Orthotics & Prosthetics Dr Munir Saadeddin

Orthotics = Calipers Traditionally calipers were the most known form of orthosis Caliper is a device which is applied to lower limb to give support or control a joint

Prevention of Deformity : AFO

Prevention of deformity : Drop Wrist In Radial N Palsy Seen in fractures junction of mid and lower 1/3rd humerus Radial N palsy makes loss of wrist and MCP joints dorsiflexion Nerve function recovers with passage of time (if not cut) Prevention of deformity is important

Dynamic wrist splint = Wrist & MCP Joints Orthosis in Radial N Palsy

Prevention of Deformity in Brachial plexus Palsy Brachial Plexus Palsy usually leads to loss of shoulder Abduction and External Rotation If not treated it leads to Adduction & Internal Rotation deformity (taking a tip position) Abduction Orthosis is used to prevent this deformity

Prevention of Deformity in Brachial Plexus Palsy Brachial Plexus injury is usually a stretching injury Shoulder should be splinted in functional position awaiting nerve recovery Also Active and Passive exercises and electrical nerve stimulation should be done

Correction of Deformity : Foot Orthosis= Shoe Raise& Heel Cup Shoe Raise is a simple orthosis which corrects limb length asymmetry Heel cups inserted into shoes may prevent development of varus or valgus heel deformity

Correction Of Deformity : Spinal orthosis Are used in deformities in excess of 25 degrees of cob’s angle Are used in Growing individuals To be effective they have to be used for 23 hours daily They have to be used till bone growth cease

Spinal Orthosis Many types : Can be Rigid or Semi-Rigid Most comprehensive form is Milwaukee Brace= Cervico- Dorso - Lumbosacral Orthosis Boston brace or Jewett brace is a type of rigid Dorso-lumbosacral orthosis

Spinal Orthosis = DLS May be concealed under the clothes Can control deformities or injuries at lumbar spine as well as dorsal spine up to level D6 Can control scoliotic or kyphotic deformities

Spinal Orthosis = CDLS Milwaukee brace

Correction of Deformity : Clubfoot

Maintenance of Correction of Deformity: Clubfoot Orthosis Plaster of Paris is a type of Temporary Orthosis following surgical correction of clubfoot Later it is replaced by backslap foot-ankle orthosis or Dennis brown night boots

Maintenance of Correction of Deformity: Dennis-Brown night boots They are used to maintain correction AT NIGHT following surgical correction and removal of Plaster of Paris Once the child is walking his body weight will maintain correction

Instability control : Knee Orthosis Knee Orthosis is a knee brace which controls of knee instability following Ligaments injuries like collateral ligaments or cruciate ligaments They stop lateral instability and control knee movements between certain degrees

Weight relief function of Orthosis: e.g. Perth's disease

Weight Relief function of Orthosis : Thomas Splint It is an orthosis which transmits the weight from the ground to Ischial Tuberosity (so weight is relived from affecting the hip In Perth's disease a similar orthosis has to be used for up to 2 years

Weight relief function of Orthosis Weight relief Foot-Ankle orthosis may be used following comminuted fractures of lower tibia ( Pylon Fractures) Weight is transmitted from the ground to patellar tendon and upper flare of tibia

Pain Relief function of Orthosis Lumbar corset, Lumbar brace or soft, semi-rigid or rigid Lumbar or Lumbo sacral orthosis is commonly used for acute pain or following injury

Pain relief Function of orthosis= Cervical collar or Cervical Orthosis

Functions Of orthosis: Facilitates Mobilisation Paralysed or weak limbs Will be able to support weight bearing if fitted with suitable orthosis This is very important in cases of Polio or other paralytic disorders

Functions of orthosis: Facilitates mobilisation Paraplegic patients may be able to mobilise if fitted with adequate Orthosis and received the necessary training

Functions of Prosthesis Restores function (Weight Bearing) Restores Shape ( Cosmetic )

Stump Is the part of the limb remaining following amputation Weight bearing is normally NOT at the end of the stump

Stump In Above Knee amputation weight bearing is at Ischial Tuberosity In Below Knee amputation weight bearing is at Patellar Tendon and upper flare of tibia

The Socket The socket is the immediate part the stump has to be placed It is usually made of plastic material and padded at pressure points A venting opening is made at the end to ease getting stump in

Lower Limb Prosthesis May be Below knee or Above knee It consists of the socket and the additional part Picture shows above knee artificial limb ( Above Knee Prosthesis) Weight bearing is at the Ischial Tuberosity

Ideal Orthosis / Prosthesis Functional Fits well Light in weight Easy to use Cosmetically acceptable Easily maintained/repaired Ideally locally manufactured