U.S. patent application number 13/663282 was filed with the patent office on 2013-02-28 for devices and methods for bone stabilization.
The applicant listed for this patent is Randall D. Alley, T. Walley Williams, III. Invention is credited to Randall D. Alley, T. Walley Williams, III.
Application Number | 20130053981 13/663282 |
Document ID | / |
Family ID | 47226642 |
Filed Date | 2013-02-28 |
United States Patent
Application |
20130053981 |
Kind Code |
A1 |
Alley; Randall D. ; et
al. |
February 28, 2013 |
DEVICES AND METHODS FOR BONE STABILIZATION
Abstract
A compression stabilized prosthetic socket for a patient having
an amputated limb and a remaining portion includes a first socket
portion for contacting a patient's remaining portion of a limb, and
a second socket portion for attachment of a prosthetic device. The
first socket portion has compression portions having a radius for
compressing portions of the patient's remaining portion of a limb,
and relief portions receiving any portions of the patient's
remaining limb which bulge upon the compression applied by the
compression portions. The relief portions may be formed as openings
or as enlarged radius portions.
Inventors: |
Alley; Randall D.; (Thousand
Oaks, CA) ; Williams, III; T. Walley; (Belmont,
MA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Alley; Randall D.
Williams, III; T. Walley |
Thousand Oaks
Belmont |
CA
MA |
US
US |
|
|
Family ID: |
47226642 |
Appl. No.: |
13/663282 |
Filed: |
October 29, 2012 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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12945876 |
Nov 14, 2010 |
8323353 |
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13663282 |
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12792728 |
Jun 2, 2010 |
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12945876 |
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12380861 |
Mar 4, 2009 |
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12792728 |
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61068263 |
Mar 4, 2008 |
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Current U.S.
Class: |
623/33 |
Current CPC
Class: |
A61F 2/78 20130101; A61F
2/76 20130101; A61F 2/80 20130101; A61F 2002/7818 20130101 |
Class at
Publication: |
623/33 |
International
Class: |
A61F 2/78 20060101
A61F002/78 |
Claims
1. A prosthetic device for use by a patient having a limb that has
been amputated and that has a longitudinal axis, wherein the
prosthetic device comprises: a first portion configured for
placement on the limb and having a plurality of compression
portions and a plurality of relief portions, wherein each of the
plurality of compression portions is comprised of a strut, wherein
each of the plurality of relief portions is a window disposed
between two of the struts, wherein each of the plurality of
compression portions is configured to compress a portion of the
limb thereby causing excess portions of the limb to flow outwardly
at the plurality of relief portions, so that the excess portions of
the limb bulge outwardly without restriction through the windows
and beyond the first portion of the prosthetic device, wherein the
plurality of compression portions is disposed circumferentially
around the limb when the first portion of the prosthetic device is
placed on the limb, and wherein each of the plurality of
compression portions has a generally longitudinal shape and is
disposed longitudinally along a direction of the longitudinal axis
of the limb when the first portion of the prosthetic device is
placed on the limb.
2. The prosthetic device of claim 1 wherein the limb has an outer
circumference along an outer surface of the limb and has an at-rest
radius measured from a central longitudinal axis of the limb, and
wherein each of the plurality of compression portions is further
configured to compress the portion of the limb so that the outer
circumference of the limb is compressed to a radius that is reduced
by at least thirty percent from the at-rest radius of the limb and
no more than seventy percent from the at-rest radius.
3. The prosthetic device of claim 1 wherein each strut is
constructed of a material that includes an acrylic laminate.
4. The prosthetic device of claim 1 wherein each strut is
constructed of a material that includes an acrylic laminate with a
stiffening member constructed of one of carbon fiber and
para-aramid synthetic fiber.
5. The prosthetic device of claim 1 wherein the limb further has a
longest bone having a length, and wherein each of the plurality of
compression portions extends for a length that is approximately
equal to the length of the longest bone.
6. The prosthetic device of claim 1 wherein the limb further has a
longest bone having a length, and wherein each of the plurality of
compression portions extends for a length that is no less than
approximately 80% of the length of the longest bone.
7. The prosthetic device of claim 1 wherein the prosthetic device
is further for use with a flexible membrane configured to
encapsulate at least a portion of the limb of the patient, wherein
the first portion of the prosthetic device is further configured
for placement over the flexible membrane and on the limb when the
at least the portion of the limb is encapsulated by the flexible
membrane, and wherein portions of the flexible membrane are
configured to bulge outwardly through the windows along with the
excess portions of the limb in response to the compressing of the
portions of the limb.
8. A prosthetic device for use by a patient having a limb that has
been amputated and that has a longitudinal axis, wherein the
prosthetic device comprises: an enclosure portion configured for
placement on the limb and having a plurality of compression
portions and a plurality of relief portions, wherein the plurality
of compression portions and the plurality of relief portions form
at least a portion of an inner wall of the enclosure portion,
wherein the inner wall is configured for encapsulating at least a
portion of the limb when the enclosure portion is placed on the
limb; wherein each of the plurality of compression portions is
configured to compress a portion of the limb thereby causing excess
portions of the limb to flow outwardly and into the plurality of
relief portions, so that the excess portions of the limb flow
outwardly with essentially no restriction away from the plurality
of compression portions, wherein the plurality of compression
portions is disposed circumferentially around the limb when the
enclosure portion of the prosthetic device is on the limb, wherein
each of the plurality of compression portions has a generally
longitudinal shape and is disposed longitudinally along a direction
of the longitudinal axis of the limb when the enclosure portion of
the prosthetic device is on the limb, and wherein each of the
plurality of relief portions has a generally longitudinal shape, is
disposed between two of the compression portions, and is disposed
longitudinally along the direction of the longitudinal axis of the
limb when the enclosure portion of the prosthetic device is on the
limb.
9. The prosthetic device of claim 8 wherein the limb further has a
longest bone having a length, and wherein each of the plurality of
compression portions extends for a length that is approximately
equal to the length of the longest bone.
10. The prosthetic device of claim 8 wherein the limb further has a
longest bone having a length, and wherein each of the plurality of
compression portions extends for a length that is no less than
approximately 80% of the length of the longest bone.
11. The prosthetic device of claim 8 wherein the limb further has
an outer circumference along an outer surface of the limb and has
an at-rest radius measured from a central longitudinal axis of the
limb, and wherein each of the plurality of compression portions is
further configured to compress the portion of the limb so that the
outer circumference of the limb is compressed to a radius that is
reduced by at least thirty percent from the at-rest radius of the
limb and no more than seventy percent from the at-rest radius.
12. A method for using a prosthetic device comprising: placing an
enclosure portion of the prosthetic device on a limb of a patient,
wherein the limb has been amputated and has a longitudinal axis,
wherein the enclosure portion has a plurality of compression
portions and a plurality of relief portions, and wherein the
plurality of compression portions and the plurality of relief
portions form at least a portion of an inner wall of the enclosure
portion, wherein the inner wall is configured for encapsulating at
least a portion of the limb when the enclosure portion is placed on
the limb; compressing portions of the limb using the plurality of
compression portions; and causing excess portions of the limb to
flow outwardly and into the plurality of relief portions, so that
the excess portions of the limb flow outwardly with essentially no
restriction away from the plurality of compression portions,
wherein the plurality of compression portions is disposed
circumferentially around the limb when the enclosure portion of the
prosthetic device is on the limb, wherein each of the plurality of
compression portions has a generally longitudinal shape and is
disposed longitudinally along a direction of the longitudinal axis
of the limb when the enclosure portion of the prosthetic device is
on the limb, and wherein each of the plurality of relief portions
has a generally longitudinal shape, is disposed between two of the
compression portions, and is disposed longitudinally along a
direction of the longitudinal axis of the limb when the enclosure
portion of the prosthetic device is on the limb.
13. The method of claim 12 wherein the limb further has a longest
bone having a length, and wherein each of the plurality of
compression portions extends for a length that is approximately
equal to the length of the longest bone.
14. The method of claim 12 wherein the limb further has a longest
bone having a length, and wherein each of the plurality of
compression portions extends for a length that is no less than
approximately 80% of the length of the longest bone.
15. The method of claim 12 wherein the limb further has an outer
circumference along an outer surface of the limb and has an at-rest
radius measured from a central longitudinal axis of the limb, and
wherein the compressing of the portions of the limb includes
compressing the portions of the limb so that the outer
circumference of the limb is compressed to a radius that is reduced
by at least thirty percent from the at-rest radius of the limb and
no more than seventy percent from the at-rest radius.
16. A prosthetic device for use by a patient having a limb that has
been amputated, wherein the limb has a longitudinal axis and has a
bone generally extending along the longitudinal axis, wherein the
prosthetic device comprises: means for reducing relative movement
of the bone in relation to the prosthetic device when the
prosthetic device is disposed on the limb and when the patient
moves the limb; wherein the means for reducing the relative
movement includes a plurality of compression portions and a
plurality of relief portions; wherein each of the plurality of
compression portions has a generally longitudinal shape and is
disposed longitudinally along a direction of the longitudinal axis
of the limb when the prosthetic device is disposed on the limb, and
wherein each of the plurality of relief portions has a generally
longitudinal shape, is disposed between two of the compression
portions, and is disposed longitudinally along the direction of the
longitudinal axis of the limb when the prosthetic device is
disposed on the limb.
17. The prosthetic device of claim 16 wherein the bone of the limb
has a length and is a longest bone of the limb, and wherein each of
the plurality of compression portions extends for a length that is
approximately equal to the length of the bone.
18. The prosthetic device of claim 16 wherein the bone of the limb
has a length and is a longest bone of the limb, and wherein each of
the plurality of compression portions extends for a length that is
no less than approximately 80% of the length of the bone.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of, and claims the
benefit of priority from U.S. patent application Ser. No.
12/945,876, filed Nov. 14, 2010 which in turn is a
continuation-in-part of, and claims the benefit of priority from
U.S. patent application Ser. No. 12/792,728, filed Jun. 2, 2010
which in turn is a continuation-in-part of, and claims the benefit
of priority from U.S. patent application Ser. No. 12/380,861, filed
Mar. 4, 2009, which in turn claims benefit of U.S. Provisional
Patent Application No. 61/068,263 filed Mar. 4, 2008, all four of
which such applications are incorporated by reference herein.
FIELD OF INVENTION
[0002] The present invention relates to the prosthetic limbs worn
by upper or lower limb amputees and in particular to the portion of
a limb prosthesis that is in direct contact with the user's
skin.
DESCRIPTION OF THE RELATED ART
Definitions of Terms
[0003] Socket--is that part of a prosthesis in direct contact with
the user's skin. The word Socket usually implies a traditional
socket that is essentially circular in cross section. A traditional
prosthesis consists of an inner socket to interface with the user's
skin and an outer socket over it that continues to incorporate the
mechanisms that comprise the next distal structure which may be a
joint or a device to function as a foot or gripping device. The
inner and outer sockets may be separate structures or may be
unitary consisting of a single unit.
[0004] Interface--is often used as a synonym for socket, but is
more often reserved for socket-like structures that have openings
in the outer socket and occasionally in both the outer and inner
sockets.
[0005] Cast--is a thin layer of wet plaster impregnated gauze
wrapped around a residual limb and the surrounding body parts and
then permitted to harden to reproduce the shape of the limb. While
the plaster is hardening, pressure from the hands of the plaster
technician often modifies the shape to accommodate the underlying
boney anatomy.
[0006] Positive Model--is the plaster model that results from
filling a cast with plaster or similar material. Modifications by
adding and subtracting plaster are made to this model before its
outer surface is used to define the shape of the user's socket or
interface.
[0007] Check Socket--is a temporary socket made over the model and
used to test whether the modifications have had the desired effect
on the fit of the resulting socket.
[0008] Channel--is used here to describe a longitudinal area where
the wall of a socket is depressed inward as close to the underlying
skeletal structures as is comfortable.
[0009] Relief Area--is the region in a socket system between two
channels or around or near a compressed area which provides a place
for the displaced tissue to migrate.
[0010] Lost Motion--is the motion of the skeletal structures with
respect to the prosthetic interface when force is applied between
the two as would occur as an amputee tries to move the prosthesis
as a whole. In a traditional socket lost motion occurs when the
bone moves toward the socket wall a substantial distance before
imparting force to the wall.
[0011] Compression Bar--is a long flat bar typically a little
shorter than the shaft of the remaining long bone(s). The width of
the bar is usually about ten percent of the circumference of the
remaining limb.
[0012] Optimal Tissue Compression--is compression of the tissue
against the socket wall such that lost motion is minimized without
causing discomfort to the user.
[0013] High-fidelity Interface or device--is the name given to the
socket or interface that utilizes compression stabilization as the
basis for its function and physical structure.
BACKGROUND OF THE INVENTION
[0014] Historically the prosthetic user interface has been a
cylindrical socket that merely surrounds the remaining limb part
with some contouring of the proximal brim so that it will
accommodate the shape of the next proximal joint or body part.
Typically this socket is made by taking a plaster cast over the
limb and filling it with plaster to form a positive model of the
limb. Minor changes are made to this shape to relieve boney
prominences. When this model is used to create a socket by
laminating or thermoforming a layer of plastic there over, the
resulting socket mainly encapsulates the limb part. Conventionally,
no modification of the traditional model is done. This opportunity
to specifically enhance the resulting structure's ability to impart
desired motion to the complete prosthesis, and to prevent undesired
motion from occurring, has been overlooked, even though these are
the most important functions of the interface. The traditional
encapsulating or closed volume socket merely contains the soft
tissue but does little or nothing to prevent lost motion between
the socket and the underlying skeletal structure.
[0015] Some improvements have been made in the traditional
interface. In particular, many technicians replace the fully
encapsulating outer socket with a frame having one or more
openings. This change is accompanied by making the inner socket of
a flexible material. The resulting frame-style design usually is
more comfortable. New materials such as carbon fiber composites add
rigidity where needed especially in open frame designs. New
flexible materials allow the socket wall to flex in other areas for
comfort. Even when these newer flexible materials are used, the
soft liner still fully encapsulates the remaining limb as
traditionally done, and thus provides a compressive or elastic
force to all of the limb's soft tissue.
[0016] Conventional laminations over a plaster model work best when
the surfaces of the model are convex facing outward, following the
general contours of the outside surface of the limb.
SUMMARY OF THE INVENTION
[0017] In a preferred embodiment of the invention a mold (negative
model) is made by making a cast of a remaining limb on which a
prosthesis will be used. From the mold/cast, a positive model is
made of the remaining limb. There are deep channels formed in the
positive model, which are a cause of excessive thickness in these
areas when conventional lamination procedures are used. Where the
areas between the channels are to be left open, however, the model
may be brought almost flush with the edges of the compressed areas.
This alteration permits a much stronger lamination. Another
technique to strengthen the resulting struts is to corrugate the
compression channel area to create a resistance to flex upon
lamination.
[0018] When taking a cast of the area above the knee, prosthetists
are often assisted by using jigs especially to establish the shape
of the brim area for transfemoral sockets. In the new socket
technology of this invention one may also use a jig to assist in
achieving an optimal cast of the area above the knee.
[0019] Preventing Lost Motion
[0020] In one embodiment, a basis of this invention stems from a
simple observation using a procedure such as described below. A
person holds his/her arm in a fixed position so that an
experimenter cannot easily move the arm side to side. The
experimenter then pushes with a finger on the fleshy area over the
long bone of the upper arm. Typically, the finger will push into
the soft tissue a centimeter or more before it compresses the
tissue against the bone and no further motion is possible without
the subject moving. During compression, tissue moves aside away
from the area of compression. From the inventor's knowledge, no
prior designs have specifically allowed for the displacement of
tissue as a requirement for achieving stability even if local
compressed areas exist. For a long bone to be fully stabilized with
respect to the prosthetic interface, compression must be applied in
a specific way. Typically three or four channels are created in the
socket along the entire length of the bone except at the very ends.
Accordingly, the channels extend proximate to ends of the bone,
e.g. at least eighty and more preferably at least ninety percent of
the existing longest bone in the existing limb. The inner surfaces
of these channels compress the tissue against the long bone until
little further motion is possible. For this compression to be
effective, there must be a longitudinal relief area between each
pair of channels. The channels and the relief areas are two key
elements of a preferred embodiment of the invention and both must
be present for optimal performance. In a more preferred embodiment,
a third key element is that at least three channels are needed to
impart full stability.
[0021] Creating the Compression Stabilized Socket Interface
[0022] The traditional prosthetic socket is created by taking a
cast, making a positive model, and modifying the model to create a
form for shaping a final socket interface. An important element of
a preferred embodiment of this invention is the use of the
traditional sequence in a new way. Three to four compression bars
are made prior to taking the cast. These are tested by spacing them
appropriately around the remaining limb and pushing in. Care is
given to both the physical and anatomical structures of the limb in
determining proper placement. In the case of the upper limb,
specifically the humeral level in which positional precision and
lifting capacity take precedent, the locations of these compression
bars are biased toward stabilization in flexion and abduction, the
two most common functional motions utilized, resulting in narrower
relief windows in the anterior and lateral areas of the socket. The
length, width, and curvature of the bars are adjusted until they
lock the underlying bone in place when equal pressure is applied to
the bars. The individual bars are checked to see if they rock
end-to-end when pressure is shifted in which case a change in shape
is indicated. Before taking the cast, the prosthetist must decide
how to arrange the bars around the limb so that forces are
optimally transmitted when the resulting interface is used. The
underlying location of nerves and other structures will determine
the exact angular orientation of the bars and may determine the
optimum number of bars to use.
[0023] The cast is taken by applying a loose wrap of wet elastic
casting plaster. The bars are then placed in the pre-planned
positions, pressed into the elastic wrap and soft tissue by hand or
with a casting jig with sufficient force to impart substantial
compression on the limb and held in place while the plaster sets.
It is important for the wrap to be able to stretch so that the
displaced tissue has somewhere to go. Even in the best of
circumstances, the plaster will prevent the bars from achieving
optimal penetration. This is corrected during the cast
rectification stage. Before, during or after the channels in the
plaster and the bulges in between are sufficiently set, the
proximal parts of the cast are taken in the usual manner. However,
some areas in this secondary area of the wrap may also need to be
compressed by the fingers of the cast taker to create additional
areas of pre-compression.
[0024] For taking a femoral level cast, the distances and forces
needed are greater and a bar-location jig is of great help. This
jig is an integral part of the invention for femoral casting and
femoral interface sockets and could also be used if desired for
humeral casting. The jig consists of two or more stiff "d"- or
"c"-shaped rings with the flattened surface of the d-rings or the
open surface of the c-rings positioned to the medial or inside area
next to the midline of the body or the opposite leg if present.
These rings are large enough to allow some space inside the rings
when they are placed around the limb. Each ring can accept a single
screw attachment or plurality of screw attachments. Each attachment
can be oriented azimuthally around the ring and then locked in
place. Each attachment has a screw or screws aimed at the center of
the ring capable of applying force to one of the channel-forming
bars. In addition the attachments are open on one of the sides that
face parallel to the limb in the B-ring design. This opening
permits the prosthetist to remove a single pair of attachments and
the underlying bar after the preliminary setup described below. The
c-ring design inherently already has this opening. Small snap-in
pockets along the outside of each bar and the fact that the screw
ends are spherical prevent slipping once the bars are in place. In
the ideal embodiment the pockets have a restriction at the opening
that makes the attachment of the screw ends act like pop beads to
hold the screw end to the bar. In a typical cast taking at the
femoral level, two rings are used and each has four attachments
oriented approximately ninety degrees apart. In the design
utilizing two screws for each compression bar, the attachment
screws are placed in pockets on the bars about twenty percent of
the length of the bar in from the end. Before the cast is taken the
prosthetist experiments and selects the best length and width for
each bar and the optimal location. To speed application during the
actual cast taking, all positions are marked with the anticipated
extra circumference of the added plaster wrap accounted for.
[0025] After the cast has been filled to create a positive model,
the plaster technician will usually need to deepen the channels
before pulling a thermoformed check socket out of transparent
plastic. If a solid-bodied check socket will be utilized, then
additional plaster must be added over the relief areas of the
positive model to allow sufficient displacement of soft tissue into
the check socket's relief areas. Usually several check sockets will
be needed. As each is applied to the user, the fit and stability of
the check socket is evaluated. The color of the tissue will tell
the experienced practitioner where too much compression is being
applied and where there is too little. In addition substantial
forces should be applied in all directions to ensure that the
stabilization is optimal. Since the compression stabilized
interface design requires that the areas between channels be left
free or sufficiently relieved for tissue movement, there is good
reason for leaving these areas fully open in the check socket
unless an encapsulating or solid-body interface is desired. The
user can then more readily perspire and dissipate excess body heat.
With three or more long openings in the socket wall, a traditional
cloth laminate is usually replaced by a stiff, strong carbon fiber
reinforced laminate in the form of a frame.
[0026] Usually a temporary assembly of the distal prosthetic
components is added to the final check socket and tested before the
shape of the check socket is approved for creating the definitive
prosthesis. For approval, the interface must transmit force and
motion to the prosthesis in every direction that the user will
require with minimal lost motion between the interface and the rest
of the prosthesis.
[0027] In a presently preferred embodiment of the invention, there
is a limb interface device. The limb interface device has either an
encapsulating design with adequate soft tissue reliefs or an open
cage or strut-type configuration of rigid, semi-rigid or
dynamically adjustable struts appropriately contoured to a
patient's residual limb. The open cage or strut-type configuration
contains windows through which soft tissue can flow out of the
interface confines.
[0028] The limb interface device may have any of various prosthetic
components attached to it to provide an upper or lower extremity
prosthesis extending from the distal end of the interface device.
The regions of compression in both the encapsulating and strut-type
embodiments are configured and aligned in such a way as to transfer
skeletal movement as efficiently as possible such that interface
response to volitional movement and interface stability are
maximized. Optionally, stabilizers or other devices may be attached
to a proximal end of the limb interface device.
[0029] In the open cage or strut-type configuration, the strut
edges can be configured such that they are either flexible enough
or shaped appropriately to mitigate edge pressure and hence soft
tissue stress, or a material can be fitted to the struts such that
it extends just beyond the border of the rigid or semi-rigid edge
and provides a more gradual transition of pressure at this
location.
[0030] In another preferred embodiment, the interface device may
have the ability to alter the stiffness of the strut assembly
itself on demand or automatically in response to applied loads such
that edge pressure or overall strut compression is varied
appropriately to prevent skin or underlying soft tissue damage.
Finally, an inner, highly flexible membrane may be utilized that
encapsulates the entirety of the limb and is placed between the
strut assembly and the limb yet still allows sufficient soft tissue
flow beyond the confines of the strut assembly such that edge
pressure on the soft tissue and redundant intrinsic skeletal motion
are minimized.
[0031] Although embodiments of the present interface assembly finds
particular application with prosthetic limbs, it is also to be
appreciated that the interface assembly may be used in other
applications such as orthotics or other interface applications
involving the human body.
[0032] Still other objects, advantages and constructions of the
present invention, among various considered improvements and
modifications, will become apparent from the detailed description
provided hereinafter. It should be understood that the detailed
description and specific examples, while indicating a presently
preferred embodiment of the invention, are intended for purposes of
illustration only and are not intended to limit the scope of the
invention.
[0033] In some parts of the orthotic and prosthetic industry, cast
taking has been replaced by laser scanning of the residual limb and
the creation of a virtual solid model. It is anticipated that
simple algorithms can be created to permit insertion of channels
and bulges in a virtual model such that the area inside the virtual
wall of any cross section of the residual limb would remain the
same. Such an algorithm automatically creates appropriate bulges
when the technician moves a portion of the wall toward the skeletal
structures in the virtual model. Principles of the embodiments of
the invention are not changed when the model for creating the
definitive interface structure is based on a plaster cast or on a
virtual model produced with software.
[0034] In a preferred embodiment, there is a prosthetic socket
which prevents lost motion between an amputee's remaining limb and
the prosthesis by selectively compressing tissue against the bone
in some areas while providing relief in other areas so that
displaced tissue is accommodated when forces are applied between
the bone and the interface. Additional embodiments of the invention
include methods for creating the new socket design.
[0035] It is an object of various embodiments of the present
invention to provide a prosthetic interface within which the
individual's upper or lower extremity residual limb part is
captured with greater stability than in known prior art.
[0036] It is a further object of various embodiments of the
invention to provide a mechanism to selectively compress the soft
tissue between the residual limb's skeletal structure and socket
structures to minimize lost motion when the skeletal structures of
the residual limb move with respect to the socket and attached
prosthesis.
[0037] It is a further object of various embodiments of the present
invention to provide a plurality of areas of compression parallel
to the long axis of the major bone or bones of the residual
anatomy.
[0038] It is a further object of various embodiments of the present
invention to provide open or low-compression relief areas between
said areas of compression so that said compression is not impeded
by the inability of the underlying tissue to flow or migrate
sideways.
[0039] It is a further object of various embodiments of the present
invention to provide a method for taking a cast of the residual
limb that results in an approximation of the desired final shape of
the socket interface.
[0040] It is a further object of various embodiments of the present
invention to create areas of compression in a plaster cast parallel
to the long axis of the residual limb during the process of cast
taking with bulges in between that will define areas of relief in
the complete prosthetic interface.
[0041] It is a further object of various embodiments of the present
invention to provide check sockets where areas of relief are
created by leaving the socket wall completely open or are large
enough in the encapsulating version to allow for sufficient soft
tissue displacement.
[0042] It is a further object of various embodiments of the present
invention to provide definitive prosthetic interfaces where areas
of compression, both with respect to the underlying bone as well as
with respect to the area of compression just proximal to the
bulging soft tissue, to stabilize the longitudinal motion of the
prosthesis with respect to the skeletal anatomy thus aiding in
suspension and weight bearing.
[0043] It is a further object of various embodiments of the present
invention to provide definitive prosthetic sockets where a soft
liner covers the limb but is stabilized by a frame there over with
the frame performing the functions of a traditional outer socket.
(If such a liner is used, the model over which it is formed must
have bulges between the compression channels large enough to create
a liner with little or no tissue compression in the areas between
the areas of compression.)
[0044] It is a further object of various embodiments of the
invention to provide areas into or through which a significant
amount of soft tissue of the said limb can flow freely, without
restriction or with minimal restriction so as to permit sufficient
soft tissue flow away from areas of compression along the shaft of
the bone or bones in the aforementioned areas of high
compression.
[0045] It is a further object of various embodiments of the present
invention to take advantage of the anatomical response such that
tissue can be compressed against bone just so far before further
motion is impeded if there is room for the displaced tissue to move
out of the way.
[0046] It is a further object of various embodiments of the present
invention to create prosthetic sockets with longitudinal grooves
alternated with areas sufficiently open that the displaced tissue
suffers no compression.
[0047] It is a further object of various embodiments of the present
invention to create sockets that have three or more compression
channels so that lost motion is prevented in all directions.
[0048] It is a further object of various embodiments of the present
invention to shape the interior surfaces of the grooves such that
when the prosthesis is loaded the local pressure along the length
of the bone is equal without excessive pressure at the ends.
[0049] It is a further object of various embodiments of the present
invention to provide means for creating a prosthetic interface by
applying a plurality of bars or a loose plaster wrap during the
cast taking procedure.
[0050] It is a further object of various embodiments of the present
invention to provide a jig for holding the bars in position during
cast taking
[0051] It is a further object of various embodiments of the present
invention to provide a jig having two or more rings larger in
diameter than the limb. Each ring has a single or plurality of
snap-in-place screw holder(s) with adjustment screws oriented so
the axis of the screw passes through the center of the ring.
[0052] It is a further object of various embodiments of the present
invention to provide screw holders that are applied to the ring by
moving parallel to the axis of the ring. This feature permits a bar
screw holder or a bar and two screw holders to be removed from a
pair of rings as a unit.
[0053] It is a further object of various embodiments of the present
invention to provide adjustment screws with spherical ends.
[0054] It is a further object of various embodiments of the present
invention to provide a snap-in socket or plurality of snap-in
sockets along the center line of the outside of each bar which
accept the spheres on the adjustment screws.
[0055] It is a further object of various embodiments of the present
invention to provide bars with center sections that telescope so
bar length can be adjusted as well as to offer different length
bars to be snapped in place depending on the application.
BRIEF DESCRIPTION OF THE DRAWINGS
[0056] FIG. 1 is a perspective view from an anterior position of a
transhumeral high-fidelity interface device in accordance with a
first preferred embodiment of the invention, where the device has
an open cage or strut-type structure;
[0057] FIG. 2 is a perspective view from an anterior position of a
transhumeral high-fidelity interface device in accordance with a
second preferred embodiment of the invention, where the device has
a closed structure;
[0058] FIG. 3 is a cutaway view from the top of the interface
device of FIG. 2, showing an interior thereof;
[0059] FIG. 4 is a view of the device of FIG. 1 on a patient's left
arm;
[0060] FIG. 5 is a perspective view from a medial position of a
transradial high-fidelity radial interface device as a closed
structure;
[0061] FIG. 6 is a perspective view from an anterior position of a
transfemoral high-fidelity interface device in accordance with a
fourth embodiment, where the device has a closed structure;
[0062] FIGS. 7a, 7b show an example of a jig design utilized for
transfemoral cast taking in preparation for the creation of a
transfemoral high-fidelity interface;
[0063] FIGS. 8a and 8b show the anterior and posterior perspectives
of an exemplary transfemoral high-fidelity interface attached to
prosthetic components;
[0064] FIG. 9 is a drawing showing a casting
[0065] FIG. 10 is a drawing showing a mold formed from the
casting;
[0066] FIG. 11 is a flow chart showing steps in a process of an
embodiment of the invention for making a high-fidelity interface
for a prosthesis and limb, preferably a lower limb; and
[0067] FIG. 12 is a flow chart showing steps in an alternate
process of another embodiment of the invention for making a
high-fidelity interface for a prosthesis and limb, preferably an
upper limb.
DESCRIPTION OF THE PREFERRED EMBODIMENT(S)
[0068] As shown in FIG. 1, a the transhumeral open-cage interface
embodiment, there is an upper portion 1, which has both an anterior
stabilizer 2 and a posterior stabilizer 3 and which extends in a
proximal (in this case toward a patient's shoulder) and medial
(toward a patient's midline) direction from a lower portion 4 to
stabilize the interface on a patient's body. Although stabilizers 2
and 3 are not required, they are recommended to impart or enhance
rotational stability. The lower portion 4 (below line 5) has an
open-cage structure. Dashed horizontal line 5 demarcates the upper
and lower portions. The lower portion 4 of this open-cage
embodiment has multiple, e.g. three or four struts 6, which look
like fingers that extend along the long axis of the residual limb
and are designed to partially encompass the residual limb, allowing
soft tissue to flow through windows 7.
[0069] As shown in FIG. 2, a transhumeral solid-body interface
embodiment, there is an upper portion 1a, which has both an
anterior stabilizer 2a and a posterior stabilizer 3a and which
extends in a proximal (in this case toward the shoulder) and medial
(toward the midline) direction from lower portion 8 to stabilize
the interface on the body. Although stabilizers 2a and 3a are not
required, they are recommended to impart or enhance rotational
stability. In this embodiment, lower portion 8 is a solid body
structure. A dashed horizontal line 5a demarcates the upper and
lower portions. The lower portion of this solid-body embodiment has
multiple, e.g. three or four, compression areas 9 and soft tissue
relief areas 10 that extend along the long axis of the residual
limb and are arranged circumferentially in an alternating
compression-relief pattern as shown. Soft tissue relief areas 10
must have a volume sufficient to cleave displaced skin and other
tissue from compression applied by compression areas 9.
[0070] In FIG. 3, an interior of the transhumeral solid-body
interface embodiment is shown, with alternating compression areas 9
and relief areas 10 indicated.
[0071] In FIG. 4, a patient is shown wearing a transhumeral
open-cage interface embodiment such as that of FIG. 1 with a
suspension liner 30 of minimal thickness or of sufficient stretch
to minimally restrict soft tissue flow through the relief windows.
Struts 6 providing soft tissue compression and windows 7 allowing
soft tissue flow are indicated.
[0072] In FIG. 5, a transradial solid-body interface is shown. In
this embodiment, there is an upper portion 11, which comprises the
area of the interface proximal to olecranon 12 and cubital fold 13.
A lower portion 14 has multiple, e.g. three or four, compression
areas 15 and soft tissue relief areas 16 that extend along the long
axis of the residual limb and are arranged circumferentially in an
alternating compression-relief pattern as shown.
[0073] In FIG. 6, a transfemoral solid-body interface is shown.
This embodiment has multiple, e.g., three or four, compression
areas 17 and soft tissue relief areas 18 that extend along the long
axis of the residual limb and are arranged circumferentially in an
alternating compression-relief pattern as shown.
[0074] In FIGS. 7a and 7b, there is shown a tool for use in imaging
(and particularly helpful for the lower limb), which tool
optionally may be used with various embodiments of the invention.
Imaging is a process to render a model of the limb using plaster
bandage, laser scanning or other such technique. Imaging of a limb
under compression may be done to create the model. This tool is
essentially a connected set of adjustable bars attached to screws
which in turn are connected to a circumferential or partially
circumferential ring that allows this tool to be placed over the
limb either before, during or after the imaging process and that
applies the appropriate compression to the soft tissues of the limb
in desired target areas while allowing redundant soft tissue to
flow through the areas between the struts unhindered.
[0075] More specifically, the jig consists of a multiplicity of
paddles 101 for pushing inward against the limb remnant of an
amputee. For most purposes, four paddles preferably are used. For
the configuration shown, eight sectors 110 are assembled into two
rings. Eight screws are used at locations 111 to assemble the
rings.
[0076] In FIG. 7b, a screw (not shown) is inserted into clearance
hole 112 to secure the turnbuckle holder 108 to the sector 110.
Until the screw is tight, the holder is free to rotate with respect
to the sector. The turnbuckle rod 106 is threaded with an eyelet
113 on the far end to connect to paddle holder 105. A pin attaching
these two parts is inserted into hole 114. Paddles 101 each have a
channel 103 into which a slider 102 is captured. This slider has
two threaded bosses 104 which are secured to paddle holder 105 by
nuts (not shown). By loosening these two nuts the slider may be
repositioned along the paddle.
[0077] To adjust the position of the paddle, a threaded wheel 107
is turned. In the configuration shown, there are a total of eight
turnbuckle assemblies to position the paddles in contact with the
amputee's limb. Preferably, the paddles are made from a rigid,
inexpensive plastic that can be trimmed to a width and length
suitable to the individual amputee fitting. All of the other
components are preferably reusable.
[0078] As shown in FIGS. 8a (an anterior perspective) and 8b (a
posterior perspective), an exemplary prosthetic component set 22 is
attached to one device 23. Various prosthetic components may be
attached to the device by any one of various methods currently
available or available in the future. The device may have at a
proximal end any one of various support structures known in the art
or developed in the future.
[0079] In a method in accordance with an embodiment of the
invention, an interface device with open-cage or strut-type is
fitted onto a person.
[0080] First, it is determined whether a patient needs a
transradial (radial level) device, a transhumeral (humeral level)
device, a transtibial (tibial level) device or a transfemoral
(femoral level) device. The patient or prosthetist may select a
closed device or an open cage strut-type high-fidelity device.
[0081] Second, the patient's limb radius is determined at one or
more locations. Third, the device is essentially crimped during
modification or creation of the device until sufficient compression
from the at rest radius of the patient's limb at the cage or strut
region of the device is at a desired amount. The desired amount of
compression will depend in part on the patient's bone size, body
fat, and other tissue parameters at the area of the cage or strut.
The compression generally is at least 20% or at least 30% from the
at rest radius of the limb. Typically, compression will be from 20%
to 70% or 30% to 70%. The amount of compression is sufficient such
that there is minimum redundant tissue between the maximum point of
compression and the target bone contained within the interface such
that motion capture of the bone is maximized while retaining
sufficient comfort to allow the wearer to withstand the compression
for a useable amount of time and to ensure adequate blood flow over
time, which can be ascertained through the use of a blood perfusion
sensor and monitor. The blood perfusion sensor can be utilized
during casting, diagnostic interface assessment or in the
definitive socket.
[0082] However, compression can be lower than 20% or higher than
70% depending upon bone size, body fat and other tissue parameters,
and the prosthetician and/or physician will use the blood perfusion
sensor and monitor and make a determination of the safety and
effectiveness of the particular amount of compression for the
particular patient.
[0083] Fourth, the modified or rectified high-fidelity device with
an inner radius or inner radii of size that can be fit over the
distal (free) end of the patient's limb (for fitting with a
prosthesis) is selected, and applied to the patient's limb, e.g.,
by sliding onto the limb.
[0084] Creation and Fabrication of High-Fidelity Interface
[0085] In a method in accordance with an embodiment of the
invention, an interface device with open-cage (strut-type) or
solid-body configuration is fitted onto a person.
[0086] First, it is determined whether a patient needs a wrist
disarticulation device, a transradial device, a transhumeral
device, a symes device, a transtibial device, a knee
disarticulation device, a transfemoral device or a hip
disarticulation device. The patient or prosthetist may select a
closed or open cage strut-type high-fidelity device as disclosed
herein.
[0087] Second, the patient's limb radius is determined at one or
more locations along the limb where the interface device will be
fit.
[0088] Third, the interface is created using one of several
different methods, all of which require modification by the
prosthetist to complete fitting of such a final socket.
[0089] One method commonly employed is to cast the patient's limb
utilizing a plaster bandage. This casting allows the prosthetist or
clinician to add compression forces to the plaster wrap and hence
to the limb in the target areas that will hold this compression and
allow for subsequent tissue relief between these compression areas
as the plaster sets.
[0090] The cast, which will function as a negative model or mold,
is removed and filled with liquid plaster.
[0091] The liquid plaster is allowed to set in the mold.
[0092] Once the liquid plaster has solidified, the plaster bandage
(mold) surrounding the solid (positive) model is removed. The
positive model is now revealed to which the prosthetist or
clinician applies additional compression to the target areas by
carving directly on the model. Carving on the positive model
creates a pressure or compression point on the target areas because
the "negative" model (the socket being molded from the positive
model) will now have a larger inwardly facing compression area.
[0093] Another way to generate the limb shape to be modified is to
use a scanner to obtain the image shape and then modify the digital
image accordingly using well known software, e.g., on a computer
such as a laptop. This digital model (as modified to apply targeted
compression and relief) can then be sent to a carver or 3d printer
to generate a physical positive model over which a negative model
(mold) can be created for fitting or additional fabrication.
[0094] In order to determine appropriate compression levels, the
device is essentially crimped during modification or creation of
the device until sufficient compression from the at rest radius of
the patient's limb at the cage or strut region of the device is at
a desired amount. The desired amount of compression will depend in
part on the patient's bone size, body fat, and other tissue
parameters at the area of the cage or strut. The compression
generally is at least 20% from the at rest radius of the limb.
Typically, compression will be from 20% to 70%, or at least 30% to
70%. For certain patients, such as very muscular, or those having
calcification, the minimum compression to achieve the advantages of
the inventive method may be a little below the above minimum
ranges, and for certain patients, such as obese patients or others
with extremely fleshy skin, a higher than 70% compression may be
appropriate. However, comfort and medical safety can dictate the
final appropriate amount of compression for any particular
patient.
[0095] The amount of compression is sufficient such that there is
minimum redundant tissue between the maximum point of compression
and the target bone contained within the interface such that motion
capture of the bone is maximized while retaining sufficient comfort
to allow the wearer to withstand the compression for a useable
amount of time.
[0096] Fourth, the decision is made whether a diagnostic interface
(transparent thermoplastic socket for analysis of fit and function
prior to creating the definitive model) or a definitive interface,
typically consisting of a laminated framework, is to be
created.
[0097] Over the now modified or crimped model, in order to create
the diagnostic interface, a thermoplastic material is heated and
draped or blister-formed, preferably under vacuum, to render a new
negative model. Once the thermoplastic has cooled and become rigid,
the plaster is then removed from within the thermoplastic interface
and the interface is trimmed and smoothed and is of sufficient
stiffness and transparency to allow the clinician to don it on the
patient and judge the fit and pressures acting on the limb. This
model can be removed from the patient's limb and trimmed or heated
to change its boundaries or perimeter and shape, including the
amount of compression or relief that is applied to the limb based
on what is observed and comments from the wearer.
[0098] In order to create the definitive interface, an acrylic
laminate (with or without stiffeners such as carbon fiber,
Kevlar.RTM., i.e., para-aramid synthetic fiber, etc.) or similar
can be vacuum formed directly over the model or in the case of a
frame style interface with a flexible liner and rigid frame, over
an inner flexible liner that has been previously vacuum-formed over
the same model.
[0099] The now compressed negative socket, whether in diagnostic or
definitive form can be donned by either a push-in or pull-in
method, with the latter being preferred due to the high levels of
compression applied to the limb. This compression imparts friction
on the skin during donning and hence makes it more difficult to get
all the limb tissue down in the interface unless a donning sock or
similar is used to pull the tissue in. The pull-in method utilizes
a donning sock or similar such device that surrounds the limb and
is pulled through a distal aperture at the distal end or bottom of
the interface. As the wearer pulls down on the end of the donning
sock and pulls it through the aperture, the limb is pulled down
into the interface until fully seated.
[0100] In FIG. 9, an example of a casting 240, e.g., for an upper
limb, is shown.
[0101] In FIG. 10, a socket 202 having compression regions 209 and
relief regions 210 is shown on a patient's limb, e.g., an upper
limb.
[0102] FIG. 11 is a flow chart showing steps in a process of an
embodiment of the invention for making a high-fidelity interface
for a prosthesis and limb, preferably a lower limb, the lower limbs
being the ones that will be bearing weight of the wearer's body;
and
[0103] FIG. 12 is a flow chart showing steps in an alternate
process of another embodiment of the invention for making a
high-fidelity interface for a prosthesis and limb, preferably an
upper limb.
[0104] In FIG. 11, in a step 221, a technician will locate
biomechanically, anatomically and physiologically appropriate
location of compression bars to be applied to an upper limb during
casting or scanning such that there are alternating fields of
compression and relief arranged longitudinally along shaft of long
bone.
[0105] In step 222, a technician will, if casting, preferably use a
casting jig as shown in FIG. 7a or 7b both before and after the
plaster bandage is applied to the limb in order to identify the
locations described above and to apply appropriate compression to
the limb underweight bearing conditions after the plaster wrap is
applied respectively. If scanning, the technician will identify
locations for compression bars such that they are retained in the
modification software after scan is complete.
[0106] In step 223, a technician will create positive model from
negative model created above and modify such that the longitudinal
compression areas correspond to at least a 20% (or 30%) (up to 70%)
diameter reduction as compared to the uncompressed measurement if
anatomically and physically appropriate. In some cases, compression
below 20% or above 70% may be acceptable.
[0107] In step 224, a technician will create a diagnostic, negative
model from the positive model above including longitudinally
extending compression regions corresponding to the amount of
compression determined above, and relief regions adjacent and in
between the compression regions for receiving at least a volume of
the patient's fleshy portions on the remaining limb that are to be
displaced by the compression regions. The relief/release regions
can be enclosed or completely open provided there is minimal
restriction to soft tissue flow.
[0108] In step 225, which is optional, one preferably will put on
al sock or sleeve to facilitate donning by pulling the limb down
into the socket more completely.
[0109] In the process of FIG. 12, in step 231, a technician will
locate biomechanically, anatomically and physiologically
appropriate location of compression bars to be applied to (lower)
limb during casting or scanning such that there are alternating
fields of compression and relief arranged longitudinally along
shaft of long bone.
[0110] In step 232, the technician will, if casting, apply a
plaster bandage to limb and over this apply compression bars in the
predetermined locations above. If scanning, the technician will
identify locations for compression bars such that they are retained
in the modification software after scan is complete.
[0111] In step 233, the technician will, create positive model from
negative model created above and modify such that the longitudinal
compression areas correspond to at least a 20% (or 30%) (up to 70%)
diameter reduction as compared to the uncompressed measurement if
anatomically and physically appropriate. In some cases, compression
below 20% or above 70% may be acceptable.
[0112] In step 234, the technician will create a diagnostic,
negative model from the positive model above including
longitudinally extending compression regions corresponding to the
amount of compression determined above, and relief regions adjacent
and in between the compression regions for receiving at least a
volume of the patient's fleshy portions on the remaining limb that
are to be displaced by the compression regions. The relief/release
regions can be enclosed or completely open provided there is
minimal restriction to soft tissue flow.
[0113] In step 235, which is optional, one preferably will put on
al sock or sleeve to facilitate donning by pulling the limb down
into the socket more completely.
[0114] Although the invention has been described using specific
terms, devices, and/or methods, such description is for
illustrative purposes of the preferred embodiment(s) only. Changes
may be made to the preferred embodiment(s) by those of ordinary
skill in the art without departing from the scope of the present
invention, which is set forth in the following claims. In addition,
it should be understood that aspects of the preferred embodiment(s)
generally may be interchanged in whole or in part.
* * * * *