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Topic: Residual limb
Problem

Cause

Solution

pressure  in  the  proximal  area.
The  vacuum  pulls  the  liner  and
the  residual  limb  into  a  gap
distally and also creates the feel­
ing of pressure.
The  proximal  pressure  is  usually
the dominant sensation.

User  wears  too  many  long
residual limb socks.

The  residual  limb  hangs  proxim­
ally  in  the  prosthetic  socket  due
to the increased volume.

Remove all fillers.

Compensate  for  the  volume  loss  with  distal  spots
and  half  residual  limb  socks  until  the  markings  on
the liner become visible and the pressure abates.

If  the  distal  fillers  do  not  produce  a  perfect,
comfortable fit:

 Pull a long residual limb sock over

the  liner  and  compensate  again  with  distal  spots
and half residual limb socks.

If more than three fillers are used, a new prosthetic
socket should be made.

Pressure  in  the  prox­
imal area

Prosthetic socket too tight.

Make  a  new  prosthetic  socket  according  to  the
instructions of this document.

Area  around  the  head  of  the
fibula moulded incorrectly.

Either  too  much  reduction  or
incorrect  moulding  occurred.
This  applies  especially  to  the
area  of  the  head  of  the  fibula,
because  the  nerve  behind  it  can
be irritated.

Modify  the  check  socket  in  the  area  of  the  head  of
the fibula thermoplastically.

Alternatively:

 Make a new plaster cast.

Pressure on the head
of the fibula

Volume  loss  on  the  residual
limb.

The residual limb has lost volume
and  slipped  deeper  into  the
prosthetic  socket.  This  causes
the  head  of  the  fibula  to  press
against  the  lower  edge  of  the
recesses  in  the  prosthetic  sock­
et.

If  the  medial  and  lateral  markings  on  the  liner  have
slipped into the prosthetic socket, the residual limb
has lost volume.

Ensure  that  the  vacuum  is  generated  and  main­
tained. Without vacuum, the user loses residual limb
volume every day.

If  there  is  vacuum:

  Compensate  for  the  volume

loss  with  a  distal  spot/half  residual  limb  sock  until
the  marks  on  the  liner  are  located  at  the  height  of
the socket brim again.

Try pulling a long residual limb sock over the liner. It
may be necessary to remove distal fillers.

Prosthetic  socket  too  tight
overall.

Make  a  new  prosthetic  socket  according  to  the
instructions of this document.

User  wears  too  many  long
residual limb socks.

Remove all long residual limb socks.

Compensate  for  the  volume  loss  with  distal
spots/half residual limb socks until the markings on
the liner become visible.

If  the  distal  fillers  cause  pressure  in  the  distal
area:

 Try pulling a long residual limb sock over the

liner. It may be necessary to remove distal fillers.

Cramp­
ing/aching/throbbing
while  standing  or  sit­
ting

User  did  not  tense  the  calf
musculature  during  moulding
of the volume.

Enclose  the  user's  residual  limb  with  both  hands
and  ask  him  or  her  to  tense  his  or  her  calf  muscu­
lature.

If  this  significantly  changes  the  residual  limb
shape:

 Make a new prosthetic socket according to

the instructions of this document.

Ottobock  |  27

Harmony System

Tips and tricks

Summary of Contents for Harmony P3

Page 1: ...Technical information 2 1 8 Harmony system Fabricating a transtibial prosthesis using example of Harmony P3...

Page 2: ...thesis 3 6 16 Attaching the socket connector 3 6 1 16 Optional Transferring the adapter position 3 6 2 17 Selecting the functional ring 3 6 3 17 Replacing the functional ring 3 6 4 18 Dynamic trial fi...

Page 3: ...y experts It is a prerequisite that the qualified personnel are trained in the handling of the various materials machines and tools This technical information does not claim to be exhaustive Reading t...

Page 4: ...k 99B25 Plaster bandages e g 699G3 ThermoLyn soft 616T53 Bonding agent 617H46 Wax 633W8 Polyethylene adhesive tape 627B4 Perlon stockinette 623T3 Closed cell foam e g 617S70 4 PVA bag 99B81 70X19X5 99...

Page 5: ...liners Liners without pre flexion are particularly appropriate for cyl indrical residual limbs Liners with pre flexion have an anatomical shape and are appropriate for short to medi um length slightly...

Page 6: ...ive The liner fit is checked to prepare for the plaster cast Residual limb dimensions can then be measured and critical structures on the residual limb marked to facilitate modelling Required tools an...

Page 7: ...r splint is moulded by vacuum in a latex casting bag Moulding is carried out at a flexion angle of approx 85 to enable easy bending of the knee when the prosthesis is being worn Required tools and mat...

Page 8: ...tte Position the residual limb such that the flexion angle is approx 85 Switch on the vacuum pump vacuum min 500 mbar Mould the lower edge of the patella Let the plaster cure Hold the plaster splint i...

Page 9: ...d place it on the residual limb Pull a nylon stockinette over the residual limb Pull the latex casting bag over the plaster cast and seal proximally Connect the vacuum hose and position the distal con...

Page 10: ...tex casting bag over the plaster cast and seal proximally Connect the vacuum hose and position the distal con nection of the casting bag on the nylon stockinette or the Perlon stockinette Switch on th...

Page 11: ...Mark the transitions between convex and concave shapes with horizontal lines Reduce the distal end of the model by 5 mm to 8 mm without changing the shape If there is overhang of soft tissue more redu...

Page 12: ...he test socket Objective To ensure a good fit a transparent ThermoLyn check socket is made It allows the fit to be evaluated since the col our of the skin and the flow properties of the liner are visi...

Page 13: ...d materials 743A11 plaster device 451F20 liner FitKit 616S132 sticky spots 453H1 1 lubricating cream or 453H26 SensiCare lotion waterproof marker check socket liner Mark at least three points on each...

Page 14: ...h a hot air blower and adapted The flow properties of the liner and thus the good fit of the prosthetic socket are verified by comparing the pos ition of points on the liner with the circles on the pr...

Page 15: ...l limb sock from the liner FitKit to increase the compression in the area The liner flow properties are correct in the proximal and medial areas The compression is insufficient in the distal area Posi...

Page 16: ...me even if the prosthetic socket is opaque The prosthetic socket is not worn Insert the liner into the socket Mark one line on the liner both medially and laterally on the course of the socket brim Th...

Page 17: ...The hardness of the functional ring affects the vacuum generation and the heel strike with the prosthesis Required tools and materials Harmony P3 unit functional rings 4X247 pre compression device Ott...

Page 18: ...stop in order to compress the functional ring com pletely Compress the functional ring from at least 3 minutes to at most 15 minutes Open the pre compression device and remove the func tional ring 3...

Page 19: ...Page 24 3 7 3 Trial fitting Donning the prosthesis 1 Don the liner onto the residual limb 2 For liners without textile cover Pull a residual limb sock on 3 Put on the prosthesis 4 Pull the residual l...

Page 20: ...ll the check socket with plaster to secure the vacuum pipe Remove the plaster model from the check socket Prepare the plaster model for the lamination process Reduce the plaster model according to the...

Page 21: ...Carry out the first lamination process Clamp the plaster model with the laminate into the transfer device Establish the connection between the prosthetic socket and the prosthesis components e g with...

Page 22: ...does not protect against friction between the sealing sleeve and socket brim Required tools and materials Laminated prosthetic socket hook and loop pads 623T1 cotton stockinette 623T3 Perlon stockinet...

Page 23: ...ional Attaching a cosmetic cover Objective A foam cover can be used as a cosmetic cover Correct attachment ensures the function of the Harmony P3 unit Required tools and materials Foam cover with 34 m...

Page 24: ...area 2 or 3 Connect the manometer directly to the suction con nection of the vacuum pump Activate the vacuum pump until vacuum of 500 hPa to 850 hPa is reached Check whether the vacuum is maintained T...

Page 25: ...ea of the prosthetic socket and the liner tightly without impeding knee flexion Plaster cast was produced with 2 phase technique The condyles do not have enough space during knee flex ion Make a new p...

Page 26: ...ut load The vacuum pulls the liner and the residual limb into a gap and creates a feeling of pressure in the user This feel ing is frequently misinterpreted as contact in the prosthetic sock et If the...

Page 27: ...b has lost volume and slipped deeper into the prosthetic socket This causes the head of the fibula to press against the lower edge of the recesses in the prosthetic sock et If the medial and lateral m...

Page 28: ...t compensate for volume loss Explain to the user how he or she can recognise volume losses from the markings on the liner and compensate for them using the liner FitKit Topic Flow properties of the li...

Page 29: ...eeve No lubricant in the proximal area of the liner This allows air to leak along the thigh and the non stick surface of the liner Apply a thin layer of lubricant to seal the area Sealing sleeve does...

Page 30: ...264 269 274 278 283 288 305 310 315 320 325 330 335 340 345 350 355 360 365 370 375 380 385 390 395 400 293 298 302 307 312 317 322 326 331 336 341 346 350 355 360 365 370 374 379 384 405 410 415 420...

Page 31: ...s a h t s a c r e t s a l p e h t f I nee flexion 15 a bulging eccentric or concave residual limb end pronounced invaginated scar tissue or excess size length 50 cm circumference 50 5 cm a 6Y416 Shap...

Page 32: ...Harmony System 32 Ottobock...

Page 33: ...Ottobock 33 Harmony System...

Page 34: ...Harmony System 34 Ottobock...

Page 35: ...info ottobock rs www ottobock rs Otto Bock Ortopedi ve Rehabilitasyon Tekni i Ltd ti Ali Dursun Bey Caddesi Lati Lokum Sokak Meri Sitesi B Block No 6 1 34387 Mecidiyek y stanbul Turkey T 90 212 356504...

Page 36: ...k has a certified Quality Management System in accordance with ISO 13485 Otto Bock HealthCare GmbH Max N der Stra e 15 37115 Duderstadt Germany T 49 5527 848 0 F 49 5527 72330 healthcare ottobock de w...

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