Ruth J. Clark

Socketless Prosthetic Technology can be a superb prosthetic solution for pediatric amputee patients, especially difficult to fit congenital amputees or those with partial hands. Socketless Prosthetic Technology (SPT) was initially created to provide large numbers of highly functional, economic prosthetic devices for International Humanitarian missions. It soon became obvious that the applications were much further reaching. The devices have been used in the United States as an Immediate Post Operative Prosthesis (IPOP), as well as a definitive limb. One adult upper extremity amputee received a limb within days of surgery, while still in dressings. He was able to begin therapy immediately and return home with a functional prosthesis.

Child with forearm prosthesis

Socketless Prosthetic Systems in upper extremity applications have proven to be a superb pediatric solution. One of the biggest problems encountered when trying to fit pediatric patients is that residual limb growth will render a traditional socket based prosthesis unwearable in a matter of months. This starts a continuous cycle of frequent limb fabrication during the primary growth years. The cost of this frequent replacement cycle carries an emotional cost for the patient, in addition to the financial cost and family and Professional time. This may be one of the reasons for pediatric patients periodically abandoning the use of a prosthetic. Socketless limbs can be adjusted to accommodate this growth, allowing a pediatric amputee to stay in the same limb system for years. One patient in North Carolina received a limb at age four, and has been in the same device for two years. With the exception of minor repairs to the cosmetic cover (caused by play and roughhousing that all 3 and 4 year olds should be involved in!) the system has required no major modifications or component replacements.

Pediatric patients with partial hands have traditionally been difficult to Fit. In the past, the choice of surgical intervention has been decided upon, and authorized, by guardian adults and medical personnel, acting in what they feel is the best interest of the child's future. The elimination of the need for early surgical intervention allows the amputee to maximize improved or new medical procedures, as they grow into adulthood. Frequently this revision surgery is suggested in order to permit conventional socket fabrication. A three year old congenital amputee with a partial hand (proximal palm only) and hypoplastic thumb was provided with a Socketless Below-Elbow System. Fitting over, but not touching or encasing the partial hand, this socketless limb has allowed fully functional, active terminal-device control.

During the formative years, a child explores and learns about their environment and personal capabilities in many ways.

As can be seen in the photograph, the open exposure of the wrist and thumb afforded by the socketless system has an unforeseen benefit of providing the opportunity for the patient to balance the learning of fine motor skills with both organic hands. Tactile and sensory perception can also be learned equally as both arms have similar weight and skin exposure during the daily wearing of a socket-less prosthetic.

Child and family


Below-Elbow Application - Advantages of Socketless Technology:

  • Removable IPOP, allowing a Below-elbow amputee to leave the hospital with independent, bilateral function. Familiarize a BE amputee with prosthetic function during the post surgical healing period, so they will consider prosthetic options as a permanent part of their future
  • Can provide non-surgical option to obtain full prosthetic function for an individual with a partial hand
  • Can provide full body powered prosthetic function for an individual with reduced hand function due to partial paralysis, etc.
  • Up to a fifty percent reduction in weight compared to socket-based systems, thus reducing fatigue, discomfort, and assisting with prosthetic acceptance and retention
  • Substantially reduces the number of devices needed to be constructed during a child's growth years, a substantial savings in clinic time, professional, and financial resources. Within an existing budget, as many as 4 times as many patients can be fit, during the first year of introduction of this system. Due to the long life of the system, during subsequent years fewer than 10% of the SMP systems will need to be re-fit each year.
  • Can act as a secondary/ back-up limb for sport and hobby activities (i.e.. Summer beach time, gardening, back yard mechanic, etc.) This preserves the function and aesthetics of a cosmetic socket, body powered prosthesis or myoelectric limb.

The field of Socketless Prosthetic Technology has been pioneered by Chaz Holder, MD, PhD a triple amputee, a Bio-medical/Bio-mechanical Engineer at CZBioMed ( More than 350 patients have been fitted with these systems worldwide.

Authors Address:

Ruth J. Clark 859
Battle Street
Kamloops, BC
V2C 2M7

Phone 250-314-1849