Effects of sitting postures on risks for deep tissue injury in the residuum of a transtibial prosthetic-user: A biomechanical case study

S. Portnoy, I. Siev-Ner, N. Shabshin, A. Gefen

Research output: Contribution to journalArticlepeer-review

Abstract

Transtibial amputation prosthetic-users are at risk of developing deep tissue injury (DTI) while donning their prosthesis for prolonged periods; however, no study addresses the mechanical loading of the residuum during sitting with a prosthesis. We combined MRI-based 3D finite element modelling of a residuum with an injury threshold and a muscle damage law to study risks for DTI in one sitting subject in two postures: 30°-knee-flexion vs. 90°-knee-flexion. We recorded skin-socket pressures, used as model boundary conditions. During the 90°-knee-flexion simulations, major internal muscle injuries were predicted (>1000mm3). In contrast, the 30°-knee-flexion simulations only produced minor injury (<14mm3). Predicted injury rates at 90°-knee-flexion were over one order of magnitude higher than those at 30°-knee-flexion. We concluded that in this particular subject, prolonged 90°-knee-flexion sitting theoretically endangers muscle viability in the residuum. By expanding the studies to large subject groups, this research approach can support development of guidelines for DTI prevention in prosthetic-users.

Original languageEnglish
Pages (from-to)1009-1019
Number of pages11
JournalComputer Methods in Biomechanics and Biomedical Engineering
Volume14
Issue number11
DOIs
StatePublished - 2011

Keywords

  • Amputation rehabilitation
  • Below-knee prosthesis
  • Patient-specific finite element model
  • Pressure ulcer
  • Tissue injury threshold

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