TYPES OF SOCKETS

Trans-femoral Prosthesis
HUFSA SHAHZAD

Introduction to TFP:Trans-femoral (above knee) prosthetics

refers to an artificial limb replacement
where the knee joint has been
removed and the individual still has
part of the femur or thighbone intact.
Our goal in prosthetics is to fit the
client comfortably with the greatest
return of function, and to make it look
as natural as possible.
TFP SOCKETS- HUFSA SHAHZAD

TFP Sockets:Of all the changes and advancements

in prosthetics today, none has had a
greater impact on our industry as has
the trans-femoral (AK) socket design.
Weve gone from wooden plug sockets,
to laminated quadrilateral sockets, to
todays popular design of the ischial
containment socket.
Each style still has its place in our
industry today.
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QL vs IC Socket:-

TFP SOCKETS- HUFSA SHAHZAD

Wooden plug socket:A person fit with a plug socket 50 years

ago usually has a hard time changing to
the newer design sockets. The plug socket
was a design that used the soft tissue at
the groin level to support the body weight.
The shape of the socket was very much
like the shape of the thigh, oval.
Unfortunately, this design does not provide
the femur and pelvis with adequate
stability.
TFP SOCKETS- HUFSA SHAHZAD

Wooden plug socket:To compensate for the lack of stability

a pelvic joint and band (usually
fabricated out of metal) are added to
the socket and then to a waist belt .
Today, versions of the plug socket
are still used in instances where the
socket cant be fit all the way up to the
ischium.
TFP SOCKETS- HUFSA SHAHZAD

Quadrilateral Socket:-
The quadrilateral socket designed in the
late 1940s at the University of California,
Berkeley, has been a very effective design.
The socket is divided into four walls (quad)
and each wall has a specific function in
either positioning the ischium, controlling
tissue, or stabilizing the femur. The front
wall positions the ischium onto the top of
the back wall.
TFP SOCKETS- HUFSA SHAHZAD

Cont

TFP SOCKETS- HUFSA SHAHZAD

Quadrilateral Socket:Its shape is such that it creates a space for the

large rectus muscle of the thigh and still allows
pressure backwards without impinging on the
neurovascular bundle located on the inner top
thigh.
The inside wall must contain the soft tissue
between the legs. Care is taken to provide
sufficient relief to the strong adductor tendon
at the front part of the inside wall. Failure to
provide adequate relief to this tendon results in
pain and burning sensations.
TFP SOCKETS- HUFSA SHAHZAD

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Quadrilateral Socket:The side wall has the big job of

controlling the side displacement of
the femur.
This wall should be flat and angled
toward the opposite limb from just
below the hip joint to just above the
cut edge of the bone.
At the cut edge of the bone a relief is
made.
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Quadrilateral Socket:When an individual with an above knee

amputation walks, the femur moves out to
the side because the muscles used to
stabilize the hip are flexing.
The position of these muscles are such that
they pull the femur out to the side. The
ischium sits on a shelf on the top of the
back wall. This prevents the limb from
dropping down into the socket, which
would result in breakdown on the bottom.
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Quadrilateral Socket:The disadvantage with the quad

design is that the ischium sitting on
the back shelf acts as a fulcrum
allowing the femur to move out to the
side.
Because of this the individual walks
with a limp or a side to side gait.

TFP SOCKETS- HUFSA SHAHZAD

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Ischial Containment
Socket:-

The
basic
concept
behind
ischial
containment is that the inner (medial) wall
of the socket actually cups inside ischium.
This prevents the socket from shifting
laterally during the stance phase of gait.
Capturing the ischium provides a secure
fulcrum against the pelvis so that when the
amputee abducts the amputated femur,
the muscle force actually moves the pelvis,
not just shifting the socket from side to side
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Ischial Containment
Socket:-

This is the primary theoretical benefit of the

ischial containment socket, to control the sideto-side shift of the socket on the upper thigh.
This potentially makes the thigh/prosthesis
interface more stable and thus more energy
efficient.
Fitting the ischial containment portion of the
socket brim is very critical because having it
too high makes it very uncomfortable in the
perineum. Having it too low does not allow it to
control pelvic shift.
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Fabrication Of Socket:CASTING:-

Once the decision has been made as to what type of

socket to use the next step is to get an impression of the
residual limb.
Making a plaster impression of the residual limb or
scanning the limb with computer technology can do this.
The first way is probably the most widely used method in
the field today.
A typical casting procedure will first require the prosthetist
to record precise measurements of the residual limb to be
used in modifying the mold. A cast separator (i.e.,
Vaseline) is applied to the limb to prevent the plaster from
sticking and then a cotton sock is put on.
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Casting:The sock may be just a tube of stockinet or it

could be in the form of pajamas that are held
up with suspenders. Rolls of plaster of Paris
or rolls of synthetic casting material are
molded onto the limb. Once the plaster has
hardened it is removed from the residual
limb by sliding it off. It is very infrequent that
a transfemoral cast will need to be cut off.
The client is sent home and the prosthetist
begins working on creating the prosthesis.
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