Abstract

Introduction

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Prosthetic suspension systems play a crucial role in the functionality and comfort of prosthetic limbs for patients with lower and upper extremity limb loss. Various suspension options are available, each with unique advantages and limitations. For lower extremity prosthetics, common methods include suction, pin-lock, and vacuum suspension, which offer varying degrees of security and comfort. For instance, a study found that vacuum-assisted suspension systems significantly reduce vertical displacement (axial pistoning) compared to passive suction systems. Upper extremity prosthetics often utilize harness systems, self-suspending designs, and magnetic attachments to achieve optimal fit and function. Research indicates that self-suspending designs can improve the range of motion and rotational stability.

Recent advancements in 3D printing technology are revolutionizing prosthetic design and manufacturing, offering highly customizable and cost-effective solutions. However, these innovations must be approached with caution. The materials used in 3D printing may not always match the durability and long-term performance of traditional prosthetics. Additionally, the rapid production capabilities of 3D printing require rigorous testing and quality control to ensure safety and effectiveness. Understanding the differences between these suspension options is essential for clinicians to tailor prosthetic solutions to individual patient needs, enhancing mobility and quality of life. This abstract aims to explore the diverse suspension systems available, highlighting their benefits, challenges, and suitability for different types of limb loss, with special considerations for those with quad-involved limb loss.

Mots Clés

3D printing, prosthetic suspension, quad-limb amputee, myoelectric prosthesis, knee disarticulation, rapid prototyping

Corps du résumé / Matériels et méthodes

The patient is a 45-year-old male with quad limb amputations, including bilateral trans-radial amputations, a knee disarticulation, and a transtibial amputation secondary to a sepsis infection. The patient requires prosthetic solutions that cater to both upper and lower extremity needs, ensuring functionality, comfort, and ease of use. 3D printing techniques were utilized to ensure optimal fit while allowing the prosthetist to increase their range of options for best success.

Myoelectric Upper Extremity Devices: For the bilateral trans-radial amputations, myoelectric prosthetic arms were manufactured. These arms utilize electromyographic signals from the residual limb muscles to control the prosthetic hand's movements. The manufacturing process included electrodes strategically placed on the residual limb to capture muscle signals. Custom sockets were designed using 3D scanning and printing technology to ensure a precise fit. The sockets were made from lightweight, durable materials to enhance comfort and reduce fatigue. Myoelectric components, including sensors, batteries, and motors, were integrated into the prosthetic arms. The design ensured that the components were securely housed within the socket, allowing for smooth and responsive movements. For activities such as walking, specialized prosthetic arms were designed to provide stability and support.

Knee Disarticulation and Transtibial Prostheses: For the knee disarticulation and transtibial amputations, prosthetic legs were fabricated using advanced suspension methods. The process involved: Custom sockets were created using 3D printing technology. The sockets were designed to provide a snug fit, reducing the risk of skin irritation and enhancing comfort, various suspension methods were employed to ensure ease of giving and doffing, as well as stability during use.

The use of 3D printing technology in the manufacture of prosthetic components offered several advantages including customization, efficiency, and cost-effectiveness. 3D printing allowed for precise customization of prosthetic sockets and components, ensuring a perfect fit for the patient. The technology enabled rapid production of prosthetic parts, reducing the time required for manufacturing due to the patient undergoing significant weight loss from GLP-1 medications. 3D printing reduced the cost of prosthetic manufacturing by minimizing material waste and labor costs, especially considering the size of the patient. To ensure that the prosthetics were easy to donate and doff independently, the following strategies were employed: Lever mechanisms were integrated into the suspension systems, allowing the patient to easily attach and detach the prosthetics, adjustable components were used to accommodate changes in limb volume and ensure a secure fit, and design elements with user-friendly features, such as easy-to-reach buttons and ergonomic shapes, to facilitate independent use.

Résultats

The implementation of 3D printing technology significantly expedited the fitting process for the patient. Compared to his previous fitting process, which took approximately six weeks total, the new process was completed in just two-three weeks. This reduction in time was primarily due to the efficiency and precision of 3D printing, which allowed for rapid prototyping and customization of prosthetic components. The ability to quickly produce and adjust the prosthetic sockets ensured that the patient could begin using his new prosthetics much sooner, enhancing his overall rehabilitation experience. The use of various drop-in style suspension methods contributed to the faster fitting process. These suspension methods were compatible with 3D printing technology, enabling the production of precise and reliable components that could be easily integrated into the prosthetic design.

The patient reported experiencing significantly less pain with the new prosthetic sockets compared to his previous ones. This improvement was attributed to the advanced locking mechanisms used in the new designs, which effectively eliminated pistoning within the socket. The reduction in pistoning minimizes skin irritation and pressure points, leading to greater comfort during use. Additionally, the new locking mechanisms were designed to accommodate the patient's significant weight loss due to his new medications. The adjustable components and secure fit ensured that the prosthetics remained comfortable and functional despite changes in the patient's residual limb volume. The combination of reduced pain and improved comfort contributed to the patient's overall satisfaction with the new prosthetic solutions.

Discussion

This fitting technique highlights the significant benefits of combining advanced suspension strategies with 3D printing technology for a patient with complex quad limb amputations. By customizing both upper and lower extremity prosthetics using 3D scanning and printing, clinicians were able to create sockets that enhanced comfort, reduced pistoning, and accommodated ongoing physiological changes, such as weight loss. The use of drop-in style and adjustable suspension mechanisms further improved giving and doffing ease, which is particularly crucial for a patient with limited dexterity and mobility. Moreover, integrating user-friendly features like ergonomic shapes and lever systems enabled greater independence. These results highlight the clinical potential of 3D printing to improve fit, reduce fabrication time, and increase patient satisfaction in high-complexity prosthetic cases.

Conclusion

3D printing, when combined with carefully selected suspension methods, can offer transformative improvements in comfort, functionality, and efficiency for individuals with multi-limb amputations. The patient's enhanced mobility, reduced pain, and quicker rehabilitation timeline highlight the importance of embracing innovative technologies to meet evolving patient needs. As 3D printing materials and methods continue to advance, this approach may become a standard for addressing complex prosthetic challenges.

Bibliographie / Références

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4. Jagyasi, DP, & Team. (2020). 3D printed prosthetics: The pros and cons. Dr Prem .
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