Transfemoral socket design

Quadrilateral / Ischial containment

C. Ribeiro-Wagener
 
[email protected]

Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
 Socket Casting, Positive Mould, and
Rectification

• The process of making a socket begins with taking measurements and a negative cast of the
residual limb. The cast is filled with plaster to create a positive mould. The positive mould is then
modified to optimize the socket fit, this process is called “rectification”.
• The socket is then laminated using carbon and resin to create the custom socket, this is referred to
as the definitive socket.

• A “check”/test/diagnostic socket is sometimes fabricated before creating the definitive socket (this
socket is usually transparent, allowing the clinician a complete view to evaluate the fit and make
changes).

• TEST SOCKET VIDEO

https://youtu.be/iFzhH-WWEh4

Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
 Socket design = Quality of use

 Comfort
 Ability to control the prosthesis
 Quality of the socket fit
 Prosthetists experience(precise measurements during casting and suitable rectification of the
positive mould to distribute forces over the socket)

Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
 OTHER TECHNOLOGY:

 Polypropylene technology developed by the International Committee of the Red Cross (ICRC) is used in
prosthetics all over the world, especially in resource-limited countries and projects by the ICRC. Polypropylene is
used in the US also as an alternative to laminating a definitive socket.  It is cheaper than laminating but can be just
as durable. VIDEO= https://youtu.be/ou4fqBrAm5g

 The Modular Socket System developed by Ossur can be used to make a socket directly on the patient's residual
limb. It is an easier and quicker process but the cost is higher. Delivery time to the patient could be within one day. 

 A more sophisticated and expensive technique utilized today is a CAD system (Computer Aided Design). With the
improvement of technology 3D printed sockets are also gaining momentum.

 Adjustable sockets are gaining more popularity, such as the RevoFit2 Adjustable Socket.  BOA VIDEO
https://youtu.be/sEsHw0tYnNw

Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Pressure tolerant
and pressure-
sensitive areas:

The purpose of the socket is to

provide structural integrity to the
prosthesis where it interfaces with
the residual limb. It also may
provide elements of suspension to
hold the prosthesis in place. The
socket should be comfortable and
able to withstand all of the external
forces placed upon it by the user.

Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
 Quadrilateral Socket -Overview

 The traditional quadrilateral socket has a narrow

anterior to posterior dimension (A) compared to 
The corner between the anterior and medial
the medial to lateral dimension (B) - see Fig 1.
walls of the socket is shaped to provide relief for
 The anterior wall of the socket is ideally 5-7cm the adductor tendon when it comes into action in
higher than the posterior wall to retain the the stance phase; the proximal edge of the
residuum, and combined with the narrow medial wall is kept low enough to prevent
anterior to posterior dimension, helps keep the painful contact with the ischial ramus.
ischial tuberosity on the ischial seating area of
the posterior brim, but may need to be reduced
to provide comfort when sitting. The ischial
seating should normally be parallel to the
ground.

Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
 Quadrilateral Socket -Overview

 The lateral wall of the socket, whilst it should be kept as high as possible in order to spread the
lateral forces over as large an area as possible, is generally lower than with other types of socket.
 This combined with the wider medial to lateral dimension can allow a lack of mediolateral
stabilising force, but since this lower lateral wall makes it very suitable for use with a rigid pelvic
band suspension, this problem is then negated.
 The diagram below gives some idea of the socket shape at brim level, but soft tissue or highly
toned muscular tissue would change the shape of the residuum and subsequently the shape of the
socket would need to change to accommodate the differences.

Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Prescription Guideline

 Quadrilateral sockets should be prescribed for any patient with a transfemoral

amputation, when some or all of the indications are observed, whilst ideally none
of the contraindications are exhibited.

Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Indications / contraindications

Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Exceptions

 Those patients who are deemed medically unfit, unwilling, or because of their
current lifestyle or circumstances, unsuitable for the provision of a prosthesis.
 Poor cognitive ability and compromised hand function may, in some cases, be
contraindications for prosthetic rehabilitation. The MDT must assess whether the
patient has the level of ability required with or without a carer, to use the
prosthesis being prescribed, correctly, safely and consistently before proceeding.
 Where an alternative approach is seen to be more suitable according to the
indications/ contraindications of its guideline.

Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Transversal view Medial view Posterior view

Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
Casting & Rectification Video

 Hand positioninghttps://youtu.be/E87-VGzARRg

 Cast rectification https://youtu.be/w0Y81Uhn7tw

Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)
THANK YOU

Faculty of Science
Department of Sports Rehabilitation and Dental Science
Bachelor of Health Science in Medical Orthotics and Prosthetics (BPOP20)