket there is no additional liner (soft insert) worn

A

True

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27
Q

When is a hard socket interface indicated (3)

A
  1. Limbs with intact sensation
  2. Good soft tissue coverage
  3. No sharp bony prominences
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28
Q

What is the advantage to a hard socket (3)

A
  1. Less bulky
  2. Easy to clean
  3. Durable
29
Q

What are the disadvantages to a hard socket (3)

A
  1. Prosthetic labor
  2. More difficult to fit and modify
  3. Less comfortable
30
Q

What are soft liners indicated for

A

Patients with fragile skin, bony prominences, or high level of activity

31
Q

What do soft liners do

A

Provide additional protection, padding, and they are easily adjustable

32
Q

What are soft liners commonly made of (6)

A
  1. Pelite
  2. Nickelplast
  3. PPT
  4. Silicone gel
  5. Plastazote
  6. Leather
33
Q

What is the order of putting things on with a prosthetic (4)

A
  1. Sheath
  2. Socks
  3. Liner
  4. Prosthetic
34
Q

What do suspension mechanisms do (3)

A
  1. Hold prosthesis firmly to the limb during gait
  2. Allow patient to sit comfortably
  3. Minimize movement pistoning/torque between socket and limb
35
Q

What is choice of suspension mechanism influenced by (5)

A
  1. Patient present and predicted activities
  2. Goals
  3. Physical abilities
  4. Climate
  5. Distance to prosthetist
36
Q

What are the 7 types of suspension systems

A
  1. Supracondylar cuff
  2. Supracondylar system (PTB SC)
  3. Supracondylar/suprapatellar system (PTBSC/SP)
  4. Thigh corset
  5. Waist belt
  6. Sleeve
  7. Pin/shuttle
37
Q

How does the supracondylar system (PTB SC) work

A

Wedge suspension captures femoral condyles as they taper into shaft of femur

38
Q

When is a supracondylar system (PTB SC) indicated (2)

A
  1. Short residual limb

2. Provide M-L stability to knee

39
Q

How does the supracondylar suprapatellar (PTBSC-SP) suspension system work

A

Encapsulates the patella and quadriceps and leaves knee in slight flexion and an anterior wall is added

40
Q

When is a supracondylar suprapatellar (PTBSC-SP) suspension system indicated (3)

A
  1. Short residual limb
  2. Instability A-P and M-L
  3. Ligamentous difficulty
41
Q 
True or False:
Supracondylar suprapatellar (PTBSC-SP) suspension systems make it difficult to kneel
A

True

42
Q

True or False:

Thigh corset and knee joint cause serious atrophy of the thigh

A

True

43
Q

What is a sleeve suspension made of

A

Neoprene, urethane, or latex

44
Q

How is the sleeve suspension positioned

A

Around the shank and rolled over thigh

45
Q

What is the advantage of sleeve suspension (4)

A
  1. Cosmetic
  2. Airtight
  3. Showering
  4. Unrestricted knee motion
46
Q

What is the disadvantage of sleeve suspension (3)

A
  1. Not durable
  2. Hygiene
  3. Need good hand function to don/doff
47
Q

What is a shuttle/pin design often used with

A

Total surface bearing (TSB) socket

48
Q

What is the advantage of shuttle/pin design (2)

A
  1. Unrestricted knee flexion

2. Minimal pistoning

49
Q

When is a shuttle/pin design suspension system indicated

A

Scarred or sensitive limb

50
Q

What is the disadvantage of shuttle/ pin design suspension system (3)

A
  1. Expensive
  2. Not durable
  3. Need good hand function
51
Q

When is a suspension design indicated (2)

A
  1. Cannot tolerate thigh lacer

2. Present with extremely short residual limb

52
Q

How much of a difference can be present for a suspension design to be used

A

Less than 2 inches from knee center to distal residual limb

53
Q

What is the shank/pylon of an endoskeletal design

A

Modular and central tube transmits weight from socket to foot

54
Q

What is the shank/pylon of an exoskeletal design

A

Outer wall transmits weight from socket to foot and like a crustacean

55
Q

What are the 3 types of prosthetic alignment

A
  1. Bench
  2. Static
  3. Dynamic
56
Q

What is bench prosthetic alignment

A

Done at office how things are lined up nice and vertical

57
Q

What is static prosthetic alignment

A

Put prosthetic on patient and stand them up in parallel bars and visually inspect for verticality

58
Q

What is dynamic prosthetic alignment

A

Patient walks with prosthesis and you fine tune the prosthesis

59
Q

True or False:

Slight knee flexion of the prosthesis provides nice distribution of pressure

A

True

60
Q

True or False:

You can angulate the socket to keep the foot flat on the floor

A

True

61
Q

Why is the foot set in

A

So we land on our heel and roll lateral to medial and have quality push off

62
Q

What happens if the prosthesis rotates medially

A

You will have contact with the fibular head

63
Q

What does DF of the prosthetic foot cause

A

Knee flexion

64
Q

What does PF of the prosthetic foot cause

A

Hyperextension

65
Q

What happens at the knee if the heel is too firm

A

You get into knee flexion

66
Q

What happens at the knee if the heel is too soft

A

You get hyperextension at the knee

67
Q

True or False:
When the prosthesis gets taken off the patient it is good to see pinkness on the skin but not good to see redness on the skin

A

True

68
Q

What is the lipstick test

A

Put lipstick on a sore spot and the lipstick will rub off on prosthesis and you will be able to put pads around the area to relieve pressure

69
Q

What is the powder test ball and clay test

A

Take play doh and drop a dime sized ball in prosthesis and have patient walk and if play doh is still a ball then some sock layers need to come off, if too flat add socks, if nicely flattened keep sock layers

Prosthetics (8 decks)

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