Short Textbook of Prosthetics and Orthotics R Chinnathurai, P Sekar, M Ramaa Kumar, K Nithya Manoj, C Senthil Kumar
INDEX
A
Abducted gait 51
Acute complications 18
Adherent scar 19
AFO 124
AFO with varus 107
Amputation 3, 9, 25
Amputation surgery 9
anesthesia 10
blood vessels 11
bone 10
controlled environment method 14
crepe bandaging 14
definite (classical) amputation 9
Guillotine amputation 9
levels of amputation 11
above elbow amputation 13
below elbow amputation 13
knee disarticulation 13
transfemoral amputation 12
transtibial amputation 12
muscles 10
nerves 10
postoperative care 13
revision amputation 9
rigid dressing 14
skin closure 11
soft dressing 14
stump 11
stump flaps 10
technique of amputation 9
tourniquet 10
types of amputation 9
wound closure 11
Anesthesia 10
Ankle foot assembly 34
Ankle foot orthosis 105, 122
Ankle joints 106
Anterior knee supports 110
Anterior wall 46
Axillary crutch 134
B
Before donning of prosthesis 38, 49
Below elbow amputation 13
Below elbow prosthesis 65
Below knee lower limb prosthesis 42
Below knee prosthesis (PTB) 56
Bent knee socket 32
Berkeley dual ankle orthosis 111
Biomechanical principle 104
Blood vessels 11
Body powered 64
Bone 10
Bony complications 20
Bony overgrowth 20
Boots for amputations 121
Braces 92
C
C leg 72
C4-5 injuries 129
C5 injuries 129
C6 injuries 130
C7-C8 injuries 130
Cable system 65
Calf band 106
Canadian Syme's prosthesis 28
Cane 124, 133
indications 133
measurement 133
types of canes 133
Causes of amputation 5
congenital limb deficiency 5
infections 5
trauma 5
tumors–malignant 5
vascular 5
Cervical collars 80
Cervical orthosis 79
Chair back brace 86
Chair back brace with sternal attachment 89
Chopart's amputation 26
Circumduction gait 40, 52
Classical amputation 9
Clinical evaluation 122
Closed expandable Syme's prosthesis 28
Club foot boot 121
Computer aided design 72
Computer assisted manufacturing 72
Congenital limb deficiency 5
Continuous passive motion orthosis 99
Controlled environment method 14
Conventional below knee socket 30
Corrective orthosis 92
Corrective pads 93
Cosmetic hand 62
Craig scott orthosis 111
Crepe bandaging 14
Crutch gaits 135
axillary crutch 134
crutch gaits 135
drag to gait 136
forearm crutches 134
four-point crutch gait 136
swing through gait 136
swing to gait 136
three-point gait 135
two-point gait 135
types 134
Cuffs and straps 59
D
Definite amputation 9
Deformity 122
Delayed complications 18
adherent scar 19
bony complications 20
bony overgrowth 20
dog ear 19
increased sweating 19
neuroma 20
management of neuroma 20
prevention of neuroma 20
phantom pain 21
phantom sensation 21
skin complications 19
skin infection 19
skin ulceration 19
theories of pain 21
types of pain 22
Dog ear 19
Drag to gait 136
Drop off 40, 51
Dropping of hip 39
Dynamic hand orthosis 101
Dynamic motion blocking 99
Dynamic orthosis 77, 99, 101
elbow orthosis 101
hand and finger orthosis 102
hand orthosis 101
shoulder orthosis 101
wrist orthosis 101
Dynamic response feet 71
Dynamic traction splints 99
E
Elbow amputation 13
Elbow hinges 60
Elbow mechanism 72
Elbow orthosis 100
Elbow units 64
Endoskeletal (modular) 34
Endoskeletal shank 42, 71
Energy storing feet 71
Energy storing foot 36
Equinus 121
Exoskeletal (Crustacean) 33
Exoskeletal shank 42
External knee joint 32
F
Figure of “8” suspension 58
Finger orthosis 101
Flat foot 117
Flexible flat foot 117
Flexible hinge 60
Flexion/extension control devices 80
cervical collars 80
halo device 82
minerva body jacket 83
normal motion vs restriction of neck movement with orthosis 84
philadelphia orthosis 80
poster appliances 82
somi brace 81
yale cervicothoracic orthosis 82
Flexion/extension/lateral flexion/rotation control devices 80
Floor reaction orthosis 113
indications for floor reaction orthosis 115
principle 114
results 114
types 114
Foot orthoses 117
Foot piece 48
Foot slap 50
Foot wear modifications 116
AFO – ankle foot orthosis 122
clinical evaluation 122
deformity 122
equinus 121
foot orthoses 117
flexible flat foot 117
pes planus (flat foot) 117
footwear modification 118
fore foot adduction 121
boots for amputations 121
HKAFO – hip knee ankle foot orthosis 123
insensitive foot 120
club foot boot 121
KAFO – knee ankle foot orthosis 123
lower part 116
muscle power 122
orthotic prescription 122
parts of shoes 116
pes cavus 118
heel pain–plantar fasciitis 120
limb length discrepancy 120
osteoarthitis of knee 120
pain behind heel 120
toe pain 120
rigid flat foot 118
shortening 122
spinal support 123
upper part 117
varus/inversion 121
Footwear modification 118
Fore foot adduction 121
Forearm crutches 134
Forearm shell 65
Four-point crutch gait 136
Functional cast bracing 110
Functions of cervical orthosis 79
classification 79
G
Gait analysis in transfemoral amputees 49
abducted gait 51
excessive trunk extension 51
before donning of prosthesis 49
heel contact to midstance 50
foot slap 50
knee instability 50
terminal impact 50
midstance 50
lateral trunk bending 50
sitting with prosthesis 49
standing with prosthesis 49
transfemoral gait deviations 50
walking 49
Gait analysis in transtibial amputees 38
before donning of prosthesis 38
excessive knee extension 39
knee instability 39
gait deviations 39
heel contact to foot flat 39
mid stance 39
excessive dropping of hip 39
excessive raising of hip 39
narrow based gait 40
sitting with prosthesis 38
standing with prosthesis 38
swing phase 40
circumduction 40
pistoning 40
uneven step length 40
terminal stance 40
drop off 40
knee extension vaulting 40
walking 38
wide based gait 39
Gait deviations 39
Gritti-stokes amputation 41
Guillotine amputation 9
H
Halo device 82
Hand and finger orthosis 100, 102
Head support unit 93
Heel contact 39, 50
foot flat 39
midstance 50
Heel off 51
Heel pain–plantar fasciitis 120
Hip knee ankle foot orthosis 110
advantages 110
Berkeley dual ankle orthosis 111
Craig scott orthosis 111
functional cast bracing 110
HKAFO with spinal support 110
knee cage 112
Madras knee cage 113
Swedish knee cage 113
principle 112
reciprocating gait orthosis 112
seattle orthosis 111
solid plastic AFO 113
swivel orthosis or para podium 111
Hip knee ankle foot orthosis (HKAFO) 110, 123
HKAFO with spinal support 110
I
Immediate prosthesis after wound healing 24
levels of amputation in foot and ankle 25
toe disarticulation 25
Increased sweating 19
Indian modification of lower limb prosthesis 56
Jaipur foot 56
Madras foot 56
modification in above knee prosthesis 56
transmetacarpal 57
transphalangeal 57
wrist disarticulation 57
modification in below knee prosthesis 56
Infections 5
Insensitive foot 120
Intercalary deficiency 68
IPOPF 14
long-term follow-up 17
postoperative program in amputee training 16
preprosthetic training 16
prosthetic training 16
reintegration into community 17
IPOPF or IPOP (immediate postoperative prosthesis) 23
advantages 24
disadvantages 24
Ischial containment socket 46
Ischial weight relieving orthosis 103
J
Jaipur foot 56
Jewett hyperextension orthosis 90
K
KAFO 124
Knee ankle foot orthosis (KAFO) 108
anterior knee supports 110
knee joints 109
knee locks 110
parts 109
thigh band 109
Knee cage 112
Knee disarticulation surgery 13, 41
Knee extension vaulting 39, 40
Knee instability 39, 50
Knee joint 42, 48, 109
Knee locks 110
Knee prosthesis 56
Knight's brace (LS AP control brace) 87
L
Lateral trunk bending 50
Lateral wall 46
Length of the stump 58
Lesions 126, 131
above elbow 126
ape tumb deformity 126
at T L3-L5 131
at T12-L2 131
at T1-T6 131
at T7 to T11 131
WRIST 126
Limb length discrepancy 120
Lisfranc's 26
Longitudinal deficiency 67
Long-term follow-up 17
Lower limb 69
Lower limb orthoses 105, 124, 130
Lower part 116
LS APL control brace 86
LS PL control brace 87
Lumbosacral orthosis 85
advantages 89
chair back brace (LS APL control brace) 86
chair back brace with sternal attachment 89
complications 95
conditions where orthosis used 92
contraindications 92
corrective pads 93
disadvantages 89
factors for orthosis prescription 92
functions of corrective orthosis 92
head support unit 93
indications 87
indications for non-operative treatment 91
Jewett hyperextension orthosis 90
Knight's brace (LS AP control brace) 87
Milwaukee brace 93
moulded plaster jacket 90
pelvic girdle 93
Taylor's brace 88
thoracolumbosacral orthosis (TLSO) 88
types of braces used 92
uprights 93
William's brace (LS PL control brace) 87
Lumbosacral orthosis 85, 97
M
Madras foot 56
Madras knee cage 113
Measurement 133
Mechanical or body powered hand 61
Medial or lateral whip 52
Medial wall 46
Metal AFO 106
Metal uprights 106
Mid stance 39, 50
Midstance to heel off 51
circumduction gait 52
drop off 51
inadequate heel off 51
medial or lateral whip 52
tilting table type 54
uneven arm swing 52
uneven timing 53
vaulting 52
Milwaukee brace 93
Minerva body jacket 83
Modified munster socket 61
Modified Syme's amputation 27
Moulded plaster jacket 90
Multi-axis foot 35
Muscle power 122
Muscle wasting in amputees 44
Muscles 10
Myoelectric arm 62
N
Naming the orthosis 98
Narrow based gait 40
Neck movement with orthosis 84
Nerves 10
Neuroma 20
Non-operative treatment 91
Normal motion 84
O
Original Syme's amputation 26
Orthosis 76, 125, 138
arthritis 132
burns 132
median nerve injury 126
radial nerve injury 127
soft tissue rheumatism 132
static orthosis 76
ulnar nerve injury 126
upper limb 125
Orthosis for radial nerve injury 127
Orthosis for ulnar nerve injury 126
Orthosis for upper limb 125
lesions above elbow 126
lesions at wrist 126
Ape tumb deformity 126
orthosis for median nerve injury 126
Orthosis in arthritis and soft tissue rheumatism 132
Orthosis in burns 132
Orthosis prescription 92
Orthotic prescription 122
Osteoarthitis of knee 120
P
Pain 21
Pain behind heel 120
Para podium 111
Passive hand 62
Patellar tendon bearing socket 30
Patellar tendon bearing weight relieving orthosis 104
Pelvic girdle 93
Pes cavus 118
Pes planus 117
Phantom pain 21
Phantom sensation 21
Philadelphia orthosis 80
Pistoning 40
Plastic AFO 107
Poster appliances 82
Posterior wall 46
Postoperative care 13
Postoperative program in amputee training 16
Pre-amputation counseling 8
Preprosthetic training 16
Principles in applying an upper limb orthosis 98
classification 98
continuous passive motion orthosis 99
dynamic orthoses: dynamic motion blocking 99
dynamic traction splints 99
tenodesis splint 99
naming the orthosis 98
static orthoses: serial static splint 99
static motion blocking splint 99
static progressive splint 99
Principles in lower limb orthoses 105
AFO with varus 107
ankle foot orthosis 105
ankle joints 106
anterior wall 46
calf band 106
comparison between quadrilateral and ischial containment sockets 47
foot piece 48
ischial containment socket 46
knee joint 48
lateral wall 46
medial wall 46
metal AFO 106
metal AFO for valgus deformity 107
metal uprights 106
muscle wasting in amputees 44
plastic AFO 107
posterior wall 46
Principles of amputation 3
Principles of transfemoral amputation 44
quadrilateral socket 46
shank piece 48
socket 46
sole plate 107
stirrup 107
suspension 48
transfemoral prosthesis 44
Prostheses 66
forequarter amputation 66
shoulder disarticulation 66
tibial supracondylien 31
Prostheses for shoulder disarticulation 66
prostheses for forequarter amputation 66
intercalary deficiency 68
longitudinal deficiency 67
transverse deficiency 67
Prosthesis 57, 137
congenital limb deficiency 68
elbow disarticulation 66
knee disarticulation 41
Prosthesis for elbow disarticulation 66
prosthetic prescription 66
Prosthesis for hand amputation and wrist disarticulation 57
advantages 57
disadvantages 57
prosthesis 57
Prosthesis for transradial amputation 58
cable system 65
cosmetic or passive hand 62
elbow units 64
body powered 64
electrical or externally powered 62
figure of “8” suspension 58
flexible hinge 60
forearm shell 65
length of the stump 58
level of amputation 63
mechanical or body powered hand 61
modified munster socket 61
myoelectric arm 62
rigid hinge 60
self suspending 59
cuffs and straps 59
elbow hinges 60
shoulder saddle 58
single channel control 62
socket 60, 64
split socket with step up hinges 61
terminal device 61
wrist unit 61
standard below elbow socket 61
step up hinges 60
suction suspension 59
suspension 58, 64
terminal device 65
transradial prosthesis 58
voluntary closing hand or hook 61
voluntary opening hook and hand 61
wrist units 65
Prosthesis in congenital limb deficiency 68
“c” leg 72
definition 75
terminal device and elbow mechanism 72
lower limb 69
advantages 72
CAD/CAM (computer aided design/computer assisted manufacturing) 72
endoskeletal shank 71
energy storing feet (dynamic response feet 71
examples 72
socket 71
suction suspension 71
upper limb 68
Prosthesis in foot and ankle amputation 26
transmetatarsal amputation 26
Chopart's amputation 26
Syme's amputation 26
original Syme's amputation 26
two-stage Syme's amputation 26
modified Syme's amputation 27
problems in Syme's amputation 27
Syme's prosthesis 27
canadian Syme's prosthesis 28
closed expandable Syme's prosthesis 28
conventional 27
Lisfranc's 26
Prosthesis in hip disarticulation 54
canadian type 54
saucer type 54
Prosthesis in knee disarticulation 41
advantages of knee disarticulation surgery 41
Gritti-stokes amputation 41
foot piece 42
knee joint 42
ship piece 42
socket 42
prescription of below knee lower limb prosthesis 42
surgical modifications 41
Prosthetic prescription 29
ankle foot assembly 34
energy storing foot 36
multi-axis foot 35
sach foot 34
single axis foot 35
solid ankle flexible keel foot 36
shin piece 33
endoskeletal (modular) 34
exoskeletal (crustacean) 33
socket 30
bent knee socket 32
conventional below knee socket 30
patellar tendon bearing socket 30
prostheses tibial supracondylien 31
slip socket 32
suspension 32
external knee joint with thigh corset 32
suction suspension 32
supracondylar cuff 32
Prosthetic prescription 29, 66
Prosthetic training 16
PTB weight relieving orthosis 104
Q
Quadrilateral containment socket 47
Quadrilateral socket 46
R
Raising of hip 39
Reciprocating gait orthosis 112
Reintegration into community 17
Revision amputation 9
Rigid dressing 14
Rigid flat foot 118
Rigid hinge 60
S
Sach foot 34, 72
Saucer type 54
Seattle orthosis 111
Self suspending 59
Semi-rigid cervical collar 80
Serial static splint 99
Shank piece 48
Shin piece 33, 42
Shoes 116
Shortening 122
Shoulder and arm orthosis 100
Shoulder orthosis 101
Shoulder saddle 58
Single axis foot 35, 42
Single channel control 62
Sitting with prosthesis 38, 49
Skin closure 11
Skin complications 19
Skin infection 19
Skin ulceration 19
Slip socket 32
Socket 30, 42, 46, 60, 64, 71
Soft cervical collar 80
Soft dressing 14
Sole plate 107
Solid ankle flexible keel foot 36
Solid plastic AFO 113
Somi brace 81
Spinal support 123
Split socket with step up hinges 61
Standard below elbow socket 61
Standard nomenclature 4
Standing with prosthesis 38, 49
Static arm orthosis 100
elbow orthosis 100
finger orthosis 101
hand and finger orthosis 100
shoulder and arm orthosis 100
wrist orthosis 100
Static motion blocking splint 99
Static orthoses 76, 99
Static progressive splint 99
Step up hinges 60
Stirrup 107
Stump flaps 10
Suction suspension 32, 59, 71
Supracondylar cuff 32
Surgical modifications 41
Suspension 32, 48, 58, 64
Swedish knee cage 113
Swing phase 40
Swing through gait 136
Swing to gait 136
Swivel orthosis 111
Syme's amputation 26
Syme's prosthesis 27
T
Taylor's brace 88
Technique of amputation 9
Tenodesis splint 99
Terminal device 61, 65, 72
Terminal impact 50
Terminal stance 40
Thigh band 109
Thigh corset 32
Thoracolumbosacral orthosis 88, 96
indications 97
lumbosacral orthosis 97
Three-point gait 135
Tilting table type 54
Toe disarticulation 25
Toe pain 120
Tourniquet 10
Transfemoral amputation 12, 44
Transfemoral gait deviations 50
Transfemoral prosthesis 44
Transmetatarsal amputation 26
Transradial prosthesis 58
Transtibial amputation 12
Transverse deficiency 67
Trauma 5
Trunk extension 51
Tumors–malignant 5
Two-point gait 135
Two-stage Syme's amputation 26
U
Uneven arm swing 52
Uneven step length 40
Uneven timing 53
Upper limb 68
Upper limb orthosis 98
Upper part 117
V
Valgus deformity 107
Varus/inversion 121
Vaulting 52
Voluntary closing hand or hook 61
Voluntary opening hook and hand 61
W
Walker 134
indications 134
measurement 134
Walking 38, 49
Weight relieving orthosis 103
biomechanical principle 104
indications 104
indications for PTB weight relieving orthosis 104
ischial weight relieving orthosis 103
patellar tendon bearing weight relieving orthosis 104
Wide based gait 39
William's brace 87
Wound closure 11
Wrist disarticulation 57
Wrist orthosis 100
Wrist unit 61
Y
Yale cervicothoracic orthosis 82
×
Chapter Notes

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1Short Textbook of Prosthetics and Orthotics2
3Short Textbook of Prosthetics and Orthotics
Author R Chinnathurai MBBS, D Phys. Med. Professor of Physical Medicine Madras Medical College, Chennai, India Head of the Institution Govt. Institute of Rehabilitation Medicine KK Nagar, Chennai Co-authors P Sekar MBBS, MD (Ped), DCH Professor of Pediatrics Institute of Child Health Madras Medical College, Chennai M Ramaa Kumar MS, FRCS Consultant Surgeon Mu. Va. Hospital, Chennai Vadapalani Multispecialty Hospital, Chennai K Nithya Manoj MBBS, D Phys. Med. Civil Assitant Surgeon Tutor in Physical Medicine Govt. Institute of Rehabilitation Medicine KK Nagar, Chennai C Senthil Kumar B Tech, M Tech Postgraduate Trainee Uppsala University, Uppsala Sweden
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Short Textbook of Prosthetics and Orthotics
© 2010, Jaypee Brothers Medical Publishers (P) Ltd.
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the authors and the publisher.
First Edition: 2010
9788184488197
Typeset at JPBMP typesetting unit
Printed at
5Preface
Physical Medicine and Rehabilitation has always been a reign unexplored by most medical professionals and paramedical personnel. There is a lacunae in the realm of prescribing an appropriate and most useful prosthesis and orthosis to the needy disabled population.
This book Short Textbook of Prosthetics and Orthotics is meant to fill in the lacunae and provide sufficient information to medical professionals, prosthetic and orthotic technicians, physiotherapists, general practitioners, orthopedicians and sports physicians.
We have simplified the text with only brief technical details with specific emphasis laid on certain common disabling conditions.
The contents have been dealt with under the heads of medical diagnosis so as to ensure that the readers can refer to it as and when a patient approaches and a prescription is needed.
The pace of growth in the field of Prosthetics and Orthotics is very fast and hence is the variety of technology available for the patient.
We have laid emphasis on the technology that is widely available and used, and the global trends in the field have been dealt within appropriate Chapters.
We regard it as a reward if the book encourages further study of Orthotics and Prosthetics. We also welcome constructive criticism for improvement.
R Chinnathurai
6
7Acknowledgments
I express my deep sense of gratitude to my mentor Dr IS Shanmugam, Former Director, Govt. Institute of Rehabilitation Medicine for infusing interest in Physical Medicine and Rehabilitation during and after my student years with him.
I also thank my friends, colleagues and co-authors – Dr P Sekar and Dr M Ramaa Kumar for their beckoning inspiration and contribution in authoring this book. Their contribution on surgical aspects of amputee rehabilitation and comprehensive rehabilitation of pediatric population has enriched the scope of the title. Also I thank my student and co-author Dr K Nithya Manoj for her efforts to bring this work into its final shape of a book.
The technical aspects of prosthesis and latest developments in the field of biotechnology included in the book are a valuable contribution of the co-author, Mr C Senthil Kumar and I extend my thanks to him for his helping hand.
I deeply appreciate the work of Dr Selwyn J Kumar and Dr R Rajkumar for their active suggestions for improvement of the book.
I thank Mrs N Vijaya for the data entry work and my cousin Mr K Rajendran for scanning of pictures and illustrations for the book.
My endeavors would have been lost in the wood but for the continuous support and encouragement of the publishers M/s Jaypee Brothers Medical Publishers (P) Ltd and I pay my sincere thanks for their support.
Last but not the least, the book has seen the light of the day only with the affection and endurance of my wife, Mrs Malarkodi Chinnathurai.