Sirindhorn School of Prosthetics & Orthotics
Faculty of Medicine Siriraj Hospital, Mahidol University
Transfemoral Socket Variation 2
SIPO 341 / 342
Transfemoral Prosthetics
4th July, 2011
Thanyaporn ( Poy )
Objectives
• At the end of this session, the students are
able to explain…
– The Ischial Containment Socket (ICS) design
– The Marlo Anatomocal Socket (M.A.S.) design
Assignment & Group Discussion
• The problems and solutions
• The medial lateral dimension & anterior
posterior dimension
• The walls of IC socket
• The main objectives of IC socket
Contents
• Development of ischial containment socket
(ICS) design
• The principle of ischial containment socket
(ICS) design
• The Marlo Anatomocal Socket (M.A.S.) design
The Development of ICS Design
Was initiated by an American by
the Narrow ML Socket technology
of IVAN LONG
A further stage of development
was the CAT-CAM Technology of
SABOLICH, FINNIESTON and other
Today, this socket design is
generally known as “Ischial
containment” or “IC socket”
Introduction to IC Socket
A
The term “ischial containment”
is self descriptive ,referring to
the socket design in which the M-L
M L
ischium and ischial ramus are
A-P
enclosed within the socket
P
** IRC = Ischial Ramal Containment
Principles of the IC socket
Medial view Posterior view
Principles of the IC socket
Unlike the quadrilateral socket design,
with the greatest width of the proximal
socket in the ML direction, the greatest
width of the IC socket is in AP direction
M-L M-L
A-P
A-P
Principles of the IC socket
Cross section at ischial tuberosity level
Principles of the IC socket
The anterior proximal brim conforms better
to the stump and exerts less pressure on
Scarpa’s triangle
This reduces the muscle displacement and
also the restriction of the blood circulation
in the stump
Anterior Medial Transition A.S.I.S. Counter-
force to
Skeletal
ML
Adductor Portion
Medial Wall
Inferior
Containment
wall
Ischium
Medial Medial
Containment wall Hamstring
Wall
Posterior Channel
Posterior Posterior
Containment Lateral
wall Transition
Biomechanical issues in a
quadrilateral socket during gait
Most above knee amputees walks with a wide
base and lurch to the amputated side.
(Long. I. A, Normal shape-normal alignment (NSNA) above-knee prosthesis, Clin.
[Link]. 9, 1985, P9~14)
Biomechanical issues in a
quadrilateral socket during gait
91% of quadrilateral
socket users have femoral
abduction inside the
socket.
(Long. I. A, Normal shape-normal alignment (NSNA) above-knee prosthesis, Clin.
[Link]. 9, 1985, P9~14)
Biomechanical issues in a
quadrilateral socket during gait
Principles of the IC socket
The solution that has emerged, and that was
clearly apparent to Long, is to extend the
medial brim upward so that pressure is
brought to bear against the ramus.
(Pritham C. H., Biomechanics and Shape of the Above-Knee Socket in Light of the
Ischial Containment Concept, [Link]. International. 14, 1990, P9~21)
Principles of the IC socket
The resulting force couple between the ischium,
trochanter and laterodistal aspect of the femur is
believed to provide much more stable mechanism
for acceptance of perineal biomechanical forces
QL socket IC socket
Principles of the IC socket
Pritham described six objectives that would
be achieved in the ideal ischial containment
socket:
1. Maintenance of normal femoral adduction
and narrow-based gait during ambulation
Principles of the IC socket
2. Enclosure of the ischial tuberosity and
ramus in the socket to varying extents
medially and posteriorly
forces involved in maintenance of
mediolateral stability are borne by the
bones of the pelvis medially
“ Bony Lock”
Principles of the IC socket
3. Maximum effort made to distribute forces
along the shaft of the femur
Principles of the IC socket
4. Decreased emphasis on a narrow AP
diameter between the adductor longus-
Scarpa’s triangle and ischium for the
maintenance of ischial-gluteal weight
bearing
5. Total contact
6. Use of suction suspension whenever
possible
Principles of the IC socket
The proximal contours of an IC socket are
affected by differences in pelvic skeletal
anatomy
– in particular, the variations of the
position of the ischium with respect to
trochanter
Principles of the IC socket
Variations of the proximal design of IC socket are
based on pelvic structure and soft tissue diameter
just distal to the pelvis
Variations are individual and significant between
male and female
Principles of the IC socket
Generally in an adult the bony ML width is between
11.5 and 13.5
>> if the measurement significantly exceeds or falls
below this limits, it should be checked and controlled
again !!
Principle of IC socket
Rotational control
is provided by the proximal medial brim and
its bony lock against the ischium , the shape
and channels of the anterior wall and the
post-trochanteric contour of the lateral wall
IC socket
The IC socket is clearly preferable…the benefit to
the amputee is increased comfort and an
easier and cosmetically improved gait
Advanced Socket Design
The Marlo Anatomical Socket Design (M.A.S.),
developed by Marlo Ortiz
The Marlo Anatomical Socket
(M.A.S.)
Because the MAS socket technology is designed to
contain the ischial tuberosity and the ischial ramus,
comfort, stability and gait are improved. Weight is
distributed evenly over the soft tissue of the residual
The Marlo Anatomical Socket
(M.A.S.)
• Improve functional gait
• Better suspension
• Enhanced cosmesis
• Donning and doffing
• Unrestricted range of motion
References
• Douglas, Tranfemoral Amputation: Prosthetic
management, Atlas of Amputations and Limb
Deficiencies ,2004
• Fitzlaff, Lower Limb Prosthetic Components,
Design, Function and Biomechanical
Properties,2002