Polytechnic of Health Sciences Jakarta I

Ministry of Health of Republic of Indonesia

Department of Prosthetics & Orthotics

Knee Disarticulation Prosthetics

Course Handout 2022
1 KD casting procedure/intake13
 KD Cast Rectification

2 KD casting procedure/intake13
 Contents

• Introduction
• Goals of measurement
• Cast reductions
• Cast build ups
• Summary of rectification

3 KD casting procedure/intake13
 Introduction
• To produce good cast – good socket
• To load pressure on tolerant areas – where?
• To unload pressure on sensitive areas – where?
– Femoral epicondyles
– Adductor tubercle
– Hamstring tendons
– Patella
– Any scar tissue
• Ischial weight bearing required? (before casting)
4 KD casting procedure/intake13
 Rectification

• Transfer the plumb line

• Clean the cast and redraw
the marks
• Check measurements and
decide goal measurements

5 KD casting procedure/intake13
 Goal measurement cont.

• Follow your measurements

• Bigger / Softer / Fatter stump – reduce
more
• Smaller / Firmer/ Leaner stump – reduce less
• Supracondylar diameter – same as
measurement (end bearing)
• Distal bulbous end – avoid pressure on
epicondyles – same as measurement

6 KD casting procedure/intake13
 Cast reductions
Medial proximal wall
o Flatten to be parallel with line
of progression
o Look at direction of patella
and epicondyles (transverse
plane)
o Trim line determination – 2
finger-width lower from
perineal area (about 2.5 to
3cm)
7 KD casting procedure/intake13
Cast reductions
Lateral proximal wall

 Flatten with even pressure

– below greater trochanter

 Trim line
- 2 fingers width lower
than inferior border of
greater trochanter

8 KD casting procedure/intake13
 Cast reductions
Anterior proximal wall
• No need to shape Scarpa's triangle
• More rounded shape
• Trim line – match medial trim and
lateral trim following inguinal fold

9 KD casting procedure/intake13
Cast reductions (cont)
• Posterior proximal wall
– Flatten for comfort
during sitting
– No Ischial shape
– Trim line - gluteal
fold
– Avoid pressure on the
brim

10 KD casting procedure/intake13
Cast reductions (end bearing)
• Supracondylar
area
– M-L diameter -
Same as stump
measurement
– Don’t reduce
epicondyle area

11 KD casting procedure/intake13
Cast build-ups
Trim lines
– Lower than TF
– Medial – 2-finger width
below perineal area
– Anterior - inguinal
fold
– Lateral – 2-finger width
lower than inf border of GT
– Posterior – gluteal fold
Posterior and anterior joining
from medial and lateral
12 KD casting procedure/intake13
Cast build-ups (cont)
Epicondyles
 Avoid pressure
 Bigger build-up for bony
stump
 Above medial and lateral
epicondyles only- end
bearing
 Attention to adductor
tubercle
 Follow the shape

13 KD casting procedure/intake13
Cast build-ups (cont)

Posterior flare of condyles

– small build up
– Hamstring tendons
– Inter-condylar notch

14 KD casting procedure/intake13
Cast build-ups (cont)

Patella
– 3-5 mm build up if present
– Proximally and distally to allow
movement if patella is mobile

15 KD casting procedure/intake13
Finalize the cast
• Recheck measurements
• Smooth the cast by using plastic net
or metal net
• Draw on trimlines and remark
alignment lines

16 KD casting procedure/intake13
 THANK YOU!

Any Questions?

17 KD casting procedure/intake13