The APOPPS™ & APOPPS-TF™ by FLO-TECH ® O&P Systems, Inc. Robert N. Brown, Sr., CPO, FAAOP...

The The APOPPSAPOPPS™ & ™ & APOPPS-TFAPOPPS-TF™ ™ by by FLO-TECHFLO-TECH®® O&P Systems, Inc. O&P Systems, Inc.

Robert N. Brown, Sr., CPO, FAAOPRobert N. Brown, Sr., CPO, FAAOP

CEO/Research, Design & EducationCEO/Research, Design & Education

Robert N. Brown, Sr., CPO, FAAOPRobert N. Brown, Sr., CPO, FAAOP

CEO/Research, Design & EducationCEO/Research, Design & Education

®

Applications in Applications in ObesityObesity

•SetupSetup

•Selection of Components & Selection of Components & MaterialsMaterials

•Trouble shootingTrouble shooting

APOPPSAPOPPSTMTM Adjustable PostOperative, Protective & Adjustable PostOperative, Protective & Preparatory System for prosthetic rehabilitation Preparatory System for prosthetic rehabilitation

• TRANSTIBIAL SYSTEM:TRANSTIBIAL SYSTEM:– The FLO-TECH-TOR™The FLO-TECH-TOR™

•Protective socket or an early Protective socket or an early (supervised) ambulatory socket(supervised) ambulatory socket

– The VCSPS™The VCSPS™• Protective, PSRD or Preparatory socketProtective, PSRD or Preparatory socket

– The UFOS™The UFOS™• Universal Frame Outer SocketUniversal Frame Outer Socket

• Ambulatory outer socket for both the Ambulatory outer socket for both the FLO-TECH-TOR™ and the VCSPS™FLO-TECH-TOR™ and the VCSPS™

APOPPS-APOPPS-TMTM

•TRANSFEMORAL SYSTEM:TRANSFEMORAL SYSTEM:– The INNER SOCKETThe INNER SOCKET

•FLO-TECH-TOR-TF™ (Protective), FLO-TECH-TOR-TF™ (Protective), early (supervised) ambulatory or early (supervised) ambulatory or preparatory socketpreparatory socket

– The OUTER SOCKETThe OUTER SOCKET•UFOS-TF™ (Universal Frame Outer UFOS-TF™ (Universal Frame Outer

Socket)Socket)

•Ambulatory outer socketAmbulatory outer socket

APOPPSAPOPPSTMTM & APOPPS-TF™ & APOPPS-TF™ Specifics for Obese PatientsSpecifics for Obese Patients

•Systems In Stock:Systems In Stock:– TranstibialTranstibial

•Adult 7” & 9” length Adult 7” & 9” length

– TransfemoralTransfemoral•Adult 12” lengthAdult 12” length

APOPPS™ & APOPPS-TF™APOPPS™ & APOPPS-TF™ Sizing Sizing

• The largest TT socket in stock:The largest TT socket in stock:– MPT circumference of 19” to 20”MPT circumference of 19” to 20”– Distal circumference of 16” to 22”Distal circumference of 16” to 22”

• The largest TF socket in stock:The largest TF socket in stock:– Ischial circumference of 30”Ischial circumference of 30”– Distal circumference of 22” to 28”Distal circumference of 22” to 28”

• Longer or larger requires custom systemLonger or larger requires custom system

CUSTOM ORDERSCUSTOM ORDERS

• 131 custom sockets 131 custom sockets provided provided

in 2003in 2003– An average of nearly 3 An average of nearly 3

custom sockets custom sockets per week per week

– Allow 3 lab daysAllow 3 lab days– Average shipping time Average shipping time

1.05 days 1.05 days •If ordered before 12 noonIf ordered before 12 noon APOPS-KD™ (Knee Disarticulation)APOPS-KD™ (Knee Disarticulation)

Stock BB-d™ Pre-custom Stock BB-d™ Pre-custom DefinitiveDefinitive

• Available in Available in Transtibial & Transtibial & Transfemoral systemsTransfemoral systems– StockStock– Custom sizesCustom sizes

Stock BB-d™ Stock BB-d™ Pre-custom DefinitivePre-custom Definitive• Adjusts Adjusts

circumferentially at all circumferentially at all levelslevels

• AP adjustability at all AP adjustability at all levelslevels

• ML conforms to patient ML conforms to patient at all levelsat all levels

• 5 stock sizes5 stock sizes

• 2” carved distal end pad2” carved distal end pad• Custom systems availableCustom systems available

BB-d™ ORDERSBB-d™ ORDERS•Available in:Available in:

– 5 Transtibial & 3 Transfemoral 5 Transtibial & 3 Transfemoral Stock sizes in left & right Stock sizes in left & right configurationsconfigurations

– Custom sizesCustom sizes– Custom strength Custom strength

• Based on weight & activity levelBased on weight & activity level– Non-ambulatory (polypropylene inner socket & Non-ambulatory (polypropylene inner socket &

Polyethylene outer socket)Polyethylene outer socket)– Up to 500 lbs. (Acrylic resin, carbon & Kevlar Up to 500 lbs. (Acrylic resin, carbon & Kevlar

inner socket & co-polypropylene outer socket)inner socket & co-polypropylene outer socket)

CUSTOM ORDERS CUSTOM ORDERS PROVIDEDPROVIDED

• Adult Transtibial sockets & Adult Transtibial sockets & systemssystems

• Adult Transfemoral Adult Transfemoral sockets & systemssockets & systems

• Adult Knee Disarticulation Adult Knee Disarticulation sockets & systemssockets & systems

• Adult Symes sockets & Adult Symes sockets & systemssystems

CUSTOM ORDERS AVAILABLECUSTOM ORDERS AVAILABLE

• Toddler, children & youth Toddler, children & youth Transtibial & Transfemoral Transtibial & Transfemoral

• Toddler, children, youth & Toddler, children, youth & Knee Disarticulation & SymesKnee Disarticulation & Symes

• Not your every day shapes, Not your every day shapes, sizes and systems for adult, sizes and systems for adult, youth, children or toddlersyouth, children or toddlers

CUSTOM ORDERS PROVIDEDCUSTOM ORDERS PROVIDED

•Odd shapesOdd shapes– Extremely long Extremely long FLO-TECH-TOR ------FLO-TECH-TOR ------

•MPT to distal end = 23 ½” MPT to distal end = 23 ½” – plus 1 ½” shrinkage & paddingplus 1 ½” shrinkage & padding– plus thigh length and trim allowance of 12”plus thigh length and trim allowance of 12”

Total one piece forming 37”Total one piece forming 37”

– Extremely large TF = 45” Ischial Extremely large TF = 45” Ischial circumferencecircumference

Applying the Socket Attachment PlateApplying the Socket Attachment Plate

•Bottom portion of Bottom portion of UFOS™ MUST be flat UFOS™ MUST be flat – If not; LIGHTLY sand If not; LIGHTLY sand

with a disc sander to with a disc sander to remove any remove any protruding plasticprotruding plastic•AT POINT(S) OF AT POINT(S) OF CONTACT ONLYCONTACT ONLY

Other UFOS Trim PermittedOther UFOS Trim Permitted

• Suspension wings (A) on the Suspension wings (A) on the proximal medial & lateral proximal medial & lateral sidessides

• Proximal posterior (B); if Proximal posterior (B); if necessarynecessary

• NEVER remove material from NEVER remove material from the distal sides (C)the distal sides (C)

The Socket Attachment PlateThe Socket Attachment Plate

•The holes in the socket are The holes in the socket are oversized intentionally and line up oversized intentionally and line up with the holes in the Grace plate & with the holes in the Grace plate & the socket attachment platethe socket attachment plate– If not; carefully drill or cut away If not; carefully drill or cut away

any interfering material & any interfering material & smooth as neededsmooth as needed

Why Over Sized?Why Over Sized?

• To pTo provide & permitrovide & permit– Rotation – 7Rotation – 7

oo

to 10 to 10oo

– A & P slide – 1/4”A & P slide – 1/4”– M & L slide – 1/4”M & L slide – 1/4”

COMPONENTS & OBESITY COMPONENTS & OBESITY

• Rating of a complete system is Rating of a complete system is determined by the lowest rated determined by the lowest rated componentcomponent

• The lower the activity level the higher The lower the activity level the higher most components are ratedmost components are rated– Pylon components rated at 300 lbs with a Pylon components rated at 300 lbs with a

socket unable to support 300 lbs. plus & an socket unable to support 300 lbs. plus & an activity level exceeding these limitations activity level exceeding these limitations negates intended ratingnegates intended rating

EXAMPLE:EXAMPLE:

• Foresee – Weight & Activity Foresee – Weight & Activity Levels for Pyramid Systems & Levels for Pyramid Systems & Delta AnkleDelta Ankle– Low activity = 250 lbsLow activity = 250 lbs– Moderate activity = 220 lbs.Moderate activity = 220 lbs.– High activity = 185 lbs.High activity = 185 lbs.

COMPONENTSCOMPONENTS

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

COMPONENTS Rated to 300 Lbs.COMPONENTS Rated to 300 Lbs.• HosmerHosmer

•The W.A.L.K. (Weight Activated Locking The W.A.L.K. (Weight Activated Locking Knee) & S.A.F.K (Single Axis Friction Knee) Knee) & S.A.F.K (Single Axis Friction Knee) units, Titanium #60794 & #60821units, Titanium #60794 & #60821

•The S.A.L.K. (Single Axis Locking Knee) The S.A.L.K. (Single Axis Locking Knee) unit #60471unit #60471

•All Titanium & Stainless Steel pylon and All Titanium & Stainless Steel pylon and attachment components in the series attachment components in the series #60000 #60000

COMPONENTS Rated To 300 Lbs.COMPONENTS Rated To 300 Lbs.

• USMCUSMC•Some Titanium & Stainless Steel pylon Some Titanium & Stainless Steel pylon

and attachment components in the # and attachment components in the # 15000 series 15000 series

– Designated by AK and BK respectively Designated by AK and BK respectively

•The Stainless Steel Knee unit #15226 The Stainless Steel Knee unit #15226 and the Black Max Knee #P24000 seriesand the Black Max Knee #P24000 series

COMPONENTS Rated To 300 Lbs.COMPONENTS Rated To 300 Lbs.

• Ohio Willow Wood Ohio Willow Wood – Magnum Heavy Duty SystemMagnum Heavy Duty System

•Functional level 4 = 300 lbs.Functional level 4 = 300 lbs.

COMPONENTS Rated to 350 Lbs.COMPONENTS Rated to 350 Lbs.

• USMCUSMC•Machined Titanium pylon and Machined Titanium pylon and

attachment components in the # 16000 attachment components in the # 16000 series series

•The Black Max Short Knee & The The Black Max Short Knee & The ProSportProSport®® Titanium Knee in the # Titanium Knee in the # 37000 series 37000 series


• Ohio Willow Wood Ohio Willow Wood – Magnum Heavy Duty SystemMagnum Heavy Duty System

•Functional level 1-3 = 350 lbs.Functional level 1-3 = 350 lbs.


• IPOS-BauerfeindIPOS-Bauerfeind– X-tra SeriesX-tra Series

COMPONENTS Rated to 500 Lbs.COMPONENTS Rated to 500 Lbs.• TiMED TiMED (Titanium Specialists in Prosthetics)(Titanium Specialists in Prosthetics)

– BK-500 (does not include foot)BK-500 (does not include foot)•GH-610 EX.HD EAR CONNECTORGH-610 EX.HD EAR CONNECTOR•EH-503 TUBE CLAMP 34 mm (requires 2)EH-503 TUBE CLAMP 34 mm (requires 2)•A-500 34 mm CARBON TUBEA-500 34 mm CARBON TUBE•EH-509 EXTRA HD SACH FOOT INSERTEH-509 EXTRA HD SACH FOOT INSERT

USEUSE

– HEAVY DUTY SACH FOOT HEAVY DUTY SACH FOOT – By KingsleyBy Kingsley

APOPPS™ Follow Up APOPPS™ Follow Up ConcernsConcerns• Sockets have specific warrantiesSockets have specific warranties

– Workmanship and initial qualityWorkmanship and initial quality– Thereafter:Thereafter:

•FLO-TECH-TOR™ 30 daysFLO-TECH-TOR™ 30 days

•VCSPS™ 90 daysVCSPS™ 90 days

•UFOS™ 90 daysUFOS™ 90 days

•FLO-TECH-TOR-TF™ 90 daysFLO-TECH-TOR-TF™ 90 days

•UFOS-TF™ 90 daysUFOS-TF™ 90 days

Follow Up ConcernsFollow Up Concerns

• Hook and Pile Velcro® on the belts Hook and Pile Velcro® on the belts are slippingare slipping

• SOLUTIONS:SOLUTIONS:– Set belt to patients specifications & stitch Set belt to patients specifications & stitch

all areas in place all areas in place •You can remove and discard the double sided You can remove and discard the double sided

hook Velcro®hook Velcro®


• Patient seems unstable and one or Patient seems unstable and one or more sockets demonstrate an more sockets demonstrate an unwanted medial-lateral motionunwanted medial-lateral motion

• SOLUTIONS:SOLUTIONS:– Practitioner may fine tune alignmentPractitioner may fine tune alignment

•The toe out and the socket placement over the The toe out and the socket placement over the foot MUST be optimal to minimize unwanted foot MUST be optimal to minimize unwanted motionmotion

Solutions ContinuedSolutions Continued

• ALIGNMENT SOLUTIONS:ALIGNMENT SOLUTIONS:– Use equally rated offset Use equally rated offset

components if necessarycomponents if necessary– Maintain alignment whenever Maintain alignment whenever

removing or disassembling removing or disassembling componentscomponents

– Use pre-custom definitive BB-d if Use pre-custom definitive BB-d if necessarynecessary


• Swelling is causing skin to protrude Swelling is causing skin to protrude through the slots on either side of the FLO-through the slots on either side of the FLO-TECH-TORTECH-TOR

• SOLUTIONS:SOLUTIONS:– Elevate the limb as often as is practicalElevate the limb as often as is practical– Be sure the proper size is usedBe sure the proper size is used– Apply a compressive sock, Ace wrap or liner to Apply a compressive sock, Ace wrap or liner to

the residuum before socket applicationthe residuum before socket application

SOLUTIONS Continued:SOLUTIONS Continued:

• Add a thin polyethylene tongue to Add a thin polyethylene tongue to the affected areathe affected area– Attach the tongue to medial and or Attach the tongue to medial and or

lateral areas of the posterior section lateral areas of the posterior section onlyonly

Follow Up ConcernsFollow Up Concerns• Socket or system is difficult to donSocket or system is difficult to don

• SOLUTIONS:SOLUTIONS:– Apply inner socket & tighten straps and Apply inner socket & tighten straps and

BandsBands– Apply a donning sleeve (nylon or parachute Apply a donning sleeve (nylon or parachute

material) over the FLO-TECH-TOR, FLO-material) over the FLO-TECH-TOR, FLO-TECH-TOR-TF or VCSPS (straps, neoprene TECH-TOR-TF or VCSPS (straps, neoprene and all) ANDand all) AND

– Open UFOS™ straps before attempting to Open UFOS™ straps before attempting to insert the inner socketinsert the inner socket


• Socket or system is showing signs of Socket or system is showing signs of stress stress

• SOLUTIONS:SOLUTIONS:– If FLO-TECH-TOR beyond warranty and If FLO-TECH-TOR beyond warranty and

patient will move to a new socket soon patient will move to a new socket soon have patient avoid unsupported have patient avoid unsupported ambulation until the new socket is readyambulation until the new socket is ready

– If within warranty call for a Return If within warranty call for a Return Authorization number and replacement Authorization number and replacement socketsocket


• Sockets are rotating one inside the otherSockets are rotating one inside the other

• SOLUTIONS:SOLUTIONS:– Be sure sockets are sized appropriatelyBe sure sockets are sized appropriately– Distal sockets are of tri-quad shape to Distal sockets are of tri-quad shape to

prevent rotationprevent rotation– Call for assistance and possible return of Call for assistance and possible return of

socket or systemsocket or system


• Patient is slipping up and down inside Patient is slipping up and down inside the socket upon heel contact and toe offthe socket upon heel contact and toe off

• SOLUTIONS:SOLUTIONS:– Most of this motion is designed into the Most of this motion is designed into the

FLO-TECH-TOR to prevent separation of FLO-TECH-TOR to prevent separation of incision upon early weight bearing andincision upon early weight bearing and

SOLUTIONS Continued:SOLUTIONS Continued:

– Be sure socks are sized appropriatelyBe sure socks are sized appropriately– Be sure all straps and bands are tightened Be sure all straps and bands are tightened

before the UFOS™ is appliedbefore the UFOS™ is applied– Be sure the waist belt is secured properlyBe sure the waist belt is secured properly– Application of the Prep Socket (VCSPS™) Application of the Prep Socket (VCSPS™)

with other forms of suspension and distal with other forms of suspension and distal AP closure should eliminate this concern AP closure should eliminate this concern “WHEN THE TIME IS RIGHT”“WHEN THE TIME IS RIGHT”

COMMITMENTCOMMITMENT

• FLO-TECHFLO-TECH®® O&P Systems is here to assist O&P Systems is here to assist you in any way we can; please call. Our you in any way we can; please call. Our staff can help with most: fitting, follow-up staff can help with most: fitting, follow-up or adjustment issues.or adjustment issues.

• Our Mission is:Our Mission is:

To make the benefits of APOPPS™ technology To make the benefits of APOPPS™ technology

available to all amputees.available to all amputees.

COMMENTARYCOMMENTARY

• Each APOPPS™ or BB-d™ prosthesis has Each APOPPS™ or BB-d™ prosthesis has

the best opportunity for maximum the best opportunity for maximum

comfort and success if the selection of comfort and success if the selection of

components conforms to the patients components conforms to the patients

needs and these components are set up, needs and these components are set up,

aligned and maintained in the most aligned and maintained in the most

effective manner.effective manner.

Questions Questions

OrOr

Shared ExperiencesShared Experiences

The APOPPS™ & APOPPS-TF™ by FLO-TECH ® O&P Systems, Inc. Robert N. Brown, Sr., CPO, FAAOP...

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