Name of the Procedure:

Addition to Lower Extremity, Symes Type, Posterior Opening (Canadian) Socket (L5634)

Summary

This procedure involves fitting a prosthetic socket for individuals with a lower extremity amputation, specifically a Symes amputation, which is an amputation through the ankle joint. The posterior opening (Canadian) socket is designed to provide better weight distribution and comfort.

Purpose

The prosthetic socket addresses the needs of patients who have undergone a Symes amputation due to trauma, infection, or other medical conditions that necessitate the removal of the foot at the ankle. The main goal is to restore mobility, improve balance, and enhance the quality of life.

Indications

• Trauma or severe injury to the lower extremity requiring amputation.
• Infections or medical conditions such as diabetes leading to gangrene, requiring lower extremity amputation.
• Congenital deformities or abnormalities.

Preparation

• Consultations with a prosthetist and surgeon to assess the patient's condition.
• Adjustments in medications as advised by the healthcare provider.
• Pre-fitting assessments, including measurements and molds of the residual limb.

Procedure Description

1. Initial Consultation: Review of the patient's medical history and assessment of the residual limb.
2. Casting and Molding: Creating a custom mold of the residual limb to ensure the socket fits accurately.
3. Fabrication: Designing and fabricating the prosthetic socket based on the mold.
4. Fitting: Trial fitting and adjustments to ensure comfort and functionality.
5. Training: Patient education on how to use and care for the prosthetic socket, including walking and balance training.

Tools and Equipment:

• Casting materials
• Fabrication tools
• Prosthetic components
• Fitting and alignment tools

Anesthesia: Typically, no anesthesia is required for fittings. However, minor procedures for socket adjustments may require local anesthesia.

Duration

The entire process from molding to final fitting can take several weeks to ensure all adjustments are accurately made.

Setting

The procedure is performed in a prosthetics and orthotics clinic, outpatient surgical center, or specialized rehabilitation facility.

Personnel

• Prosthetist
• Orthopedist or surgeon
• Physical therapist
• Rehabilitation specialists
• Medical assistants

Risks and Complications

• Skin irritation or sores due to improper fit.
• Discomfort or pain if the socket is not perfectly aligned.
• Changes in the residual limb shape requiring further adjustments.
• In rare cases, infection if there are open wounds.

Benefits

• Restored mobility and independence.
• Improved balance and gait.
• Enhanced quality of life and ability to perform daily activities.
• Benefits are typically realized within a few weeks after final adjustments.

Recovery

• Follow-up appointments for adjustments and fit checks.
• Regular skin inspections to prevent irritation or sores.
• Physical therapy to adapt to the new socket.
• Full recovery and adaptation can take a few months.

Alternatives

• Traditional prosthetic sockets without a posterior opening.
• Custom silicone liners for added comfort.
• Advanced endoskeletal prosthetic systems. Each alternative has its own pros and cons, such as differences in comfort, cost, and ease of use.

Patient Experience

During fittings, patients might feel pressure but should not experience significant pain. Comfort measures include gel liners and cushioned materials. Post-procedure, patients may need an adjustment period to adapt to the new prosthetic socket, with possible minor discomfort that is manageable with the guidance of their healthcare provider.