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Matt Lawall
As a newly hired prosthetic technician, you have much to learn about the complex process of making a prosthetic limb. This instruction set will take you step by step though the process and help you to fully understand the fabrication of a BK (below the Knee) prosthesis. As you become more familiar with the process, you will gain skills and knowledge that will help you produce many prosthetic limbs each day. In doing so, you will be improving the lives of many amputees. The process of making a BK prosthetic limb involves eight steps which are as follows: 1. 2. 3. 4. Pouring the Cast Modifying the mold Adding the adaptor to the mold Laminating the acrylic socket
5. Drawing the trim lines and cutting the socket off the cast 6. Trimming the socket to the correct trim lines and smoothing the edges of the socket 7. Cutting out the adaptor for the socket 8. Attaching the tube and foot and adjusting the limb to the correct tendon height. Below is a list of tools you will need to complete this process.
Tools
Cast saw Wood files Plaster Mixing Drill Bit Screen Stockinet Sanding cones Disc grinder Drill Allen keys/torque wrench tape Pipe cutter Wood chizzle
Instructions
1. Pouring the Cast
A certified practitioner will bring a cast of the patients limb to the workshop so that the prosthetic limb can be fabricated. The first step in this process is to pour the cast with plaster in order to get an exact mold of the patients residual limb. This ensures that each prosthetic made is fully custom to that specific patient. The first step in pouring the plaster is to add plaster powder to a bucket or trash can. Next you will add water and begin mixing with a drill and a mixing drill bit. This is the most important step in pouring the cast. It is imperative that the plaster is the right consistency. With time, you will be able to tell when the plaster has the right consistency similar to mixing cement. After that, you pour the plaster into the cast and let it sit for about five minutes. The last step is to place a metal pipe in the middle of the mold so that the mold can be put into a vice to be modified. After the plaster has finished drying, you are ready for the next step.
pointed at the right flexion angle. This is essentially how much the knee is bent. This can be found on the paper work and is usually between 5 and 7 degrees. To measure this angle a protractor can be used. When this is complete, you are finally ready to laminate the socket of the prosthetic limb.
5. Drawing the trim lines and cutting the socket off the cast
Once the resin is completely hard, it is time to remove the socket from the mold. But first, you need to draw trim lines one the socket so that you know where to cut it. When drawing trim lines for a BK prosthesis, it is important to be aware of the location of the patella tendon. This is an indentation just below the knee cap. Standard trim limes are 3 inches above the patella tendon
on each side of the limb, an inch and a half above the patella tendon in the front, and at the same level as the patella tendon in the back. The best way to do this is to place these four marks on the socket and then do your best to connect the dots without any sharp corners. Once the trim lines have been drawn on the socket, use a cast saw to cut it off the mold an inch or so above the trim lines.
6. Trimming the socket to the correct trim lines and smoothing the edges of the socket
In this step you want to trim your socket to the lines you have drawn in the previous step. To do this you will use a disc grinder. It will take some practice to follow the lines on the socket with the disc grinder. Caution: be careful not to slip and hit you knuckles on the disc. A rough sand cone on a truatman can be used to trim the socket in tight places that the disc cannot reach. The next step is to smooth the edges of the socket so that the patient does not get cut and develop sores. To do this you will need to use a smooth cone on the trautman to smooth each side of the edge; inside, outside, middle. Below is a picture of a trautman with a sand cone.
8. Attaching the tube and foot and adjusting the correct tendon height
This is the last step of the process. With the completion of the previous step, the socket is completely finished. Now all you have to do is connect the socket to the prosthetic foot. This is fairly simple. First connect the tube to the socket via the adaptor. Allen keys will be used to
tight the screws. Next attach the tube to the prosthetic foot the same way that you attached the tube and the socket. At this point the leg is assembled; however, you need to adjust it to the correct height. To do this you measure from the floor to the patella tendon. On the paper work you received with the cast, the practitioner has provided you with the correct tendon height. Subtract the height that is on the paper work from the height that the leg was originally to find the length of the tube that needs to be cut off. Once you have this number, remove the foot from the tube, use a pipe cutter to cut the tube, and reattach the tube to the foot. At this point the prosthesis is complete. Take this time to make one final inspection of the limp. The first prosthetic limb that you complete may take a long time (4-5 hours), and it may need to be redone. However, it is important to not get frustrated and to take your time. With help from your fellow employees, you will improve greatly in the first week. The most important part of this process is to remember to take pride in your work and not rush through it.
Works Cited
http://www.oandpdesign.com/prosthetics.htm http://kathleenodonnelldesign.wordpress.com/2011/03/15/learning-to-make-prosthetics/ http://www.oandp.com/articles/news_2007-11-01_11.asp