How to make a Prosthetic Limb

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.

2. Modifying the Mold

Now that you have a mold of the patients leg, you need to modify the mold so that it is ready for acrylic lamination. The purpose of modifying the mold is to make the mold smooth. If the mold is not smooth, the finished product will not be smooth either. Another reason to modify the mold is to make it smaller in some spots and build it up in others. Areas of the patients limb that is comprised of soft tissue will need to be tight to hold the patient in the socket; however, bony prominences will need more room in the prosthetic in order to avoid sores. The first step in modifying the mold is to use the wood file to reduce areas of the limb that are made of soft tissue. After that, you need to use strips of plaster to build up areas that contain bony prominences. The most important areas are the fibula head, pointy bone on the lateral (outside) portion of the limb, and the tibia crest (shin bone). Once this portion of the modification is complete, it is time to make the mold smooth. The first tool you need to use is the wet screen. Rub this over the entire mold. When finished, use a wet stockinet to make the mold perfectly smooth. This process will be difficult at first; however, with time you will find it becomes much easier.

3. Adding the Adaptor to the Mold

This step is simple yet very important. If this step is not completed properly, the entire process needs to be repeated. The adaptor is what connects the socket of the prosthetic limb to the tube and foot. The adaptor needs to be laminated into the socket. In order to do this you need to glue the adaptor onto the mold. Sounds simple, however, it is extremely important that the adaptor is

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.

4. Lamination of the Acrylic Socket

The purpose of this step is to make the socket of the prosthetic limb. The first step is to prep the mold. To do this you need to first place a plastic bag over the mold and tape it at the bottom on the pipe. Next you need to add a layer of cloth and tape it the same way that you taped the bag. After that comes a layer of carbon fiber and another layer of cloth both taped tightly onto the pipe. The next step is to add the last layer which is another bag. This bag however, has a hole at both ends as opposed to the other layers which only had a hole at one end. The bottom of this bag gets taped to the pipe just like every other layer. The top of this bag is open so that the resin can be poured into the bag. Last you should tape a paper funnel to the top of the bag so that the resin does not spill. The next part of this process involves making the resin. This part is fairly straight forward. The first step is to mix the resin with the promoter and the correct pigment. The promoter sets off the resin and makes it hard and durable. Next you need to mix the resin and pour it into the bag. The last step is to spread the resin evenly across the mold using a string. When this is finished wait for the resin to harden.

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.

7. Cutting out the adaptor for the socket

This is one of the fastest and most simple steps in the procedure. It is pretty self-explanatory. The adaptor is at the bottom of the socket. You need to use the disc grinder to grind away the bottom of the socket until the metal adaptor is exposed. Once you have done this use a smooth cone to make sure the area is smooth and looks presentable.

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