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AN IMPROVED PROSTHESIS FOR A SYME AMPUTATION
Rex L. Diveley and Richard H. Kiene
J Bone Joint Surg Am. 1956;38:219-221.
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Publisher Information The Journal of Bone and Joint Surgery
20 Pickering Street, Needham, MA 02492-3157
AX IMPROVED PROSTHESIS FOR A
BY REX L. DIVELEY, M.D., AND RICHARD H. KIENE, M.D., KANSAS CITY, MISSOURI
Front the Dickson-Dii’eley Clinic, Kansas City
A Syme amput.atioms, which is the most conservative below-the-kmiee amputation and
which provides the best functioning stump for w-eight-bearing, has been rarely recom-
mended for women, because the unsightly prosthesis is objectionable.
Some time ago it was necessary to amputate the foot of a female patient, twenty-
two years old. After a conference with the young woman, it was decided that the many
merits of a Syme amputation far outweighed the objection of the unattractive prosthesis,
and an amputation of the Syme type was carried out. A very good stump was obtained,
and it was fitted with the conventional prosthesis. Although the artificial limb
serviceable, it was indeed unsightly amid our patient was unhappy.
very The problem of
finding a more pleasing prosthesis was discussed with our limb maker and, after several
attempts, a very mseat, light, atsd fumictiomial pm’osthesis was comistructed from laminated
plastic material reimiforced with glass cloth. After the first lamination or moldimig, a
window was cut out of the back of the prosthesis sufficiemitly large to allow the stump to
slip completely imito the socket. Following the last laminatiomi, the opemi area was closed
with a leather lacer.
Although the stump had the usual bulbous emid, it was possible to make the bulge
less apparent by the proper build-up of the shims the
of amid by thinning
the plastic material in the region of the malleoli during the lamimiatimig process.
DETAIL OF PREPARATION
A plaster-of-Paris mold of the stump is made extetidimig to the knee aisd closed distally.
From this mold ami exact model of the stump made
is in the usual way with the usual
vented tube incorporated to serve as a hamsdle at the upper etsd. The latidmarks amid the
plumb-line are redrawis oti the model with ati indelible pemscil. Additiomsal plaster cream
is used to accentuate horsy prominemices amid sensitive areas. The model is thems thoroughly
dried at 140 degrees Fahremsheit amid coated with a plastic parting agemit to keep the mold
from adherimig to the model.
Two layers of stockinet are drawmi tightly over the model and carefully stitched
about the distal emid; next, glass cloth is added as reinforcememit in the upper and lower
thirds. Three more layers of stockitset are t.hemi drawn tightly over the model and tied
about the handle.
A polyvinyl alcohol sheet is formed imito a bag over a template its the usual maImer.
The bag is then stretched over the model amsd the proximal end is tied tightly aroummd the
handle. Plastic resimm is poured immto the opemm end of the polyvimsyl alcohol bag amid is
forced imito the layers of stockimiet as the cotie-sha.ped bag is pulled proximally over the
model. The forcing of the resims imito the stockimiet is facilitated by massaging the bag
toward its proximal emsd. All wrimmkles are pressed out amsd all air is forced out of the
stockinet. Mixed styretie polyester resins are used its the proportioms of omw-half rigid amid
The polyvimmyl alcohol bag is themi tied tightly over the distal emid of the mold, and
curing is effected at 130 to 140 degrees Fahrenheit for about thirty minutes. After the
resin has jelled, the final cure is effected at 250 degrees Fahrenheit for approximately
The top of the mold is trimmed and the plaster model is removed while the mold is
von. 38-A, NO. 1, JANUARY 1956 219
Fig. 1 Photograph
. of the
front V1(”V of the plastic Synse
ljrosthi(’sis vithsout a shoe.
Fig. 2. This VI(’W illustrates
tls(’ leather lacer amid the (‘avit.v
requir(’d to a(s’onsnl(I(lat(’ t hi’
Fig. 3. The sizs of the leather
lacs’r msi:t’ lIe 55(15 ims this side
1”ig. 4. \\‘hiems the prosthesis
is \‘oIIs1)\’ the pati(’nt, it ma’
be seen Isow su(’c(’ssful has been
the attempt to make the pros-
thsesis follov the (‘otstour of the
Fig. 5. The al)llearanc(’ of
this prosthi(’sis whets the l)atiemit
is fitlly dressed. This prosthesis
has beers fulls’ accepted by the
patient, ami(l its her opitsions it
Is much simperior to any of the
conventiomsal t\’p(’s of prosthesis
stillwarm. This mold is the trial socket. It vill be attached to a foot port.ioms and after
adjustmemsts vilI serve as a mold for the fitsal complete prosthesis.
A foot of time propel’ size is selected, givitsg comssideratiomi to the heel height. A set-up
for lemsgth atsd aligmmmemst is made i)y settitig the tm’ial socket. oti the foot amid temporarily
secimrimsg it with steel bamids from the foot to time suits by small screws. The i)ack side of
tise socket is cut out sufficietitly to allow the stump to inserted.
i)e The t.m’ial socket is
mso\\- fitted to time stump arid a(ijustnlemsts ate made that
so it is comfortable durimmg
standitsg, valkimmg, amid sitting. \Vhems the socket vitlm its attacised foot is emitim’ely comfort-
ai)le, time screws are replaced vitli m’ivets amid the imtsit is ready final the Iamimmatiomm.
The foot. is trimmed umstil it is umidersize, amid the outer surfaces of time foot amid
socket am’e roughened with a fitie rasp or sandpaper. To ol)taims the most pleasitig cosmetic
effect possible, the spaces from foot. to shims are filled with a compatible resimm amid filler.
It is cured amid samided. rfhe socket is tmov coated inside with a plastic parting agent and
THE JOURNAL OF BONE AND JOINT SURGERY
IMPROVED PROSTHESIS FOR A SYME AMPUTATION 221
a secotid model of plaster-of-Paris is poured into it, a vented tube having i)eets installed
aisd all opemmimigs havimig beets sealed.
For the second lamination, two layers of stockinet of appropriate size are pulled o’ct’
time toe portion, up over the bands on the shimm, and stretched tightly but not tied. Glass
cloth reinforcement is wrapped about the wood of the foot and over the top of the cots-
miectimig bands. Three additional layers of stockinet are pulled into place so that the
first layer extemids from the toes to imsches
two above the glass cloth which imieludes the
top of the hands. It is stretched tightly; the seconsd atsd third layers are stretched from
the toes to the top of the socket amid tied around the vetmted tube with limmen thread.
The same techtiique amid the same resins are used in this lamination as in the first one,
except that the resin mixture should be 70 per cent rigid and 30 per cent flexible styremme
polyester resins. The mold is oven-cured, amid the top and back openimigs are trimmed to
the original size while warm. All cut edges are smoothed and sealed so that moisture can-
not penetrate the cotton fiber. Excess plasticized stockinet is cut from the foot which is
sammdpapered, the edges being feathered so that no ridges remain.
A leather lacer is attached over the back opening. The foot is covered in the usual
mammner and the prosthesis is ready for final fitting and use.
With this prosthesis it is possible to overcome the major objection to a Syme amputa-
tiomm imm womemm patients and to offer them the mammy advammtages of the weight-bearing,
below--the-kmiee amputation of the Syme type.
1. STAFF OF ARTIFICIAL LIMBS PROJECT, Department of Engineering, University of California. Manual of
Upper Extremity Prosthetics. Edited by R. Deane Aylesworth. Los
Angeles, University of California,
VOL. 38-A, NO. 1, JANUARY 1956