The APOPPS™ by FLO-TECH® O&P Systems, Inc

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(No Transcript)
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The APOPPS APOPPS-TF by FLO-TECH OP
Systems, Inc.

• Robert N. Brown, Sr., CPO, FAAOP
• CEO/Research, Design Education

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Applications in Obesity

• Setup
• Selection of Components Materials
• Trouble shooting

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APOPPSTM Adjustable PostOperative, Protective
Preparatory System for prosthetic rehabilitation

• TRANSTIBIAL SYSTEM
• The FLO-TECH-TOR
• Protective socket or an early (supervised)
  ambulatory socket
• The VCSPS
• Protective, PSRD or Preparatory socket
• The UFOS
• Universal Frame Outer Socket
• Ambulatory outer socket for both the
  FLO-TECH-TOR and the VCSPS

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APOPPS-TM

• TRANSFEMORAL SYSTEM
• The INNER SOCKET
• FLO-TECH-TOR-TF (Protective), early (supervised)
  ambulatory or preparatory socket
• The OUTER SOCKET
• UFOS-TF (Universal Frame Outer Socket)
• Ambulatory outer socket

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APOPPSTM APOPPS-TF Specifics for Obese Patients

• Systems In Stock
• Transtibial
• Adult 7 9 length
• Transfemoral
• Adult 12 length

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APOPPS APOPPS-TF Sizing

• The largest TT socket in stock
• MPT circumference of 19 to 20
• Distal circumference of 16 to 22
• The largest TF socket in stock
• Ischial circumference of 30
• Distal circumference of 22 to 28
• Longer or larger requires custom system

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CUSTOM ORDERS

• 131 custom sockets
  provided
• in 2003
• An average of nearly
  3 custom
  sockets per week
• Allow 3 lab days
• Average shipping time
  1.05 days
• If ordered before 12 noon
• 
  
  APOPS-KD (Knee Disarticulation)
• 
  

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Stock BB-d Pre-custom Definitive

• Available in Transtibial Transfemoral systems
• Stock
• Custom sizes

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Stock BB-d Pre-custom
Definitive

• Adjusts circumferentially at all levels
• AP adjustability at all levels
• ML conforms to patient at all levels
• 5 stock sizes
• 2 carved distal end pad
• Custom systems available

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BB-d ORDERS

• Available in
• 5 Transtibial 3 Transfemoral Stock sizes in
  left right configurations
• Custom sizes
• Custom strength
• Based on weight activity level
• Non-ambulatory (polypropylene inner socket
  Polyethylene outer socket)
• Up to 500 lbs. (Acrylic resin, carbon Kevlar
  inner socket co-polypropylene outer socket)

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CUSTOM ORDERS PROVIDED

• Adult Transtibial sockets systems
• Adult Transfemoral sockets systems
• Adult Knee Disarticulation sockets systems
• Adult Symes sockets systems

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CUSTOM ORDERS AVAILABLE

• Toddler, children youth Transtibial
  Transfemoral
• Toddler, children, youth Knee Disarticulation
  Symes
• Not your every day shapes, sizes and systems for
  adult, youth, children or toddlers

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CUSTOM ORDERS PROVIDED

• Odd shapes
• Extremely long FLO-TECH-TOR ------?
• MPT to distal end 23 ½
• plus 1 ½ shrinkage padding
• plus thigh length and trim allowance of 12
• Total one piece forming 37
• Extremely large TF 45 Ischial circumference

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Applying the Socket Attachment Plate

• Bottom portion of UFOS MUST be flat
• If not LIGHTLY sand with a disc sander to remove
  any protruding plastic
• AT POINT(S) OF CONTACT ONLY

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Other UFOS Trim Permitted

• Suspension wings (A) on the proximal medial
  lateral sides
• Proximal posterior (B) if necessary
• NEVER remove material from the distal sides (C)

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The Socket Attachment Plate

• The holes in the socket are oversized
  intentionally and line up with the holes in the
  Grace plate the socket attachment plate
• If not carefully drill or cut away any
  interfering material smooth as needed

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Why Over Sized?

• To provide permit
• Rotation 7o to 10o
• A P slide 1/4
• M L slide 1/4

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COMPONENTS OBESITY

• Rating of a complete system is determined by the
  lowest rated component
• The lower the activity level the higher most
  components are rated
• Pylon components rated at 300 lbs with a socket
  unable to support 300 lbs. plus an activity
  level exceeding these limitations negates
  intended rating

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EXAMPLE

• Foresee Weight Activity Levels for Pyramid
  Systems Delta Ankle
• Low activity 250 lbs
• Moderate activity 220 lbs.
• High activity 185 lbs.

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COMPONENTS

• Multiple manufacturers offer choices of pylon,
  attachment components knee units for patients
  who weigh 275 lbs or less.

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COMPONENTS Rated to 300 Lbs.

• Hosmer
• The W.A.L.K. (Weight Activated Locking Knee)
  S.A.F.K (Single Axis Friction Knee) units,
  Titanium 60794 60821
• The S.A.L.K. (Single Axis Locking Knee) unit
  60471
• All Titanium Stainless Steel pylon and
  attachment components in the series 60000

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COMPONENTS Rated To 300 Lbs.

• USMC
• Some Titanium Stainless Steel pylon and
  attachment components in the 15000 series
• Designated by AK and BK respectively
• The Stainless Steel Knee unit 15226 and the
  Black Max Knee P24000 series

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COMPONENTS Rated To 300 Lbs.

• Ohio Willow Wood
• Magnum Heavy Duty System
• Functional level 4 300 lbs.

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COMPONENTS Rated to 350 Lbs.

• USMC
• Machined Titanium pylon and attachment components
  in the 16000 series
• The Black Max Short Knee The ProSport Titanium
  Knee in the 37000 series

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COMPONENTS Rated to 350 Lbs.

• Ohio Willow Wood
• Magnum Heavy Duty System
• Functional level 1-3 350 lbs.

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COMPONENTS Rated to 450 Lbs.

• IPOS-Bauerfeind
• X-tra Series

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COMPONENTS Rated to 500 Lbs.

• TiMED (Titanium Specialists in Prosthetics)
• BK-500 (does not include foot)
• GH-610 EX.HD EAR CONNECTOR
• EH-503 TUBE CLAMP 34 mm (requires 2)
• A-500 34 mm CARBON TUBE
• EH-509 EXTRA HD SACH FOOT INSERT
• USE
• HEAVY DUTY SACH FOOT
• By Kingsley

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APOPPS Follow Up Concerns

• Sockets have specific warranties
• Workmanship and initial quality
• Thereafter
• FLO-TECH-TOR 30 days
• VCSPS 90 days
• UFOS 90 days
• FLO-TECH-TOR-TF 90 days
• UFOS-TF 90 days

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Follow Up Concerns

• Hook and Pile Velcro on the belts are slipping
• SOLUTIONS
• Set belt to patients specifications stitch all
  areas in place
• You can remove and discard the double sided hook
  Velcro

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Follow Up Concerns

• Patient seems unstable and one or more sockets
  demonstrate an unwanted medial-lateral motion
• SOLUTIONS
• Practitioner may fine tune alignment
• The toe out and the socket placement over the
  foot MUST be optimal to minimize unwanted motion

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Solutions Continued

• ALIGNMENT SOLUTIONS
• Use equally rated offset components if necessary
• Maintain alignment whenever removing or
  disassembling components
• Use pre-custom definitive BB-d if necessary

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Follow Up Concerns

• Swelling is causing skin to protrude through the
  slots on either side of the FLO-TECH-TOR
• SOLUTIONS
• Elevate the limb as often as is practical
• Be sure the proper size is used
• Apply a compressive sock, Ace wrap or liner to
  the residuum before socket application

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SOLUTIONS Continued

• Add a thin polyethylene tongue to the affected
  area
• Attach the tongue to medial and or lateral areas
  of the posterior section only

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Follow Up Concerns

• Socket or system is difficult to don
• SOLUTIONS
• Apply inner socket tighten straps and Bands
• Apply a donning sleeve (nylon or parachute
  material) over the FLO-TECH-TOR, FLO-TECH-TOR-TF
  or VCSPS (straps, neoprene and all) AND
• Open UFOS straps before attempting to insert the
  inner socket

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Follow Up Concerns

• Socket or system is showing signs of stress
• SOLUTIONS
• If FLO-TECH-TOR beyond warranty and patient will
  move to a new socket soon have patient avoid
  unsupported ambulation until the new socket is
  ready
• If within warranty call for a Return
  Authorization number and replacement socket

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Follow Up Concerns

• Sockets are rotating one inside the other
• SOLUTIONS
• Be sure sockets are sized appropriately
• Distal sockets are of tri-quad shape to prevent
  rotation
• Call for assistance and possible return of socket
  or system

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Follow Up Concerns

• Patient is slipping up and down inside the socket
  upon heel contact and toe off
• SOLUTIONS
• Most of this motion is designed into the
  FLO-TECH-TOR to prevent separation of incision
  upon early weight bearing and

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SOLUTIONS Continued

• Be sure socks are sized appropriately
• Be sure all straps and bands are tightened before
  the UFOS is applied
• Be sure the waist belt is secured properly
• Application of the Prep Socket (VCSPS) with
  other forms of suspension and distal AP closure
  should eliminate this concern WHEN THE TIME IS
  RIGHT

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COMMITMENT

• FLO-TECH OP Systems is here to assist you in
  any way we can please call. Our staff can help
  with most fitting, follow-up or adjustment
  issues.
• Our Mission is
• To make the benefits of APOPPS technology
  available to all amputees.

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COMMENTARY

• Each APOPPS or BB-d prosthesis has the best
  opportunity for maximum comfort and success if
  the selection of components conforms to the
  patients needs and these components are set up,
  aligned and maintained in the most effective
  manner.

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Questions

• Or
• Shared Experiences