Order AK by Measurements
Modify A BK
Use this page to communicate to us how you would like your BK prosthesis modified.
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General Information
PO #::
Contact Name: Company Name:
Patient Name: Age: Height: Weight:
Activity level: Casted over a liner?: Liner thickness: Volume change: # of Ply:
Cast Modification Information
Anterior View
Medial View
M-L A-P
PML
Depth of PTB Tibial crest buildup
Length from MPT to distal end
Distal tibia buildup
Circumference Measurements Posterior View Lateral View
Level
Mid patella level 0" Depth of shelf:
2" Level of shelf:
4" Fibular head buildup
6"
8"
10"
12" Posterior Shelf Choice:
Special Instructions
110 Industrial Road Fulton, MO 65251 800.470.1188
