A problem that often occurs during assembly of the receptacle.

After installing the prosthetic limb and returning home, you will find that the prosthetic limb is uncomfortable to wear, and the socket feels either too tight or too loose. So what are the common problems with sockets in real life? In fact, many of the masters who make prosthetic sockets for us have not received scientific and systematic training. They are basically apprentices brought by masters. If you don't meet an experienced master, more or less problems may occur. Today, the editor will give you a summary based on the excerpts of clinical rehabilitation in China (the article is very long, please read it patiently and you will gain something):   (1) There is no complete contact between the socket and the residual limb: The full contact socket has many advantages, including increasing the force-bearing area of the residual limb and reducing the pressure on the residual limb per unit area; improving the blood circulation of the residual limb; the patient will have a bottoming feeling after wearing the lower limb prosthesis, which increases the sense of security when walking; reduces the patient's phantom limb pain; reduces the chance of sweating in the affected limb; and reduces the tendency of edema in the residual limb. However, in actual assembly, many prostheses do not achieve full contact between the end of the residual limb and the lower end of the socket, and around the residual limb. There is more or less a gap between the prosthesis and the socket wall, and some people deliberately fill the bottom of the plaster male shape a lot, resulting in a large space between the end of the residual limb and the bottom of the socket, which will naturally form a negative pressure cavity. If the patient wears such a prosthesis for a long time, it will cause obstacles to the blood circulation of the residual limb, especially for the patient. Patients with amputations due to blood circulation disorders are even more disadvantaged; at the same time, the patient's control over the prosthetic limb will be reduced, and the patient will lack a sense of security. For patients with poor condition of the end of the residual limb, flexible contact can be achieved by using foam plastic pads or silicone sleeves to avoid hard contact between the end of the residual limb and the prosthetic socket. (2) The bottom end of the residual limb does not bear weight: After an amputation patient is fitted with a prosthetic limb, he should be able to use the bottom end of his residual limb to stand on the bottom end of the socket. Maximizing the load-bearing use of the bottom end of the residual limb will be an important step for the patient to approach the natural gait after the prosthetic limb is fitted. The maximum utilization of the load-bearing at the bottom of the residual limb is of greater significance than the transmission of force; the contact at the bottom of the residual limb will transmit indirect information such as the pressure and condition of the ground to the patient through the patient's sensory nervous system. Weight-bearing at the base of the residual limb is the only effective psychological method to load-bear the bones of the residual limb and combat decalcification (active osteoporosis); it is beneficial in stimulating post-amputation growth in children. The weight-bearing capacity of the base of the residual limb depends on the height of the amputation and the quality of the surgical treatment of the soft tissue. Generally speaking, when the scar suture is located in front of the residual limb and avoids the load-bearing area, the bottom end of the residual limb can be used to bear weight. However, when the scar suture is located in the load-bearing area, it must take a period of time before it can fully bear weight. For residual limbs with poor load-bearing capacity, the usual method is to increase the thickness of the cushion at the end of the residual limb, and 2-4 layers of flexible socket materials can be used. (3) The socket causes blood circulation and nerve conduction disorders in the residual limb: Efforts are made to achieve full contact and load-bearing at the bottom of the residual limb in order not to damage the arterial, venous and lymphatic circulation, but also to affect nerve conduction, let alone numb the residual limb. To achieve this goal, the cross-section of the proximal end of the socket cannot be made too small. Sooner or later, an overly tight socket entrance will inevitably lead to chronic blood circulation disorders and swelling of the end of the residual limb. The consequences are excessive sweating leading to the formation of eczema, overheating and the formation of blisters, chronic ulcers, and serious lesions of the skin at the socket entrance. In this way, the bottom end of the residual limb will truly lose its weight-bearing capacity, and the force will inevitably be transmitted through a tighter socket entrance, which will naturally form a sensitive ring, which will be even less conducive to blood circulation and nerve innervation. Therefore, the full contact between the residual limb and the socket and the load-bearing capacity of the bottom of the residual limb will directly affect the quality of arterial, venous, lymphatic circulation and innervation. (4) It is inconvenient to put on and take off the socket: For the patient, even if the physical and physiological functions are reduced, the socket should be put on and taken off without external force. The socket can be put on and taken off in a comfortable and safe position, including a sitting position, without the use of special force or skill. Ideally, the patient can put the prosthesis on and off like a boot; avoid the use of straps, belts, condylar wedges, and donning aids whenever possible. The socket should accommodate the residual limb well and should not be too tight or too loose. If the size of the socket is too small, it will be difficult for the residual limb to be put in place, and the end of the residual limb cannot contact the bottom of the socket. Even if the socket is forcibly put in place, the patient will not feel it, affecting blood circulation, gait of the prosthetic limb, etc., and it will be difficult for the patient to take off the prosthesis. The size of the socket is too large and the residual limb is easy to put on, but once the patient enters the swing phase, the prosthesis can easily fall off or the patient will consume a lot of energy to prevent the prosthesis from falling off, which will affect gait. This will seriously affect the patient's attitude and trust in the prosthesis, and can easily lead to the patient eventually giving up using the prosthesis. (5) Insufficient cleaning and maintenance of the socket: The suction socket is in direct contact with the skin. If the inner surface of the socket is not clean, the risk of skin infection of the residual limb will increase. Patients should wipe the surface of the socket clean every night before going to bed. They can wipe it with a towel soaked in light soapy water, and then let it dry naturally. The sleeves and pads in the socket are often soaked with sweat and will produce odors when dirt adheres to them. They should be wiped clean with a towel dipped in soapy water and dried. Residual limb covers should be cleaned and replaced frequently. (6) Poor refitting of the socket: When a patient gains or loses weight, changes in the size of the residual limb will appear in about 1 month. Full contact between the residual limb and the socket requires more adaptation of the socket than previously possible. Refitting problems are easily solved by applying filler material to the side walls, base, and edges of the socket. (7) The suspension of the socket is not good: The transmission of force and motion directly and without loss between the residual limb and the prosthetic limb is a prerequisite for the rehabilitation of amputees. The suspension function of the socket effectively ensures the transmission of force and motion between the residual limb and the prosthesis, reducing energy consumption. It is necessary to make full use of various suspension mechanisms to achieve the best suspension effect. For example, in modern calf prostheses, supracondylar calf prostheses (PTK) and patella-wrapped calf prostheses (PTS) are suspended by supracondylar containment. During production, the shape of the condyle must be trimmed, and the internal and external dimensions must be trimmed in place. It must not be made into an outward bell mouth, otherwise the suspension function will not be achieved. (8) Static alignment error of the socket: The purpose of socket alignment is to determine the spatial positional relationship of the socket when assembling the prosthesis, that is, to position the socket in the three-dimensional space of the frontal plane, sagittal plane, and horizontal plane. The frontal plane determines the adduction and abduction angles, the sagittal plane determines flexion and extension, and the horizontal plane determines the edge direction and the length of the entire prosthesis. A common misalignment is the failure to connect the general principles of static socket alignment with the differences in residual limbs in different patients, resulting in static alignment errors. Take the alignment of calf prostheses as an example: the knee joint is usually required to flex 5°. However, many people blindly use 5° to align the line regardless of the length of the residual limb. This is wrong. The normal pattern is: the long residual limb is greater than 5°, the medium residual limb is 5°, and the short residual limb is between 5°-10°. For small group residual limb patients with knee flexion contracture, the flexion angle during alignment can be increased by 1°-5° based on the knee flexion contracture angle, and the patient is required to perform regular knee extension exercises to slowly reduce the knee flexion contracture angle, and then the angle must be adjusted in time. Viewed from the frontal plane, the lower leg residual limb appears to be in an abducted posture, and the long residual limb is in an adducted posture. This is determined by the natural physiological direction; this direction must be taken into consideration when making the calf prosthetic socket, otherwise abnormal gait will occur.

Reference: Clinical Rehabilitation in China

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