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trans-tibial ProsthesisPhysical Rehabilitation Programme
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Manufacturing guidelines
MISSION
The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of war and internal violence and to provide them with assistance. It directs and coordinates the international relief activities conducted by the Movement in situations of conflict. It also endeavours to prevent suffering by promoting and strengthening humanitarian law and universal humanitarian principles. Established in 1863, the ICRC is at the origin of the International Red Cross and Red Crescent Movement.
Acknowledgements:
Jean François GallayLeo GasserPierre GauthierFrank JoumierJacques LepetitBernard MatagneJoel NiningerGuy NuryPeter PoestmaHmayak Tarakhchyan
and all prosthetists-orthotists who have worked in ICRC-assisted physical rehabilitation centres.
International Committee of the Red Cross19 Avenue de la Paix1202 Geneva, SwitzerlandT + 41 22 734 60 01 F + 41 22 733 20 57E-mail: [email protected]© ICRC, September 2006All photographs: ICRC/PRP
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Table of contents
Foreword 2Introduction 41.Rawmaterialsandcomponents 42.Measurementsandsoftsocketmanufacture 63.Trans-tibialcupalignmentandsocketmanufacture 114.Buildinguptheprosthesisandbenchalignment 175.Polypropylenecosmeticmanufacture 26
5.1Cosmeticwithupperpartofsocketremoved 265.2CosmeticwithcompletePPsocket 34
6.EVAcosmeticmanufacture 41Referencelistofmaterials 46Standardcutsofpolypropylenesheetsforlower-limbprostheses 48
Manufac tur ing Guidel ines Trans-Tibial Prosthesis
� ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
Foreword
The ICRC polypropylene technology
Sinceitsinceptionin1979,theICRC’sPhysicalRehabilitationProgrammehaspromotedtheuseoftechnologythatisappropriatetothespecificcontextsinwhichtheorganizationoperates,i.e.,countriesaffectedbywarandlow-incomeordevelopingcountries.
Thetechnologymustalsobetailoredtomeettheneedsofthephysicallydisabledinthecountriesconcerned.
Thetechnologyadoptedmustthereforebe:
• durable,comfortable,easyforpatientstouseandmaintain;• easyfortechnicianstolearn,useandrepair;• standardizedbutcompatiblewiththeclimateindifferentregionsoftheworld;• low-costbutmodernandconsistentwithinternationallyacceptedstandards;• easilyavailable.
Thechoiceoftechnologyisofgreatimportanceforpromotingsustainablephysicalrehabilitationservices.
Forallthesereasons,theICRCpreferredtodevelopitsowntechniqueinsteadofbuyingready-madeorthopaediccomponents,whicharegenerallytooexpensiveandunsuitedtothecontextsinwhichtheorganizationworks.ThecostofthematerialsusedinICRCprostheticandorthoticdevicesislowerthanthatofthematerialsusedinappliancesassembledfromcommercialready-madecomponents.
WhentheICRClauncheditsphysicalrehabilitationprogrammesbackin1979,locallyavailablematerialssuchaswood,leatherandmetalwereused,andorthopaediccomponentsweremanufacturedlocally.Intheearly1990stheICRCstartedtheprocessofstandardizingthetechniquesusedinitsvariousprojectsaroundtheworld,forthesakeofharmonizationbetweentheprojects,butmoreimportantlytoimprovethequalityofservicestopatients.
Polypropylene(PP)wasintroducedintoICRCprojectsin1988forthemanufactureofprostheticsockets.Thefirstpolypropyleneknee-jointwasproducedinCambodiain1991;othercomponentssuchasvariousalignmentsystemswerefirstdevelopedinColombiaandgraduallyimproved.Inparallel,adurablefoot,madeinitiallyofpolypropyleneandEthylVinylAcetate(EVA),andnowofpolypropyleneandpolyurethane,replacedthetraditionalwooden/rubberfoot.
In1998,aftercarefulconsideration,itwasdecidedtoscaledownlocalcomponentproductioninordertofocusonpatientcareandtrainingofpersonnelatcountrylevel.
�ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
Objective of the manuals
TheICRC’s“ManufacturingGuidelines”aredesignedtoprovidetheinformationnecessaryforproductionofhigh-qualityassistivedevices.
Themainaimsoftheseinformativemanualsareasfollows:
• TopromoteandenhancestandardizationofICRCpolypropylenetechnology;• Toprovidesupportfortrainingintheuseofthistechnology;• Topromotegoodpractice.
Thisisanotherstepforwardintheefforttoensurethatpatientshaveaccesstohigh-qualityservices.
ICRCAssistanceDivision/HealthUnitPhysicalRehabilitationProgramme
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Introduction
Theaimofthisdocumentistodescribeamethodformanufacturingtrans-tibial (TT) prosthesesusingtheICRC’spolypropylenetechnologyasappliedinICRCprojectsworldwide.
Thecasting,rectificationandalignmentmethodsusedcorrespondtointernationalprostheticandorthotic(P&O)standardsofpracticeandarethereforenotdescribedintheseICRCmanufacturingguidelines.
ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
For short and medium stump, adult
The alignment system and foot components are available in adult and child sizes.
Raw maTeRIals and COmpOnenTs1
4Description:
� Convexankle
� Twoconcavecylinders
� Convexdisc
� CylindricalTTcup
5 Flatsteelwasherandcountersunkheadbolt
6 SolidAnkleCushionHeel(SACH)foot
7 Hexagonalheadboltandlockwasher
5ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
For long stump
The alignment system and foot components are available only in adult size.
4PTB(patellar-tendon-bearing)socketsecuredwithacuffsuspension.Thesuspensioncanbeadjusted.
Incaseofmedio-lateralinstabilityofthekneeorforastronghyperextension,athighcorsetwithsidebarsissuitable.
Thiscanbemadewithorwithoutasoftliner.
Socket design
4Description:
� Concaveankle
� Convexdisc
� CylindricalTTcup
� Flatsteelwasher
5 SolidAnkleCushionHeel(SACH)foot
6 CountersunkheadM10boltandthelockwasher
6 ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
measuRemenTs and sOFT sOCkeT manuFaCTuRe2
6PTB-SC(supra-condylar)
Shouldbemadewithasoftliner.
6PTB-SCSP(supra-condylar,supra-patellar)
Mustbemadewithasoftliner.
6Thepatientisassessed,aprescriptionismade,measurementsaretakenandmouldingandrectificationareperformedaccordingtobestP&Opractice.
7
soft liner manufacture
ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
4Measuretheplastermould.Notethe:• smallestcircumference;• largestcircumerence;• length.
6Drawatrapezoidonasheetof6mmEVAaccordingtothemeasurementstakenbutadding3cmtothelengthontheshortsideofthetrapezoid.
CuttheEVAandskivethelateralandthedistalsides(about12mm).
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6Applyglueonbothskivedsidesandformacone.Keepthetrimmeddistalsideontheoutsideoftheconeandleaveitfreeofglue.
ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
Applytalcumpowderinsidetheconeandontheplastermodel.
Thermoformingisdoneusingthevacuumpump,onaverticalsuctionhose.
HeattheEVAconeintheovenat120°C.
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4Allowthesoftlinertocooldownforfewminutes.
Removetheplasticbag.
Prepareapieceof6mmEVAtocoverthebottomedge.
Applygluetothetrimmededgeandthecovercap.
Heatthecapintheovenandmoulditonthesocket.
CutofftheextraEVAandgrindtillsmooth.
Addpaddingabovethemedialcondyleandotherareasifrequired.
ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
6PulltheEVAconeovertheplastermould,keepingthegluedlineontheposteriorside,untilthetrimmeddistalsidecoincideswiththetipoftheplastermould.
Coverthemouldwithaplasticbag,closeitsecurelybelowthemouldwithanelasticstrapandswitchonthevacuumpump.
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4Coverthesoftsocketwithatubularcottonstockingandglue.
ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
4Prepareasheetof3mmEVAtocoverthecotton.
SkiveonesideoftheEVA,applygluetotheentiresurfaceoftheEVAincludingtheskivedside,andplaceitintheovenat120°C.
Coverthesoftliner,startingfromtheposteriorside.RemovetheexcessEVAandgrindtheposteriorsideandthedistalparttillsmooth.
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4Lastly,coverthedistalpartwitha3mmor6mmEVA“cap”andgrindtillsmooth.
ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
TRans-TIbIal Cup alIgnmenT and sOCkeT manuFaCTuRe3
4Grindtheedgeofthesocketcup.
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alignment of the trans-tibial cup
4Fixthenailatthebottomofthemould,wherethecupwillbeattached.
PlacetheTTmouldontheCRalignmentjig;alignaccordingtotheinstructionsontheuseofthejig(separatemanual).Performthealignmentinaccordancewiththemeasurementcard.Fixthecuptothesocketwithplaster.
4Fromthemiddleofthecondyle,theplumblineshouldpassabout1cminfrontofthecupaxis.
ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
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manufacture of the socket (4 mm polypropylene)
measurements
4Whentheplasterhasset,smoothit.
4Add15cmtothemeasurementtakenatpatellalevel.
ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
4Coverthesoftlinerwithanylonorcottonstocking.Removethenyloncoveringthecup.
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4FixaroundpieceofEVA(12+6mm)withanailinsidetheopeningofthecup.
ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
4Add15cmtothemeasurementtakenatthedistalpart.
4Add15cmtothemeasuredlengthofthesocket.
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4Cutasheetof4mmPPcorrespondingtothesemeasurements.CleanthePPsheetandtheTeflonintheovenwiththinner.
Put the PP in the oven at 180°C .
4Switchonthevacuumpump;drapethePParoundthesocket.
Weldingseamposition:• forPPcosmetic:lateralormedial• forEVAcosmetic:posterior
CutofftheexcessPPwhileitis stillhot.
LeavethevacuumonuntilthePPcoolsdown.
ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
�6 ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
6CutthePPaccordingtothetrimlines,removetheplasterwithoutdamagingthesocketlinerandPPsocket,andgrindtheweldingseamdownto3mm.
6Oncetheplasterisremoved,useascrewdrivertoremovethepieceofEVA.
6Grindthedistalpartandcheckthatthesurfaceisflat.
Formaximumstrength,keepaminimumPPthicknessof2to3mmunderthecup.
�7ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
buIldIng up The pROsThesIs and benCh alIgnmenT4
steps to follow:
•Ankle-footbuild-upandalignment;•Socketbuild-up;•Adjustmentoflengthandweldingofconcavecylinderbutt;•Finalbenchalignment.
6The foot, the convex ankle and the concave cylinder are attached together.
The window in the concave cylinder must be anterior.
�� ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
ankle-foot alignment
Anextra4mmplatemustbeattachedtotheconvexankle.DrilltwoholesasshownontheillustrationbelowandfixthetwocomponentstogetherwithaPPweldingrod.This will prevent breakage of the foot bolt.
Components
��ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
preparation before fixation
Attachtheconcavecylinder(withtheopeninginfront)tothefootandtheconvexankle.
Theheelheightisadjustedaccordingtothepatient’sshoe;theconcavecylindermust be perpendicular to the ground.
Thefoothasaheelheightof10mm(maximumheelheight:15to20mm).
• The ankle alignment system allows antero-posterior movements (flexion, extension).• This alignment system is used to adjust the angulation of the prosthesis according
to heel height.• In any event, the concave cylinder must remain perpendicular to the ground.
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6Thefootisadjustedin5°to8°externalrotations.
ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
6Checkthealignmentonceagainwiththepatient’sshoeonthefoot.
6Thesocketisattachedtotheconcavecylinderwiththeconvexdiscinbetween.
6Theopeningintheconcavecylinderremainsinfront.Thealignmentsystemisinneutralpositionforthefirstfitting.
��ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
4Adjustthelengthaccordingtothemeasurementstakenonthepatient.
Marktheconcavecylinderandsawofftheexcess.
Cuttheconcavecylinderatanangleof90°.
4Setthetemperatureofthemirrorwelderbetween185°and200°C.
6HoldtheconcavecylindersonthemirrorwelderuntilarollofmeltedPPforms.
�� ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
6Carefullybringthecylinderstogetherandapplyslightpressure.
Concave cylinders correctly welded
��ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
Concave cylinders incorrectly welded
socket alignment
Thesocketisconnectedtoaconcavecylinderwithaconvexdiskinbetween.Theconnectionissecuredbyacountersunkheadboltandflatwasherinsidethesocket,withtheT-nutinsidetheconcavecylinder.
Shiftingcanoccurinalldirections:anterior,posterior,medial,lateralandcombinedmovements,witharangeof10mminalldirections
anterior shifting Initial position posterior shifting
�� ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
6Thealignmentsystemalsoallowsflexion,extension,abduction,adductionandrotation.
6BenchalignmentisperformedaccordingtoP&Opracticeandadjustedduringfittingandduringthegaittrainingperiod.
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6Beforethecosmeticismade,allthecomponentsmustbeweldedtogether.
�6 ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
pOlypROpylene COsmeTIC manuFaCTuRe5
TherearetwowaysofmanufacturingaPPcosmetic.
5.1 Cosmetic with upper part of socket removed
adjustment of ankle part
6Drawalinefollowingtheshapeofthefoot,thendisassemblethefoot.
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Minus � mm
ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
4Checkyourmarkandgrinditcarefully.
Checkoncemoreagainstthefoot.
4Stickadhesivetapeonthefootanddrawalinewithapermanentmarkeronthetopoftheconvexankleandonthetape.
4Disassemblethefootanddrawalineallaroundtheplate4mmfromtheedge.
Grindtheedgecarefully.
�� ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
4Checkagainwiththefoot.
Weldthetwoplatestogether,firstusingtheweldingirontomakeagrooveandthenweldingwiththehot-airweldinggun.
Grindagaincarefully.
manufacture of cosmetic shell
6Cutacrosstheprosthesisbelowthelevelofthehamstringtendonsandremovetheupperpart.
4SkivethePPedgecarefully.
��ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
4Addplastertoshapetheshank.
4Reducethecircumferenceoftheshankby3cmtoallowforthethicknessofthe4mmPPsheet.
Smooththeplaster.
Leavetheankleedgefree ofplasterforthefinalwelding.
4Fixthe4mmPPreinforcementplateatthepopliteallevelwith2nails.
4Drawanylonorcottonstockingovertheplaster.
Addtalcumpowder.
Heatthe4mmPPsheetintheovenat180°C.
�0 ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
4Glueornail5mmPPundertheankleplatetocompensateforretractionofthePPafteropening.
6DrapethePPundervacuum.
6CutofftheexcessPPattheweldingseam.Keepthevacuumonuntiltheplasticcoolsdown.
��ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
4Grindtheposteriorseamdownto2to3mm.Inthreeplaces,leaveawideroverlapofPPforholdingtheprosthesisduringwelding.
4Opentheseamcarefullywithanoscillatingsawtoavoidbreakage.
6RemovethePPshellfromtheprosthesisandremovetheplaster.Cleantheprosthesisthoroughlytoensurethatnopiecesofplasterremain.Puttheprosthesisbackintotheshell.
�� ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
4HoldtheprosthesisinaparallelvicewithEVAorrubberprotectionbetweenthevicejawsandthecosmeticshell.Closethetwosidesoftheposteriorseamwithlockgripsand/orothersuitabletools.
Beforewelding,makeV-shapedindentationsalongtheseamwithaweldingiron.
4Thefinalweldingisdonewithahot-airweldinggunanda4mmPPweldingrod.
4Weldtheankletotheshell.Afterwelding,carefullyflattentheanklesurface.
��ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
4Polishwitharaspand/orasharppieceofglass.
4Attachthe4mmPPreinforcementtotheshellwithtubularrivets.
Thelaststepistofixthefootontheprosthesis.
�� ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
5.2 Cosmetic with complete pp socket
adjustment of ankle part
6Drawalinefollowingtheshapeofthefoot,thendisassemblethefoot.
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Minus � mm
ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
4Checkyourmarkandgrinditcarefully.
Checkoncemoreagainstthefoot.
4Stickadhesivetapeonthefootanddrawalinewithapermanentmarkeronthetopoftheconvexankleandonthetape.
4Disassemblethefootanddrawalineallaroundtheplate3mmfromtheedge.
Grindtheedgecarefully.
�6 ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
4Checkagainwiththefoot.
Onceagoodfithasbeenachieved,weldthetwoplatestogether:firstmakeagroovewiththeweldingironandthenweldwiththehot-airweldinggun.
Grindagaincarefully.
4Roughenthesurfaceofthesocket.
4Covertheconcavecylinderswithadhesivetape.
�7ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
4Shapetheshankwithplaster.
4Drawanylonorcottonstockingovertheprosthesis.
4Glueornail5mmPPundertheankleplatetocompensateforshrinkageofthePPafterthermoforming.
�� ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
6Drapeasheetof3mmPParoundthemouldundervacuum.
4Grindtheposteriorseamdownto2to3mm.Inthreeplaces,leaveawideroverlapofPPforholdingtheprosthesisduringwelding.
4Opentheseamcarefullywithanoscillatingsawtoavoidbreakage.
4RemovethePPshellfromtheprosthesisandremovetheplaster.Cleantheprosthesisthoroughlytoensurethatnopiecesofplasterremain.
��ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
4HoldtheprosthesisinaparallelvicewithEVAorrubberprotectionbetweenthevicejawsandthecosmeticshell.Closethetwosidesoftheposteriorseamwithlockgripsand/orothersuitabletools.
Beforewelding,makeV-shapedindentationsalongtheseamwithaweldingiron.
4Thefinalweldingisdonewithahot-airweldinggunanda4mmPPweldingrod.
4Weldtheankletotheshell.Afterwelding,carefullyflattentheanklesurface.
�0 ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
6Grindtheseamdownto2to3mm.Polishwitharasporapieceofglass.
6Weldtheproximalpartoftheprosthesis.
Thelaststepistofixthefootbackontheprosthesis.Checktheflatnessoftheankle.
��ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
eVa COsmeTIC manuFaCTuRe6
adjustment of ankle part
6Drawalinefollowingtheshapeofthefoot,thendisassemblethefoot.
4Checkyourmarkandgrinditcarefully.
Checkoncemoreagainstthefoot.
4Stickadhesivetapeonthefootanddrawalinewithapermanentmarkeronthetopoftheconvexankleandonthetape.
�� ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
4Dismantlethefootanddrawalineallaroundtheplate,3mmfromtheedge.
4Grindtheedgecarefully.
4Roughenthesurfaceofthesocket.
For heavy patients, reinforce the concave cylinders with a 3 mm PP sheet.
��ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
4GluelayersofEVAontheprosthesis.
4Shapetomatchthesoundleg.
LeavetheankleplatefreeofEVAforthefinalcosmetic.
Bearinmindthefactthatanadditionallayerof3mmEVAwillcovertheentireprosthesis,andthatthiswillincreasethecircumferenceoftheprosthesisbyabout1cm.Atthisstage,checkyourcircumferencesbycomparingthemwiththemeasurementsnotedonthepatient’stechnicalcard,andreducethesizeby1cmallover.
�� ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
4Cutasheetof3mmEVAaccordingtothecircumferencesmeasured,butlongerthanthemeasurements.
Skivethesidethatwillbegluedontopofthefoot.
SkiveonelongsideoftheEVAsheetandapplygluetothatpart.
TurntheEVAsheetover,andcoverthisreversesidewithglue.
4Applygluetotheentireprosthesis(exceptthefoot).
Heatthe3mmEVAsheetintheovenat120°Cforafewsecondsuntilitbecomesveryflexible.DonotoverheattheEVAoryoumayaccidentallymakeprintmarksonitduringmanipulation.
Takethe3mmEVAsheetoutoftheovenandglueitovertheprosthesis,startingbygluingtheskivededgealongtheposteriorsideoftheprosthesis.
4Thenstartgluingthe3mmEVAsheetontheprosthesisbyrevolvingtheprosthesisonit,applyingconstanttensionontheEVAtoavoidairbubblesandfolds.
�5ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
4ThelaststepistoremovetheexcessEVAandtogrindtheseamandtheproximaltrimlineoftheprosthesissmoothly.
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ICRC Code Description Specification Unit of MeasureTrans-tibial module, childOCPOMODUTTC Countersunk head bolt
Flat washer, steelTrans-tibial cupConvex discConcave cylinder with M8 T-nutConvex ankle
M8 x 60 mmD40 x d10 x H2.5 mmD70 x H26 mm
dia. 22 mm
1 piece1 piece1 piece1 piece2 pieces1 piece
Reference list of materials
Components: Trans-tibial module, child
ICRC Code Description Specification Unit of MeasureTrans-tibial module, adultOCPOMODUTTA Countersunk head bolt
Flat washer, steelTrans-tibial cupConvex discConcave cylinder with T-nut M8Convex ankle
M10 x 60 mmD44 x d15 x H3 mmD70 x H26 mm
dia. 25 mm
1 piece1 piece1 piece1 piece2 pieces1 piece
Components: Trans-tibial module, adult
Weight per unit of measurement: 285 grams • Quantity per box: 25 sets • Box size: L40 x l30 x H44 cm
Weight per unit of measurement: 490 grams • Quantity per box: 25 sets • Box size: L40 x l30 x H44 cm
ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
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ICRC Code Description Specification Unit of MeasureTrans-tibial module, long stump prosthesisOCPOMODUTTLA Flat washer, steel
Trans-tibial cupConvex discConcave ankle
D44 x d15 x H3 mmD70 x H26 mm
1 piece1 piece1 piece1 piece
Components: Trans-tibial module, long stump prosthesis
Weight per unit of measurement: 130 grams • Quantity per packet: 1 piece
ICRC Code Description SpecificationFeet for prosthesisOCPOFOOT... Foot 22 – 28 cm, left and right,
olive and terra coloursHeel, 10 mm
When ordering feet from 22 to 28 cm, change the number in the ICRC code and description.4With all the adult feet a M10 bolt and a M10 lock washer are included.4Weight per unit: (size 25) 605 grams • Quantity per box: 25 pcs. • Box L40 x l30 x H44 cmOCPOFOOT... Foot 14 -21 cm, left and right,
olive and terra coloursHeel, 10 mm
When ordering feet from 14 to 21 cm, change the number in the ICRC code and description.4With all child feet a M8 bolt and a M10 lock washer are included.4Weight per unit: (size 19) 340 grams. • Quantity per packet: 1 pc.
Components: Feet for prosthesis
ICRC Physical Rehabi l i tat ion Programme Manufac tur ing Guidel ines Trans-Tibial Prosthesis
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Designation Used forMaterialsPOP bandage 15 cm Cast-takingPOP powder Positive mouldContact glue Soft socketSoap (demoulding agent) Positive mouldTalcum powder ThermoformingVaseline Cast-takingNails Positive mouldColorant for plaster Positive mouldCotton/nylon stockinet dia. 8 or 10 cm Cast taking and soft socketCotton stockinet or sock Stump sockWelding rod PP dia. 4 mm Welding componentsPolypropylene 4 mm Hard socketEVA 3 mm Soft socketEVA 6 mm Soft socketPolypropylene cosmeticPolypropylene 3 or 4 mm Cosmetic shellWelding rod dia. 4 mm Welding cosmetic shellPlaster powder Cosmetic shapeAdhesive tapeTubular rivets (2) Posterior reinforcementEVA cosmeticEVA 3 mm; 6 mm; 12 mmContact glue
pp, eVa and other consumables
ICRC Physical Rehabi l i tat ion Programme
polypropylene sheet: 2000 mm x 1000 mm
standard cuts of polypropylene sheets for lower-limb prostheses
Trans-tibial socket4 mm
Trans-tibial cosmetic3 mm or 4 mm
MISSION
The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of war and internal violence and to provide them with assistance. It directs and coordinates the international relief activities conducted by the Movement in situations of conflict. It also endeavours to prevent suffering by promoting and strengthening humanitarian law and universal humanitarian principles. Established in 1863, the ICRC is at the origin of the International Red Cross and Red Crescent Movement.
Acknowledgements:
Jean François GallayLeo GasserPierre GauthierFrank JoumierJacques LepetitBernard MatagneJoel NiningerGuy NuryPeter PoetsmaHmayak Tarakhchyan
and all prosthetists-orthotists who have worked in ICRC-assisted physical rehabilitation centres.
International Committee of the Red Cross19 Avenue de la Paix1202 Geneva, SwitzerlandT + 41 22 734 60 01 F + 41 22 733 20 57E-mail: [email protected]© ICRC, September 2006All photographs: ICRC/PRP
Physical Rehabilitation Programmeankle-Foot orthosis
Manufacturing guidelines
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