Name: Laura Hillas
Phone: 022 577 6202
Event Number : LH-2020-1/Direct Socket
(The event number should start with your initials, then the year, then which case study submission this is for you, then an internal job number that will allow you to identify the case in your practice. E.g. jcs-2009-01/1435b)
All sections below must be filled in for case study to be accepted by Credentialing Committee
Start Date: 7-8-20
Finish Date: 24-9-20
Brief Patient Description: On a PTB socket with pelite liner for many years. Patient feels that it is not providing the stability within the socket that it should. Would like a recast
Orthotic/Prosthetic Aims/Requests: To provide more socket stability. To learn how to manufacture a direct socket.
Summary of case study. Include details of patient, method and outcome
Clinical Presentation: On a PTB socket with pelite liner for many years.
Subjective: Patient feels that it is not providing the stability within the socket that it should. Would like a recast.
Objective: Residual limb is cylindrical, good soft tissue coverage, no wounds, and patient is in a position to try a new method. (Ie lives locally and is not constrained by work so that if not successful is able to return for traditional cast.)
Prosthetic Aims: To manufacture a socket that will provide more stability (ie less movement in the socket) than a PTB socket
Discussion with Mulidisciplinary Team: 2 direct socket super users in Hamilton. Asked for peer review of patient to check that he is a candidate for direct socket. Discussed liner options and manufacture considerations. Peer review outcome was that patient would be a good candidate but we would need to order the necessary parts and liner first.
Prosthetic Prescription: Dermo Wave locking liner. Direct socket it with 214 ossur lock.
Summary and critical appraisal of literature used in clinical management, and/or in support of clinical management. Add more table rows for more articles.
Visit 1 (initial meeting): Assessment of residual limb and needs as already described earlier. Consent from patient received to try a new socket style and manufacture method. Patient advised that it will take about 4 hours but that his socket will be ready to take on the day all going well.
Visit 2: Manufacture/cast of residual limb using direct socket method. Peer support gained from super user. Used instructions provided in booklet. All went as expected with no issues experienced. Advised by super user that some clinicians mould the posterior wall of the socket out a little whilst the socket is still a little soft to provide a relief which was undertaken. Prominence pads were also used at the hamstrings. Socket trimmed down. Fitting undertaken. Fitting successful. No issues experienced.
Visit 3: Review: Patient reports of some minor socket alignment adjustments required (toe needs dorsiflexing) and the anterior edge of socket trimming a little. No issues with posterior wall as has been experienced by some other clinicians. Patient very happy with new socket and feels that it is a lot easier to don. Overall it is the same socket as if we had manufactured it in the workshop, however the patient was able to take the socket away on the same day.
Critical Appraisal of Case Study
What have you learned from this case?: I now have the confidence to undertake direct sockets by myself. I feel that direct sockets offer a very timely solution for patients and are in fact overall more cost effective due to the reduced overall time that is needed for the manufacture stage. Prep does need to be done beforehand (all parts in stock including liner and casting liners, and time booked out in the clinical diary) and also needed a helping hand, but with these in place, it provides an excellent solution for the patient will all the added benefits of roll on silicone sleeves over PTB sockets.
What could have been done better?
I should have ordered 2 liners of differing sizes as on the day, the smaller casting liner seemed a better fit, but I had ordered him the liner that was the size advised according to the measures of his residual limb.
Does this study contribute to orthotic research/evidence? No