Patient-specific analyses of deep tissue loads post transtibial amputation in residual limbs of multiple prosthetic users

Portnoy, Sigal; Siev-Ner, Itzhak; Shabshin, Nogah; Kristal, Anat; Yizhar, Ziva; Gefen, Amit

doi:10.1016/j.jbiomech.2009.08.019

Cited by 48 publications

(60 citation statements)

References 16 publications

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“…In an early study of pressure, circumferential application of 200 mmHg was established as a pain threshold relative to pressure [27]. More recently, researchers have stated that muscle cell death can occur in less than 3 to 6 hr with as little as 68 mmHg [28][29][30][31][32][33][34]. The nondisabled person experiences negligible pressure on the ischium while standing and ambulating.…”

Section: Discussionmentioning

confidence: 99%

Transfemoral sockets with vacuum-assisted suspension comparison of hip kinematics, socket position, contact pressure, and preference: Ischial containment versus brimless

Kahle

Highsmith²

2013

J Rehabil Res Dev

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Abstract-The objective of this study was to investigate the effect of brimless compared with ischial ramus containment (IRC) prosthetic sockets when using vacuum-assisted suspension (VAS) on persons with a unilateral transfemoral amputation (TFA). A randomized crossover design with a 2 d accommodation was used. People with unilateral TFA (n = 9 analyzed) were enrolled. Interventions were IRC VAS and brimless VAS sockets. Main outcome measures included coronal hip angle and vertical and lateral socket movement as measured by X-ray, skin pressure measured by Tekscan, and preference measured subjectively. The brimless design was statistically equivalent to IRC in all measured coronal hip angles and vertical and lateral socket displacement. The peak/stance mean pressure in the medial proximal aspect of the socket was 322 mmHg in the IRC compared with 190 mmHg in the brimless condition. Except for medial proximal pressure, no other measures reached statistical significance. All subjects reported the brimless design to be more comfortable than the IRC in short-term preference. Brimless VAS socket design may be a clinically viable choice for people with TFA.

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Section: Discussionmentioning

confidence: 99%

Transfemoral sockets with vacuum-assisted suspension comparison of hip kinematics, socket position, contact pressure, and preference: Ischial containment versus brimless

Kahle

Highsmith²

2013

J Rehabil Res Dev

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“…22,23 All these experimental difficulties have favored the use of numerical methods like the finite element (FE) method to assess the stress-strain state in a lower limb stump. 29 Numerical models for amputees above the knee, 23,28 and below the knee 5,[7][8][9]13,[16][17][18][19]26,27,30,31 have been developed to establish the stress-strain state in the interaction between the socket and the stump. To obtain the geometry of the model, most studies use computed tomography (CT) or magnetic resonance imaging (MRI).…”

Section: Introductionmentioning

confidence: 99%

Finite Element Analysis of Donning Procedure of a Prosthetic Transfemoral Socket

Lacroix

Patiño

2011

Ann Biomed Eng

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Lower limb amputation is a severe psychological and physical event in a patient. A prosthetic solution can be provided but should respond to a patient-specific need to accommodate for the geometrical and biomechanical specificities. A new approach to calculate the stress-strain state at the interaction between the socket and the stump of five transfemoral amputees is presented. In this study the socket donning procedure is modeled using an explicit finite element method based on the patient-specific geometry obtained from CT and laser scan data. Over stumps the mean maximum pressure is 4 kPa (SD 1.7) and the mean maximum shear stresses are 1.4 kPa (SD 0.6) and 0.6 kPa (SD 0.3) in longitudinal and circumferential directions, respectively. Locations of the maximum values are according to pressure zones at the sockets. The stress-strain states obtained in this study can be considered more reliable than others, since there are normal and tangential stresses associated to the socket donning procedure.

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“…Las interacciones entre los diferentes componentes se definieron como sigue: entre el hueso y el músculo se asignó una condición de bonded, para restringir el desplazamiento entre los dos tejidos, es decir, estas superficies permanecen unidas durante toda la simulación, el mismo tipo de consideración se hizo para las superficies del músculo y la grasa y entre la grasa y la piel, dichas consideraciones se hicieron con el fin de optimizar el tiempo computacional, aunque puede estar un poco alejado del comportamiento real, es utilizada comúnmente por otros investigadores [33]- [36] como una simplificación valida. El contacto entre el socket y el muñón se asumió de tipo frictional, con un coeficiente de fricción (CF) entre el polipropileno y la piel de 0.7, para la interacción entre el socket y la piel en el modelo y que estuviera presente en todas las fases de la simulación, este valor es utilizado en varias investigaciones [30], [37], [38], en las cuales midieron experimentalmente el valor de CF en pacientes amputados transtibiales y el valor del CF de la piel con diferentes materiales.…”

Section: Condiciones De Bordeunclassified

“…Se encontró que la distribución y concentración de los esfuerzos y deformaciones críticos para desarrollar una úlcera por presión interna o una herida en el tejido interno, se localizan en el tejido muscular cerca de la zona distal del fémur residual; donde se transmiten los esfuerzos y deformaciones por la acción de la prominencia ósea, estos resultados concuerdan con los reportados por Portnoy et al [36] y Gefen et al…”

Section: Conclusionesunclassified

Influencia de las condiciones de carga en la generación de úlceras por presión internas en amputados transfemorales

Blandón

Góez

Ossa

2018

revuin

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Vol. 17, no. 1, pp. 223-232, enero-junio 2018 Revista UIS Ingenierías RESUMENEn esta investigación se realiza la modelación tridimensional del miembro residual de un amputado transfemoral que incluye la piel, el tejido graso, el músculo y el fémur residual. Se establecen las condiciones de carga para la fase de apoyo durante el ciclo de la marcha normal, la bipedestación y la marcha por escaleras de un amputado transfemoral de 88 kg y una estatura de 1.7 m. Se realizó un análisis de la incidencia de las condiciones de carga sobre los esfuerzos y deformaciones en el tejido muscular, para establecer su influencia sobre la generación de úlceras por presión internas en el miembro residual del amputado. Del análisis se obtuvo que el esfuerzo a compresión promedio más alto es cercano a 18.6 kPa y la deformación promedio más alta a compresión es de 56.8 %, esto sucede cuando se realiza marcha por escaleras o superficies inclinadas. La mayor concentración de esfuerzo y deformación se presenta en la zona distal del fémur residual en el tejido muscular. PALABRAS CLAVE:Úlceras por presión; úlceras por presión internas; UP; UPI; amputado transfemoral; elementos finitos; EF; biomecánica. ABSTRACTIn this research, three-dimensional modeling of the residual limb of a transfemoral amputee is performed, which includes skin, fat tissue, muscle and residual femur. The loading conditions are established for the support phase during the normal gait cycle, the standing and walking through stairs of a transfemoral amputee of 88 kg and a height of 1.7 m. An analysis of the incidence of load conditions on the stresses and deformations in muscle tissue was made to establish its influence on the development of deep tissue injuries (DTI) in the residual limb of the amputee. From the analysis it was obtained that the average compressive stress is close to 18.6 kPa and the highest average strain at compression is 56.8%, it happens when the individual is walking through stairs or slope. The maximum concentration of stress and strain occurs in the distal area of the residual femur in muscle tissue.

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Patient-specific analyses of deep tissue loads post transtibial amputation in residual limbs of multiple prosthetic users

Cited by 48 publications

References 16 publications

Transfemoral sockets with vacuum-assisted suspension comparison of hip kinematics, socket position, contact pressure, and preference: Ischial containment versus brimless

Transfemoral sockets with vacuum-assisted suspension comparison of hip kinematics, socket position, contact pressure, and preference: Ischial containment versus brimless

Finite Element Analysis of Donning Procedure of a Prosthetic Transfemoral Socket

Influencia de las condiciones de carga en la generación de úlceras por presión internas en amputados transfemorales

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