From Ukraine to Norway to learn the DS method
When thousands of people are injured in war - and have to amputate body parts - prostheses must be produced at a rapid pace. Three orthopedic engineers from Ukraine recently visited OCH Orthopedics' clinic in Oslo to receive training in the production of prostheses using the Direct Socket method.
Text: Bjørnhild Fjeld | Photo: Tore Fjeld
In a normal situation, people need prostheses as a result of, for example, illness and traffic accidents. That is what we are used to in our peaceful Norway.
In war-torn Ukraine, thousands of people are amputated as a result of gunshot wounds, land mines and other dramatic situations. Many of the new amputees are young, and they want to get back on their feet quickly, even if they have suddenly become prosthetic users.
- It's not like the authorities can force you to go back to the front, but many do anyway. They want to go back to fight for their country. It doesn't just apply to young men, everyone who can hold a weapon wants to contribute, Denys Nahornyi, Oleksandr Stetsenko and Yurii Yaskiv say via an interpreter.
3 days intensive training
The orthopedic engineers are managers of their respective clinics back home in Ukraine, and recently visited Norway and OCH Orthopedics' clinic at Helsfyr in Oslo. The purpose was to receive intensive training in the Direct Socket (DS method), where the prosthetic sleeve is literally molded directly onto the patient's body, with the amputation stump as a "template".
The traditional method of making prostheses, where you take measurements and make plaster casts, means that it takes several weeks before the patient can use his new prosthesis. With the DS method, the patient can leave the clinic with a new prosthesis already the same day.
This is particularly important when the home country is at war - and many of the new amputees in need of prostheses are young people who want to return to the front.
- We have naturally heard of this method before, and we see that the big difference is precisely the time it takes to produce a prosthesis, say the Ukrainian orthopedic engineers.
After the intensive training, where they have made a total of 12 new prostheses, they are going home to Ukraine to train their colleagues. Anton Johannesson from OCH Ortopedia's owner organization Össur is also going to Ukraine to assist with the training. He has worked as an orthopedic engineer since the late 1970s, and today travels around the world to educate colleagues in the DS method.
- I see no disadvantages with the DS method, only advantages. And the most important thing for a country like Ukraine is to have prostheses made more cheaply and in a shorter time than with traditional methods.
But he will point out that it is not the products themselves that are the whole solution, but that you have to keep in mind that these people will need follow-up for the rest of their lives. Prostheses must be produced, adjusted and renewed regularly, and then there must be clinics where this can be carried out close to where you live.
Help for self-help
Anton Johannesson believes that help for self-help is the most important thing that the orthopedic industry in other countries can contribute to get Ukraine back on its feet.
- There are 50 orthopedic clinics in Ukraine, and many skilled professionals. What is missing are materials, and not least the logistics. Here, Össur is contributing together with the Icelandic state in a project that will have efficient logistics so that as many as possible of the war injured will receive good prostheses as quickly as possible, says Johannesson.
He himself was in Haiti after the great earthquake in 2010, where thousands of people were injured and needed prosthetics.
- At the time, used prostheses from all over the world were collected and sent to Haiti - but only a few of them could be used by the people who needed prostheses. It was perhaps 10 percent that was used. I think that is a huge waste of resources, he says.
Johannesson warns against considering war-torn countries exclusively as victims - but rather to help them exploit the resources they themselves possess.
- In a war situation with limited access to resources, you have to be creative. It's a shame to say it, but it is actually wars that have led the orthopedic industry to develop forward, he says.
Happy to be able to contribute
In order to be able to carry out the training of the Ukrainian colleagues, OCH Orthopedics has made its premises, staff and equipment available. In addition, they have found patients in need of prostheses - on which the Ukrainians could "practice".
- These are our international colleagues, and we always benefit greatly professionally from being able to collaborate with professionals who work on the same things as us. When some of our colleagues work in a war-torn country, it is natural that we contribute what we can, says clinic manager Lise Sundby Nybo at OCH Orthopedics in Oslo.
Anton Johannesson from Össur points out that it is no coincidence that the training takes place right here in Oslo.
- There are only two of our collaborative clinics in Europe that are suitable to carry out this type of training - there is one in Amsterdam and then OCH Orthopedics' clinic here in Oslo, he says.
This is "Direct Socket" - DS
For the patient, this means that the new prosthesis will be finished within a single day - instead of him/her having to come in several times to take measurements, try on the prosthesis, new adaptations etc.
- The traditional method of making a prosthesis is to take a plaster cast or a 3D of the amputation stump, to produce a copy of the leg stump. Based on this model, the finished prosthetic sleeve is made, explains orthopedic engineer Linn Ottem-Frydenberg.
The traditional methods are time-consuming. Plaster must dry before you can cast on it, and 3D scanning is not done with pressure against the stump. Consequently, the changes that occur in the soft parts must be modeled in, before a model can be milled out and the casting of the sleeve can begin.
- If you take measurements and make a plaster cast, it must still be adjusted in most cases, especially if a long time has passed between the measurements being taken and the prosthetic sleeve being finished. This means that the patient usually has to come back several times. DS, on the other hand, requires us to plan well in advance, before the patient arrives, so that the process of casting the prostheses goes smoothly, says Linn.