Orthotics & Prosthetics

1. Orthotics & Prosthetics Dr Munir Saadeddin

6. 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

11. Prevention of Deformity : AFO

12. 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

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

14. 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

15. 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

17. 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

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

19. 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

20. 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

21. Spinal Orthosis = CDLS • Milwaukee brace

23. Correction of Deformity : Clubfoot

24. 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

25. 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

27. 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

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

29. 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

30. 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

31. 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

32. Pain relief Function of orthosis= Cervical collar or Cervical Orthosis

33. 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

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

35. Functions of Prosthesis • Restores function (Weight Bearing) • Restores Shape ( Cosmetic )

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

37. 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

38. 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

39. 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

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