Prosthetics and Orthotics by Shurr, Donald G.

,
Michael, John W. 2nd edition

Chapter 2: Methods, materials and mechanics

Another reference:
Wong, M. S. & Hassan Beygi, Babak & Zheng, Yu. (2018). Materials for Exoskeletal Orthotic
and Prosthetic Systems. 10.1016/B978-0-12-801238-3.11040-2.
 Many factors to be considered when a new prosthesis is
designed
• Weight bearing.-For lower-limb prostheses, the weight-bearing characteristics of
the socket are the first concern. If the patient has scarring, neuromas, or sensitive
areas, specific provisions must be made in the design of the socket. Special
impact-absorbing materials may be used, or modifications may be necessary to
spread the load over a greater area.

• Socket and Socket Interface: The socket is the part that contacts the wearer’s skin.
It allows the transmission of forces and moments through the prosthesis to the
floor. Most transtibial prostheses are furnished with a combination of insert (soft
socket) or liner and prosthetic socks to distribute the stress around the limb and
increase the comfort and cushioning.

• Suspension.-Suspension is a component that prevents the prosthesis from slipping

off the amputation limb. There are many methods of suspension, ranging from
very basic leather belts to sophisticated suction sockets.

Bowker HK, Michael JW (eds): Atlas of Limb Prosthetics: Surgical, Prosthetic, and Rehabilitation Principles. Rosemont, IL, American Academy of Orthopedic
Surgeons, edition 2, 1992, reprinted 2002.
Wong, M. S. & Hassan Beygi, Babak & Zheng, Yu. (2018). Materials for Exoskeletal Orthotic
and Prosthetic Systems. 10.1016/B978-0-12-801238-3.11040-2. suspension with metal pin locking system.
 • Structure of the prosthesis.-There are two basic structural types: endoskeletal and exoskeletal.
Endoskeletal prostheses consist of internal tubes and components covered with a soft foam outer
cover. They are becoming increasingly popular because of the inter-changeability of componentry for
trial or repair, their relatively light weight, and the good appearance they offer. Exoskeletal
prostheses, on the other hand, consist of wood or polyurethane covered with a rigid plastic
lamination

• Activity level.-A person using the prosthesis only indoors different from sport/active
person

• Expense.-The expense of a prosthesis may vary greatly, primarily depending on the

need for lightweight or sophisticated componentry.

Bowker HK, Michael JW (eds): Atlas of Limb Prosthetics: Surgical, Prosthetic, and Rehabilitation Principles. Rosemont, IL,
American Academy of Orthopedic Surgeons, edition 2, 1992, reprinted 2002.
 Steps in providing prosthetics /orthotics

1. Evaluation/prescription
2. Measurement/ impression taking (casting)
3. Fabrication/ bench alignment
4. Fitting/ static alignment
5. Modification/ dynamic alignment
6. Reevaluation/ follow up.

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1-Evaluation/prescription: record factors such as adherent scar tissue, range of motion,
length and circumferences of body segments , locations of bony landmarks and tendons,
and joint range of motions.

2- Measurement/ impression taking (casting)

a. Measurements are then taken of both the residual limb and sound limb (none
prosthetic side). The length of the residual limb is measured,
-For powered upper-limb prostheses will have myoelectric control sites identified by
electromyographic (EMG) testing.

b. Impression procedure(casting): -The hollow plaster or fiberglass cast of the residual

limb creates the negative impression. It is sealed and filled with liquid plaster, which
hardens to form an accurate positive model of the patient’s limb.
-Recently, using electronic digitization technique.
-The impression procedure provides much more than simply a model of the patient’s
limb; it also simulates the socket design and provides alignment information.
3-Fabrication/ bench alignment :
 Fabrication prosthesis/ orthosis begin with conventional fabrication of plaster casts
(negative impression) and the manufacture of positive model.
 select the proper size of prefabricated devices that will be modified based on the measurements
. Or in case of custom-made devices , the prosthetist/orthotist uses the measurements and
impression to produce positive model.
 The final device will have area of increased contact area ( pressure ) and other of areas of reduced
contact (relief) so it biomechanically effective and comfortable.

4- Fitting/ static alignment

 Then the device will be fabricated and aligned to the remaining limb.
 Align the impression model to the components of the device based on clinical guideline (bench
alignment)
 Fitting it the prosthetic to the patients-how it fits and feel (static alignment )
 The pressure and force applied by the device are within the comfortable tolerance

https://www.youtube.com/watch?v=fIGX9yyPRiE
5-Modification/ dynamic alignment
Comfortable to wear
Fine tune the device after the patients try to function with it (ex. Removal of
material by trimming, substitution of components)
Dynamic alignment (for lower limb, fine adjustments are made to the device
while patient is walking on it to optimize the gait pattern)

6-Reevaluation/ follow up:

Regular reevaluation and follow up (ex. Patient’s biochemical needs may
fluctuate due to change in functional ability, life style, weight…)
CAD-CAM (computer aided design-computer
aided manufacturing)
Current computer-aided design/ computer-aided manufacturing
(CAD/CAM) systems consist of three major components:

1) A digitizer that converts information from the negative impression of

the patient's residual limb into numerical data that are read by the
computer.
2) A software system that provides a visual image of the patient's
residual limb on a video screen.
3) A carver that reads the modified computer image of the patient's
residual limb and carves a rectified model.
https://opedge.com/Articles/ViewArticle/2013-04-29/2013-05_03 https://centreharika.com/uncategorized/cad-cam-for-prosthetics-and-orthotics/
Digitizer obtaining an accurate and reproducible digital representation of the
amputated limb and transfer this digital image into computer that practitioner
can use to rectify or modify model on the computer

• Scanning the patients with non-contact 3D optical scanner the capture the image
accurately

• The shape then transfer to computer-based design software in which you can apply
anatomical corrections to the scanned shape

• High speed craver automatically fabricate an accurate, lightweight positive model

for forming the prosthetic or orthotic
 Types of 3D Scanners
• Two mainly type: Laser and structured (white) light. Both
provide accurate 3D models of scanned surfaces

• Lasers can emit very small, focused beams, making them precise
and reliable
_ provide excellent depth resolution for measuring detailed
features
• Structured light scanners use a "white light" source (halogen or
LED )to project a blanket-like pattern of pixels that deforms when it
strikes the target surface; the 3D shape is created from
measurements based on the light pattern deformations.
_ Advantage of structured-light 3D scanners is speed.
 Example of software that have been used.
Rodin4D software
• Rodin4D software
Using a finite element model designed with the
Rodin4D software, we get a prediction of what the in-
brace correction would be and can modify and
optimize the brace before it's actually fabricated.

• The Canfit™ computer-aided design (CAD) software

Watch: https://www.youtube.com/watch?v=5-
twUWOFoto&feature=emb_logo

https://www.youtube.com/watch?v=dA-YDs_opl0

https://opedge.com/Articles/ViewArticle/2013-04-29/2013-05_03
Advantage of using CAD-CAM
A faster process without plaster casting and positive model rectification makes the
experience much more comfortable for the patient.

Rectification using computer software rather than manually sculpturing plaster

positive models

References to a standard developed over time from many images (Designs are
easily repeatable)

Quick storage and retrieval of past images

Time saving
Fabrication option
• Off the shelf prefabrication
Less expensive, faster , more consistent quality,, also repair and replacement of
devices is easier
• Custom fabrication:
In some cases either portion of the device or whole device must be custom
made

Think: Local vs center fabrication

Specification for “ideal” prosthesis/orthosis
 Materials
• The partial substitution of traditional prosthetic and orthotic materials, such as
wood, aluminum, and leather by modern materials, such as thermoplastics and
advanced composites, has fostered design innovation and resulted in significant
improvements in function, durability and appearance of modern prostheses and
orthoses.

• Despite the development of new materials, traditional ones are still in wide use.
Metals, wood, leather, fabrics, thermoplastics, thermosetting composites,
foamed plastics, and elastomers are the principle materials commonly used in
current orthopedic industry.

Wong, M. S. & Hassan Beygi, Babak & Zheng, Yu. (2018). Materials for Exoskeletal Orthotic and
Prosthetic Systems. 10.1016/B978-0-12-801238-3.11040-2.
Remember! Important!

Wong, M. S. & Hassan Beygi, Babak & Zheng, Yu. (2018). Materials for Exoskeletal Orthotic and Prosthetic Systems.
10.1016/B978-0-12-801238-3.11040-2.
Characteristic of the materials
• Strength
• Durability
• Density
• Resistance to corrosion
• Easy of fabrication
• Cost and availability
Materials
• Wood
• Leather
• Metals: stainless steel, titanium alloys, aluminium
• Plastics: thermosetting and thermoplastic materials
(polypropelene,polyethylene)
• Rubber
• Fabric
1. Wood: used mainly in lower limb prosthetics application. It is lightweight,
inexpensive and, strong.
• The wooden keel of solid-ankle-cushion-heel (SACH) prosthetic foot is fabricated of maple

2. leather:
• Leather is fabricated from animal skin and hides processed tanning treatment.
• Strength, stretch, formability, and water vapor permeability are the
characteristics of leather which makes it valuable for orthosis and prosthesis
(O&P) .
• Ex.is used for components such as suspension straps, belts, and thigh corset in
conventional hinged lower limb prostheses.
• EX.straps and the upper portion of shoes
3. Metals: Metals are used for manufacturing of prosthetic modular components
such as adaptors, clamps, and joints as well as uprights and joints in orthotic designs.

Stainless steel is a steel alloy that contains nickel and chromium to enhance the
resistance of alloy to corrosion and oxidation.
Adv. Low cost, available, durability, corrosion, fatigue-resistance and high
strength.
Disadvantage, is the weight (heavy)
• Ex. Usually used for pre fabricated devices such as in , band material, springs, cuffs, cable,
and bearings of lower limb orthoses and spring bands for corset construction in metal frame
spinal orthoses
 Aluminum alloyed with copper and manganese is well suited for O&P due to
low weight and high resistance to corrosion
Mainly aluminum alloy a shiny well-finished component.
• Upper limb, pediatric applications where light weight is important
• Ex. prefabricated prosthetic components such as finger assembly in hand prostheses
Disadvantage. Poor resistance to fatigue at high load or repeated loading

Titanium alloys are very strong, lighter in weight than steel, and corrosion
resistant.
• Ex. metal components of exoskeletons are preferably chosen by titanium alloy to
decrease the total weight of device.

• In general, aluminum is used in applications in which the device is subjected to lower stresses.
To reduce the fatigue failure at attachment site, normally the component needs to be designed
from titanium or stainless steel rather than aluminum.
4. Synthetic Polymers
• Polymers are typically classified into three groups: plastics including
thermoplastics and thermosets, polyurethanes (PUR) and elastomers.

• Advantage:
 formability, superior appearance, uniform color
The ease at which they can be casted, molded or extruded.

• Thermoplastics comprise the majority of available polymers.

Cont. Synthetic Polymers
A. Thermoplastic materials get malleable when heated but will retain the
new shape when cooled.
• One advantage of thermoplastic materials is that they can be reheated and reshaped, making
possible minor adjustments of an appliance during fittings.
• This type of material usually used for upper limb orthotic application because have limited
strength and fatigue resistance
• Two groups; low-temperature or high-temperature materials, according to the temperature
range at which they become formable
• High-temperature materials require higher temperatures and must be molded over a positive
plaster replica of the patient’s limb
• high-temperature thermoplastics. Ex. polyolefins (including polyethylene and polypropylene),
acrylic, polycarbonate……………………
• Low-temperature thermoplastics, those moldable in a warm water bath, can be molded
directly onto the body. Ex. Polycaprolactone
• Low-temperature thermoplastics used in short-time spinal, upper extremity and fracture
orthoses
Wong, M. S. & Hassan Beygi, Babak & Zheng, Yu. (2018). Materials for Exoskeletal Orthotic and Prosthetic Systems. 10.1016/B978-0-12-801238-
3.11040-2.
 • Thermoforming: it is a technique in which a heated thermoplastic
sheet of plastic is drawn on a positive mold; the technique is
completed once the plastic sheet is vacuumed and conforms to the
shape of the mold

• To fabricate the components of a device such as prosthetic socket

Wong, M. S. & Hassan Beygi, Babak & Zheng, Yu. (2018). Materials for Exoskeletal Orthotic and Prosthetic Systems. 10.1016/B978-0-12-801238-
3.11040-2. and AFO
B. Thermosetting materials: degrade rather than melt upon heating.
• Thermosetting plastics (Resins) are plastics that are applied over a positive model in liquid form and
then chemically cured to maintain the shape of underlying contour.
• Ex.polyester resin: Forearm segment in above elbow prosthesis is usually a prefabricated
component which is laminated with polyester resin while encompassing the steel side bars of a
mechanical elbow joint.

**Addition of carbon fiber to plastic material increase it’s strength and stiffness

C. Elastomer: comprise a large family of elastic polymers which can snap back to
approximately original size and form once the load is released.
• Because of their properties to absorb and dissipate the loads, many of elastomers are used in shock-
absorbing shoe inserts.
 Silicone _ (remember they are part of polymer)
• Silicone cushioning and elasticity provide excellent wearing comfort
• are used in a socket ( socket liner) for prostheses or in an orthosis
• The wide range of medical-grade silicones with different degree of stiffness possesses a variety of
options to make appliances , such as:
 End bearing/cushioning pads
 Cosmetic finger and partial hand prosthetics
 Cosmetic glove for upper limb prosthesis
 Maxillofacial prostheses
 Foot orthotics
 Socket liners

• Expanding foams (foamed plastics)

• Both thermoplastic and thermosetting resins can be used to produce a rigid, semi-rigid, or flexible foam
structure
• interface to protect the skin from the appliance, to absorb the shock
• can be used in soft socket
• polyethylene (PE) foamsin lower limb prostheses

Wong, M. S. & Hassan Beygi, Babak & Zheng, Yu. (2018). Materials for Exoskeletal Orthotic and Prosthetic Systems. 10.1016/B978-0-12-801238-
3.11040-2.
5. Rubber _ (remember they are part of polymer)
• Rubber has considerable elasticity, shock absorbency, and toughness.
• Synthetic rubber has more resistant to corrosion than natural rubber
• EX.neoprene as lining material for orthoses
• Ex. nylon (polyamide)-covered neoprene acts as a shock absorber while also reducing friction on
the foot’s plantar surface.

6. Fabric
• Wool , cotton, silk,……
• Prosthetic socket in liner
• Belt ,corsets,
Mechanics ________________