Physical Rehabilitation Programme

trans-radial Prosthesis
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Manufacturing guidelines
MISSION
The International Committee of the Red Cross (ICRC) is an impartial, neutral and
independent organization whose exclusively humanitarian mission is to protect the
lives and dignity of victims of war and internal violence and to provide them with
assistance. It directs and coordinates the international relief activities conducted
by the Movement in situations of confict. It also endeavours to prevent suffering
by promoting and strengthening humanitarian law and universal humanitarian
principles. Established in 1863, the ICRC is at the origin of the International Red
Cross and Red Crescent Movement.
Acknowledgements:
Jean François Gallay
Leo Gasser
Pierre Gauthier
Frank Joumier
Jacques Lepetit
Bernard Matagne
Joel Nininger
Guy Nury
Peter Poestma
Hmayak Tarakhchyan

and all prosthetists-orthotists who have worked in ICRC-assisted physical rehabilitation centres.
International Committee of the Red Cross
19 Avenue de la Paix
1202 Geneva, Switzerland
T + 41 22 734 60 01 F + 41 22 733 20 57
E-mail: icrc.gva@icrc.org
www.icrc.org
© ICRC, September 2006
All photographs: ICRC/PRP
1 Manuf actur i ng Gui del i nes Trans-Radi al Prosthesi s
Table of contents
Foreword 2
Introduction 4
1.Castingandrectifcation 4
2.Positioningthewrist 5
3.Polypropylenedrapingoffrstsocket 7
4.Productionofsecondsocket 9
5.Positioningofcablehousing 9
6.Polypropylenedrapingofsecondsocket 10
7.Fixationofcablehousing 12
8.Cablecontrolsystem(harness) 14
9.Fitting 17
Listofcomponents,CREquipmentsSA(CRE) 19
Listofothermanufacturingmaterials 20
Manuf actur i ng Gui del i nes Trans-Radi al Prosthesi s
2 I CRC Physi cal Rehabi l i tati on Programme
Foreword
The ICRC polypropylene technology
Sinceitsinceptionin1979,theICRC’sPhysicalRehabilitationProgrammehaspromotedtheuse
oftechnologythatisappropriatetothespecifccontextsinwhichtheorganizationoperates,
i.e.,countriesafectedbywarandlow-incomeordevelopingcountries.
Tetechnologymustalsobetailoredtomeettheneedsofthephysicallydisabledinthecountries
concerned.
Tetechnologyadoptedmustthereforebe:
• durable,comfortable,easyforpatientstouseandmaintain;
• easyfortechnicianstolearn,useandrepair;
• standardizedbutcompatiblewiththeclimateindiferentregionsoftheworld;
• low-costbutmodernandconsistentwithinternationallyacceptedstandards;
• easilyavailable.
Techoiceoftechnologyisofgreatimportanceforpromotingsustainablephysicalrehabilitation
services.
Forallthesereasons,theICRCpreferredtodevelopitsowntechniqueinsteadofbuyingready-made
orthopaediccomponents,whicharegenerallytooexpensiveandunsuitedtothecontextsinwhich
theorganizationworks.TecostofthematerialsusedinICRCprostheticandorthoticdevices
islowerthanthatofthematerialsusedinappliancesassembledfromcommercialready-made
components.
WhentheICRClauncheditsphysicalrehabilitationprogrammesbackin1979,locallyavailable
materialssuchaswood,leatherandmetalwereused,andorthopaediccomponentswere
manufacturedlocally.Intheearly1990stheICRCstartedtheprocessofstandardizingthe
techniquesusedinitsvariousprojectsaroundtheworld,forthesakeofharmonizationbetweenthe
projects,butmoreimportantlytoimprovethequalityofservicestopatients.
Polypropylene(PP)wasintroducedintoICRCprojectsin1988forthemanufactureofprosthetic
sockets.Tefrstpolypropyleneknee-jointwasproducedinCambodiain1991;othercomponents
suchasvariousalignmentsystemswerefrstdevelopedinColombiaandgraduallyimproved.In
parallel,adurablefoot,madeinitiallyofpolypropyleneandEthylVinylAcetate(EVA),andnowof
polypropyleneandpolyurethane,replacedthetraditionalwooden/rubberfoot.
In1998,afercarefulconsideration,itwasdecidedtoscaledownlocalcomponentproductionin
ordertofocusonpatientcareandtrainingofpersonnelatcountrylevel.
3 Manuf actur i ng Gui del i nes Trans-Radi al Prosthesi s
Objective of the manuals
TeICRC’s“ManufacturingGuidelines”aredesignedtoprovidetheinformationnecessaryfor
productionofhigh-qualityassistivedevices.
Temainaimsoftheseinformativemanualsareasfollows:
• TopromoteandenhancestandardizationofICRCpolypropylenetechnology;
• Toprovidesupportfortrainingintheuseofthistechnology;
• Topromotegoodpractice.
Tisisanotherstepforwardintheeforttoensurethatpatientshaveaccesstohigh-qualityservices.
ICRC
AssistanceDivision/HealthUnit
PhysicalRehabilitationProgramme
4 I CRC Physi cal Rehabi l i tati on Programme
Introduction
Teaimofthisdocumentistodescribeamethodforproducingtrans-radial prostheses with
interchangeable sockets,workingwiththeICRCpolypropylenetechnologyandorthopaedic
componentsusedattheRegionalPhysicalRehabilitationCentreinBattambang,Cambodia.
Tecasting,rectifcationandalignmentmethodsusedcorrespondtointernationalprostheticand
orthotic(P&O)standardsofpracticeandarethereforenotdescribedintheseICRCmanufacturing
guidelines.
CasTIng and ReCTIFICaTIOn 1
4Patientassessment,castingand
rectifcationofpositivecastimpressions
areperformedinaccordancewithP&O
standards.
4Alignmentlinesantero-posteriorand
medio-lateral(A-P,M-L)aredrawnonthe
positivemouldforproperpositioningof
thewrist.Inmostcasesthiswillbealong
thecentralaxisofthetrans-radialstump.
Drivenailsintothedistalendofthecastto
ensuregoodadherenceforthebuild-upof
theplasterextension.
5 Manuf actur i ng Gui del i nes Trans-Radi al Prosthesi s
POsITIOnIng The wRIsT 2
4Makeaconicalextensiontube
usingEVA,plasticsheetingor
someothersuitablematerial
andplaceitaccordingto
thealignmentlinesforwrist
positioning.Tapetheconein
place.
Filltheextensionconewith
plasterupto5mmhigherthan
thelevelofthewrist,soasto
leaveroomforshapingthe
correctanglesofthewrist.
4Prolongtheproximal
alignmentlinesalongthe
plasterextensioninorderto
facilitatepositioningofthe
polypropylenewrist.
6 I CRC Physi cal Rehabi l i tati on Programme
4Smoothandshapethebuild-up
sothatitisperfectlyconical,
otherwiseitwillbedifcultto
exchangethesocketsinthis
technique.
4Temeasurementfromthe
olecranontotheradialstyloid
processofthesoundsidewill
determinethelengthofthe
prosthesistothedistalendofthe
wristunit.
Telengthoftheprosthesismay
be1to2cmshorterthanthe
soundside,butneverlonger.
7
2
1
3
Manuf actur i ng Gui del i nes Trans-Radi al Prosthesi s
POlyPROPylene dRaPIng OF FIRsT sOCkeT 3
4Measurementofpolypropylene
sheet:
1Wristcircumference+2cm
2Epicondylecircumference+4cm
3Lengthofplastercast+15cm
Tickness3or4mm,dependingon
patient.
4Beforedrapingthepolypropylene
sheet,pullastockingoverthe
plastermould.Cutitatthe
proximalpartofthewristand
fxitwithcontactglue.Dustthe
stockingwithtalcumpowder.
4Heatthepolypropyleneinan
ovenforabout20minutesat
180°C.
Drapethepolypropyleneover
theplastermodelandstickthe
sidestogetheralongtheposterior
side.Tightenthepolypropylene
aroundthesuctionconeor
tubeusingabicycleinnertube,
ropeorstocking,thenopenthe
vacuumvalve.
8 I CRC Physi cal Rehabi l i tati on Programme
4Usingscissorsoraknife,cutof
thelefoverpolypropyleneofthe
weldingseamwhileitisstillhot.
Keepthevacuumonuntilthe
plastichascooleddown.
4Removetheplaster,shapethe
sockettrimlinesandgrindthe
posteriorweldingseam.
Drillahole(dia.20mm)onthe
medial/distalsideforpullingthe
stumpsocket.
Flattenthepolypropyleneonthe
distalendofthewrist.
Checkthesocketontheamputee
forcomfort,suspensionand
length.
9 Manuf actur i ng Gui del i nes Trans-Radi al Prosthesi s
POsITIOnIng OF Cable hOusIng 5
4Drawalinefromtheproximaltothe
distalpartonthemid-anteriorofthe
socket.Te line must stop at least
5 cm from the wrist.Tisindicates
thepositionforthecablehousing
dummy.
4Takeabicyclebrakecablewith
housing,cutitinaccordancewith
thelengthofthelineandfxiton
thestockingwithcontactglue.
PROduCTIOn OF seCOnd sOCkeT 4
6Aferthefrstftting,fllthesocketwithplasteragainandprepareitfordrapingthesecondsocket.
Pull4cottonstockinettubesand1nylonstocking(toobtainasmoothsurface)overthefrstsocket.

10 I CRC Physi cal Rehabi l i tati on Programme
POlyPROPylene dRaPIng OF seCOnd sOCkeT 6
4Heatastripofpolypropylene
andshapeittothesocket,
1cmabovetheplannedtrim
linesofthe2ndsockettoavoid
faringatthetrimmededges
ofthissocket.Tiswillalso
protectthe1stsocketwhenthe
secondoneisbeingcut.

4Drapea3mmpolypropylene
sheetoverthesocket,using
thesamemeasurementsand
drapingtechniqueasforthe
1stsocket.
Whenthepolypropyleneis
cool,cutitonthestripwith
anoscillatingsaworhacksaw.

4Removethe2nd
polypropylenesocketandthe
plasterinsidethe1stsocket.

11 Manuf actur i ng Gui del i nes Trans-Radi al Prosthesi s
6Tetrimlinesofthe2ndsocketshouldbeapproximately3cmdistaltothetrimlinesofthe
anteriorsideofthe1stsocket,andshould“dip”6cmintheposteriortocreate“ears/wings”onthe
medialandlateralsides.
Tiswillpreservesomefexibilityforthe1stsocketandpreventrotationofthe2ndsocket.
Trimofthedistalendbythewrist,leavingitfushwiththelengthofthe1stsocket.
12 I CRC Physi cal Rehabi l i tati on Programme
FIxaTIOn OF Cable hOusIng 7
4Removethecablehousingdummywith
longfatnosepliersoranawl.

4Cutanddrillopeningsintheendsofthe
channelcreatedbythecablehousing.

13 Manuf actur i ng Gui del i nes Trans-Radi al Prosthesi s
4Insertthedefnitivecablehousingandpushitinsidethe
channelwitharivetingbar.

4Tecablehousingshouldextendatleast2cmoutside
thedistalchannelopeningtoprotectthecablewirefrom
bendingandbreaking,andtoallowenoughroomforthe
cabletoopenthehookfully.

14 I CRC Physi cal Rehabi l i tati on Programme
4Temostsimpletypeofharnessfor
operatingthehookisthe“fgureof
eight”suspension.
Stapleorclampanylonbelt(30mm
wide)onthewebbinghanger.
Cable COnTROl sysTem (haRness) 8
4Insertthebicyclebrakecableintothe
housing.Ontheproximalpart,fxa
polypropylenewebbinghangerwitha
screwclamp.Onthedistalpart,make
aloopwiththecableandsecure
itwithasmallmetaltube(clamp
sleeve),whichisfattened(pressed)
aroundthecable.

15 Manuf actur i ng Gui del i nes Trans-Radi al Prosthesi s
4Foldthenylonbeltaroundtheopposite
shoulder.
Teconnectionshouldbeadjustedin
themiddleoftheback(spine).
4Stapleorclamptheharnesstogether.
Whencuttingthebelt,leaveitalittle
longersothatitcanbereadjusted.
Checkwiththeamputeethatthecable
controlsystemfunctionsproperlyin
diferentarmpositions.
Toopenthehook,thepatientmoveshis
shoulderonthesoundside(opposite
sidefordoubleamputees)orthe
prosthesisforward.
6Oncetheharnesshasbeenadjustedsothatamputeefeelscomfortablewithit,sewthebelt
connectionandthefxationontothewebbinghanger.
16 I CRC Physi cal Rehabi l i tati on Programme
4Topreventfraying,meltthefbres
attheendofthebeltwithawelding
iron.
4Finishedprosthesiswith
interchangeablesocket.
17 Manuf actur i ng Gui del i nes Trans-Radi al Prosthesi s
FITTIng 9
4Tefrstsocketcanbeusedwitha
cosmetichand,aworkingringor
othertoolsnotrequiringthecable
controlsystem.

4Checkwiththeamputeethatthe
secondsocketslideseasilyoverthe
frst.

18 I CRC Physi cal Rehabi l i tati on Programme
4Teachthepatienthowtousethe
interchangeabletrans-radialsockets
andhowtoconnectandusethe
harnessandthecable-operatedhook.
19 Manuf actur i ng Gui del i nes Trans-Radi al Prosthesi s
ICRC Code Description
Unit of
measure
Quantity
OCPOWRISKIA
OCPOWRISLIA
OCPOWRISERA
PP wrist unit, adult, with M10 T-nut (dia. 45 mm) and 4 pan head Phillips framing
screws, 8 x 3 mm
* Wrist units are available in 3 diferent colours. Choose ICRC code according to colour **
** Beige colour
** Olive colour
** Terra colour
Each 1
OCPOHOOKAL
OCPOHOOKAR
KORTHOOKSP
Hook, adult, left, stainless steel, M10 thread
According to side of amputation
Hook, adult, right, stainless steel, M10 thread
According to side of amputation
Spare parts for hook:
Rubber washer, D30x d10x H6 mm
Stainless steel spring
Each
Each
Each
Each
1
1
10
10
OCPOHOOKKRT * Working round ring tool, stainless steel with rubber washer
* On request by amputee
Each 1
OCPOHANDERML
OCPOHANDERMR
OCPOHANDERWL
OCPOHANDERWR
Terra colour:
Hand, man, left, terra colour
Hand, man, right, terra colour
Hand, woman/child, left, terra colour
Hand woman/child, right, terra colour
Each
Each
Each
Each
1
1
1
1
OCPOHANDKIML
OCPOHANDKIMR
OCPOHANDKIWL
OCPOHANDKIWR
Beige colour:
Hand, man, left, beige colour
Hand, man, right, beige colour
Hand, woman/child, left, beige colour
Hand, woman/child, right, beige colour
Each
Each
Each
Each
1
1
1
1
OCPOHANDLIML
OCPOHANDLIMR
OCPOHANDLIWL
OCPOHANDLIWR
Olive colour:
Hand, man, left, olive colour
Hand, man, right, olive colour
Hand, woman/child, left, olive colour
Hand, woman/child, right, olive colour
Each
Each
Each
Each
1
1
1
1
list of components, CR equipments sa (CRe)
20 I CRC Physi cal Rehabi l i tati on Programme I CRC Physi cal Rehabi l i tati on Programme
ICRC Code Description
Unit of
measure
Quantity
For frst TR socket:
MDREBANDP10
MDREBANDP12
Plaster bandages 10 cm
or
Plaster bandages 12 cm
Each According to stump dimension
OMIS Plaster of Paris According to cast dimension
OMIS Nails Each 2
OPLAEVAFERA03
OPLAEVAFKIN03
OPLAEVAFLIV03
EVA 3 mm, plastic sheet or other for extension tube Each 1, dimensions according to extension
length
OMIS Tubular nylon stocking, 60 or 80 mm for PP draping Each 1, length according to prosthesis
OPLAPOLYCHOC03
OPLAPOLYCHOC04
OPLAPOLYSKIN03
OPLAPOLYSKIN04
OPLAPOLYLIV03
OPLAPOLYLIV04
Polypropylene 3 mm or 4 mm according to patient size:
Polypropylene 3 mm, terra brown
Polypropylene 4 mm, terra brown
Polypropylene 3 mm, beige
Polypropylene 4 mm, beige
Polypropylene 3 mm, olive
Polypropylene 4 mm, olive
Each Dimension explained in PP draping
For second TR socket:
MDREBANDP10 Plaster bandage 10 cm Each According to frst socket size
OMIS Plaster of Paris According to frst socket size
ODROSTOCOT60 Cotton stockinet 60 mm for PP draping Each 4 , length according to prosthesis
OMIS Nylon stocking for PP draping Each 1, length according to prosthesis
OMIS Bicycle brake cable housing dummy Each 1, cut according to socket length
OPLAPOLYCHOC03
OPLAPOLYSKIN03
OPLAPOLYLIV03
Polypropylene 3 mm for trim line strip:
Polypropylene 3 mm, terra brown
Polypropylene 3 mm, beige
Polypropylene 3 mm, olive
Each 1, width: 20 mm, according to
circumference
OPLAPOLYCHOC03
OPLAPOLYSKIN03
OPLAPOLYLIV03
Polypropylene 3 mm for 2nd socket
Polypropylene 3 mm, terra brown
Polypropylene 3 mm, beige
Polypropylene 3 mm, olive
Each Dimensions explained in PP draping
of 2nd socket
OMIS Defnitive bicycle brake cable housing Each 1, cut according to socket length
OMIS Bicycle brake cable Each 1, length according to patient size
OMIS PP webbing hanger or other fxation method Each 1
OSBOVSB24 Nylon (or Perlon) belt for harness, width 25 mm Each 1, length according to patient size
list of other manufacturing materials
MISSION
The International Committee of the Red Cross (ICRC) is an impartial, neutral and
independent organization whose exclusively humanitarian mission is to protect the
lives and dignity of victims of war and internal violence and to provide them with
assistance. It directs and coordinates the international relief activities conducted
by the Movement in situations of confict. It also endeavours to prevent suffering
by promoting and strengthening humanitarian law and universal humanitarian
principles. Established in 1863, the ICRC is at the origin of the International Red
Cross and Red Crescent Movement.
Acknowledgements:
Jean François Gallay
Leo Gasser
Pierre Gauthier
Frank Joumier
Jacques Lepetit
Bernard Matagne
Joel Nininger
Guy Nury
Peter Poetsma
Hmayak Tarakhchyan

and all prosthetists-orthotists who have worked in ICRC-assisted physical rehabilitation centres.
International Committee of the Red Cross
19 Avenue de la Paix
1202 Geneva, Switzerland
T + 41 22 734 60 01 F + 41 22 733 20 57
E-mail: icrc.gva@icrc.org
www.icrc.org
© ICRC, September 2006
All photographs: ICRC/PRP
Physical Rehabilitation Programme
ankle-Foot orthosis
Manufacturing guidelines
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