Name of the Procedure

Common Name: Below Elbow Socket Replacement
Technical Term: Replacement socket, below elbow/wrist disarticulation, molded to patient model, for use with or without external power (HCPCS L6883)

Summary

A replacement socket for a below-elbow or wrist disarticulation prosthesis involves creating a custom-molded socket to fit the patient's residual limb. This socket can be used with or without external power (myoelectric components).

Purpose

This procedure addresses the need for a comfortable, functional prosthetic interface for individuals who have undergone below-elbow or wrist disarticulation amputations. The goal is to provide a secure, well-fitting socket that enhances the patient's ability to perform daily activities.

Indications

• Amputees with a below-elbow or wrist disarticulation.
• Patients experiencing discomfort or poor fit with their current prosthetic socket.
• Individuals seeking an upgrade to a more functional or technologically advanced socket.

Preparation

• Pre-fitting consultation with a prosthetist.
• Assessment of the residual limb to ensure it is in optimal condition for socket fitting.
• Possible pre-fitting diagnostic tests, such as imaging or limb volume measurements.

Procedure Description

1. Assessment and Casting: The prosthetist assesses the residual limb and creates a mold, often using plaster or 3D scanning technology.
2. Model Fabrication: A positive model of the residual limb is created from the mold.
3. Socket Formation: The socket is fabricated using materials such as thermoplastics or silicone, ensuring it matches the patient's model for a snug fit.
4. Fitting and Adjustment: The prosthetist fits the socket to the patient's limb, making necessary adjustments for comfort and functionality.
5. Integration with Prosthesis: The socket is attached to the prosthesis, which may include myoelectric components if external power is being used.

Duration

The entire fitting process can take several weeks, including assessment, fabrication, and adjustments. Each fitting session typically lasts 1 to 2 hours.

Setting

The procedure is performed in a prosthetics clinic or an outpatient setting.

Personnel

• Certified Prosthetist-Orthotist (CPO)
• Prosthetic Technician
• Physical or Occupational Therapist (optional for functional training)

Risks and Complications

• Skin irritation or pressure sores
• Improper fit leading to discomfort
• Potential need for adjustments or remakes
• In rare cases, allergic reactions to socket materials

Benefits

• Improved comfort and fit, enhancing daily function
• Potential for better control and use of the prosthesis
• Reduced risk of skin irritation compared to ill-fitting sockets

Recovery

• Patients may need several fitting sessions to achieve optimal fit.
• Post-procedure, they should follow instructions for skin care and socket maintenance.
• Regular follow-up appointments ensure the socket continues to fit well as limb volume changes.

Alternatives

• Standard off-the-shelf prosthetic sockets
• Myoelectric or body-powered prostheses with non-custom sockets
• Each alternative has its own benefits and limitations, such as comfort, functionality, and cost.

Patient Experience

• Patients may feel a range of sensations as the prosthetist works on fitting and adjusting the socket.
• Some initial discomfort as they adjust to the new socket, but this usually improves with proper fit and use.
• Pain management strategies and comfort measures are provided as needed to ensure a smooth adaptation process.