Transradial and Wrist Disarticulation Socket Considerations: Case Studies

Preliminary characterization of rectification for transradial prosthetic sockets

Achieving proper socket fit is crucial for the effective use of a prosthesis. However, digital socket design lacks standardization and presents a steep learning curve for prosthetists. While research has focused on digital socket design for the lower-limb population, there is a research gap in upper-limb socket design. This study aimed to characterize the design (rectification) process for the transradial socket, specifically the three-quarter Northwestern-style design, towards the development of a more systematic, data-driven socket design approach. Fourteen (n = 14) pairs of unrectified and rectified plaster models were compared. Six common rectification zones were identified through shape analysis, with zones of plaster addition being the most prominent in terms of volume and surface area. A novel 3D vector mapping technique was employed, which revealed that most of the shape changes occurred in the anterior-posterior and proximal-distal directions. Overall, the interquartile range of each rectification zone demonstrated reasonable consistency in terms of volume, surface deviation, and 3D vector representation. The initial findings from this study support the potential for quantitively modelling the transradial socket design process. This opens the door for developing tools for categorizing and predicting socket designs across diverse populations through the application of techniques such as machine learning.

Transradial Amputation With Pedicled Pronator Quadratus Interposition and Advanced Neuroma-Prevention Techniques

Transradial amputation is a reconstructive option for upper-extremity trauma, infection, malignancy, and ischemia. The possible postoperative complications include residual radioulnar impingement and the development of a painful neuroma. In this report, a pedicled pronator quadratus flap interposition between the distal radius and ulna has been described. Additionally, various techniques to mitigate the development of symptomatic neuromas have been described.

Upper Extremity Amputation and Prosthetics Care Across the Active Duty Military and Veteran Populations

The hand and arm are exceptionally dexterous, exquisitely sensitive, and proficient in performing tasks and functions. Given the invaluable functions of the upper extremity in daily life, replacement of a missing limb through prosthetic substitution is challenging. Prosthetic and rehabilitation needs of injured Service members from recent military conflicts have brought upper extremity amputation to the forefront, which has led to an increase in attention and resource allocation. This article provides an overview of the care of the upper extremity amputee including surgical considerations, prosthetic design and fitting, and preprosthetic and post-prosthetic rehabilitation considerations.

Initial Clinical Evaluation of the Modular Prosthetic Limb

The Modular Prosthetic Limb (MPL) was examined for its feasibility and usability as an advanced, dexterous upper extremity prosthesis with surface electromyography (sEMG) control in with two individuals with below-elbow amputations. Compared to currently marketed prostheses, the MPL has a greater number of sequential and simultaneous degrees of motion, as well as wrist modularity, haptic feedback, and individual digit control. The MPL was successfully fit to a 33-year-old with a trans-radial amputation (TR01) and a 30-year-old with a wrist disarticulation amputation (TR02). To preserve anatomical limb length, we adjusted the powered degrees of freedom of wrist motion between users. Motor training began with practicing sEMG and pattern recognition control within the virtual integration environment (VIE). Prosthetic training sessions then allowed participants to complete a variety of activities of daily living with the MPL. Training and Motion Control Accuracy scores quantified their ability to consistently train and execute unique muscle-to-motion contraction patterns. Each user also completed one prosthetic functional metric—the Southampton Hand Assessment Procedure (SHAP) for TR01 and the Jebsen-Taylor Hand Function Test (JHFT) for TR02. Haptic feedback capabilities were integrated for TR01. TR01 achieved 95% accuracy at 84% of his VIE sessions. He demonstrated improved scores over a year of prosthetic training sessions, ultimately achieving simultaneous control of 13 of the 17 (76%) attempted motions. His performance on the SHAP improved from baseline to final assessment with an increase in number of tasks achieved. TR01 also used vibrotactile sensors to successfully discriminate between hard and soft objects being grasped by the MPL hand. TR02 demonstrated 95% accuracy at 79% of his VIE sessions. He demonstrated improved scores over months of prosthetic training sessions, however there was a significant drop in scores initially following a mid-study pause in testing. He ultimately achieved simultaneous control of all 13 attempted powered motions, and both attempted passive motions. He completed 5 of the 7 (71%) JHFT tasks within the testing time limit. These case studies confirm that it is possible to use non-invasive motor control to increase functional outcomes with individuals with below-elbow amputation and will help to guide future myoelectric prosthetic studies.

Biomechanical design considerations for transradial prosthetic interface: A review

Traditional function and comfort assessment of transradial prostheses pay scant attention to prosthetic interface. With better understanding of the biomechanics of prosthetic interface comes better efficiency and safety for interface design; in this way, amputees are more likely to accept prosthetic usage. This review attempts to provide design and selection criteria of transradial interface for prosthetists and clinicians. Various transradial socket types in the literature were chronologically reviewed. Biomechanical discussion of transradial prosthetic interface design from an engineering point of view was also done. Suspension control, range of motion, stability, as well as comfort and safety of socket designs have been considered in varying degrees in the literature. The human-machine interface design should change from traditional "socket design" to new "interface design." From anatomy and physiology to biomechanics of the transradial residual limb, the force and motion transfer, together with comfort and safety, are the two main aspects in prosthetic interface design. Load distribution and transmission should mainly rely on achieving additional skeletal control through targeted soft tissue relief. Biomechanics of the residual limb soft tissues should be studied to find the relationship between mechanical properties and the comfort and safety of soft tissues.