Elbow Units for below elbow amputee

• Flexible Hinge:
1. Flexible hinges of metal or leather are commercially available.
2. Attached proximally to the triceps pad and distally to the prosthetic
forearm.
3. These hinges permit the transmission of approximately
50% of the residual forearm rotation to the terminal device.

Rigid Hinge:
1)Single-Axis Hinges.-
•Single-axis hinges are designed to provide axial (rotational) stability between the prosthetic socket and residual forearm
during active prosthetic use.
• Correctly aligned single-axis hinges should not restrict the normal flexion-extension range of motion of the anatomic
elbow joint.
•Single-axis hinges are available in both adult and child sizes.
2) Polycentric Hinges:
• Polycentric hinges help to increase elbow flexion by reducing
the tendency for bunching of the soft tissues.
• Polycentric hinges are available in adult, medium, and child sizes.

3) Step-up Hinges:
• In those situations in which a full range of elbow flexion is essential, step-up hinges may be employed.
• The use of step-up hinges requires that the prosthetic forearm and socket be separated.
• Consequently, protheses employing step-up hinges are frequently referred to as split-socket prostheses.
4) Stump Activated Locking Hinge:
• Amputees with very high transradial levels of amputation are often unable
to operate a conventional transradial prosthesis for the following reasons:
1. Inadequate strength of the elbow flexors
2. Inadequate range of elbow flexion
• It is used for very high below elbow level of amputation to control
below elbow prosthesis.

Elbow Units for above elbow amputee:

• Outside-Locking Hinges
1. Outside-locking hinges are available in standard and heavy-duty models.
2. The standard units provide seven different locking positions throughout the range of flexion and come in adult,
medium, and child sizes.
3. The heavy-duty model provides five locking positions and comes in the adult size only.
• Inside-Locking Elbow Units
1. Amputations through the humerus approximately 5 cm (2 in.) proximal to the elbow joint provide adequate space to
accommodate inside-locking elbow mechanisms.
2. Inside-locking units permit the amputee to lock the elbow in any of 11 positions of flexion .
3. In addition, inside-locking units incorporate a friction-held turntable.
4. The turntable permits manual preposi-tioning of the prosthetic forearm as a substitute
for external and internal rotation of the humerus.
 SPLIT SOCKET

• It is more desirable if we provide separate forearm for the socket which

encases the stump.
• To the forearm, wrist unit and terminal device is attached and there is
mechanical coupling between them.
• This provides large range of motion of forearm in relation to stump.
• If stump motion is 65 degree then the forearm and terminal device will be
driven through flexion range of 130 degree, but the disadvantage is that the
force required from the stump is twice.
• If the stump is weak, then flexion of forearm is produced by harness and cable
control system.
• Socket should be flattened anterio-posteriorly.
• It should cover olecron and epicondyles and include V-shaped releif for
biceps tendon.
• The flattening and firm fit in the area of elbow provide effective stump-socket
stability.
Above Elbow Prosthesis
 LOWER EXTREMITY PROSTHESIS

• Total contact principle:

• For above knee amputee, socket is with quadrilateral shape and gluteal ischial bearing and support is
taken at lateral aspect of limb.
• For below knee amputee, socket uses patellar tendon bearing and medial tibial flare for support.
• Edema is observed in the amputee using socket without total contact, it is due to limitation in limb
circulation by tight proximal fittings.
• Due to total contact, pressure is distributed over the distal part of the limb.
• This relatively uniform low magnitude pressure stabilizes distal tissue, balance the hydrostatic pressure in
the limb and prevent edema.
• Advantages:
1) Greater comfort
2) Better gait results.
3) Reduced constriction
4) Reduced false joint action
5) Improved control and sensitivity.