Experience with a Corset Suspension for Above-Knee Amputees
Edward T. Haslam, M.D. *
Edward G. Scott, Jr., M.D. *
In the course of conducting a prosthetic clinic we encountered a female above-knee amputee, who was wearing a wooden prosthesis about fifteen years old which had been fabricatd by Mr. Henry Louiciani of the McDermott Surgical Instrument Company. Ltd., which no longer provides prosthetic service. The prosthesis was in poor repair hut was interesting in that it was suspended by means of rawhide strips attached to a short corset extending from just below the umbilicus to a point midway between the iliac crest and the greater trochanters and passing through outside rollers attached to the socket both medially and laterally. The patient stated that she had always worn this type of suspension and had no complaints relative to it.
At this time we had another patient who was encountering difficulties due to breakdown of a scar in the lower abdomen due to previous vascular surgery from pressure of his pelvic belt, as well as one who, because of weight and stump size changes, was not happy with her suction socket prosthesis. We therefore decided to try a suspension of this type modified to the extent that the rawhide strips were replaced with those made of dacron or elastic shock cord.
With the cooperation of Mr. Tom Maples. C.P., and Mr. Leo Marcotte, C.P., of the J.E. Hanger of Louisiana. Inc., and their orthotists, six. patients were fitted with this method of suspension. We have generally limited the application of this method to patients with adequate hips and without protruding abdomens ranee we felt that this type of patient would be more suitable (Fig. 1 ). It is possible, however, that with modifications this device could be applied to the group we have considered as being unsuitable.
It was found that dacron straps (Fig. 2A-C ) were satisfactory but that 3/16 inch elastic shock cord seemed to provide slightly more secure suspension. Attempts to sew the shock cord to the dacron straps were unsatisfactory (Fig. 3 ), but by clamping the shock cord to itself with a split metal ferrule a loop could be formed which could then be attached to a leather or dacron strap. (Fig. 4 & Fig. 4B).
The problems we have encountered have been mainly with fabricating a corset which is rigid enough to withstand the downward pull on one side and which is flexible and comfortable. The tendency for the corset to pull down on the prosthetic side could probably be counteracted by attaching the opposite side to garters attached to long stockings, but this has not been acceptable to our patients. Several different sizes of elastic cord have been tried, and although it is possible that some individuals would do better with a different one, it now seems as if the 3/16" "hard" cord No. 1784 (Russell Mfg Co., Middletown, Conn.) is the best initial selection. Recent literature from this company does not list this but suggests to us that their 3/16" shock absorber cord, X867, which has less elongation than their X1736 exerciser cord would be suitable.
Some of the rollers have shown a tendency to cut the covering on the cord, and more study is needed as to the best type of roller. Many problems seem to occur if the rollers do not rotate freely.
The advantages have been many. The corset does not produce a bulge in the person's clothing as does a hip joint and the female patients can wear more closely contoured dresses. There has been less piston action evident with a resulting feeling of greater security on the part of the patient. The previous shoulder harness wearer showed an improvement in gait since he no longer had to elevate his shoulder. The previous suction wearer was pleased with the ability to easily apply and remove the prosthesis and with the ability to compensate for changes in weight and stump size by means of varying the number of socks worn.
A similar device was also used on a bilateral BK who, because of short stumps and obesity, was having difficulties with excessive piston action not solved by other measures. Her figure was not ideal for this method and the results were not as good as in those with favorable physique.
It will be noted in these illustrations that some of the patients had leather or dacron guide straps whereas others either did not have these or did not use them. It is believed by our prosthetists that by placing the lateral outside roller about 1/4" ahead of the knee bolt and the medial outside roller a similar distance behind the knee bolt that the tendency of the prosthesis to rotate internally is corrected.
Various factors have prevented significant comparison of the amputee's reaction to this device compared to other suspension systems, or long term follow up on the majority of our patients. However, one case who is being seen periodically for another reason has used this appliance for over two years and does not wish to attempt to return to her previous suction suspension. One previous hip control wearer requested return to his previous suspension. The original patient fitted by Mr. Louiciani was refitted elsewhere with a hip control belt but subsequently resumed her previous device.
It is recognized that the "favorable" cases are more easily fitted with other types of suspension, and we do not recommend this suspension when suction or hip control belt appear to be a good prescription.
It is our belief that this device has a place in the armamentarium and deserves further study both as to details of construction and criteria for prescription. In the mean time we are continuing to use it on selected cases.