Orthotics & ProstheticsOrthotics & Prosthetics

Dr Munir SaadeddinDr Munir Saadeddin

Orthotics = CalipersOrthotics = Calipers

Traditionally calipers Traditionally calipers were the most known were the most known form of orthosisform of orthosis

Caliper is a device Caliper is a device which is applied to which is applied to lower limb to give lower limb to give support or control a support or control a jointjoint

Prevention of Deformity : AFO Prevention of Deformity : AFO

Prevention of deformity : Prevention of deformity : Drop Wrist In Radial N PalsyDrop Wrist In Radial N Palsy

Seen in fractures Seen in fractures junction of mid and junction of mid and lower 1/3rd humeruslower 1/3rd humerus

Radial N palsy makes Radial N palsy makes loss of wrist and MCP loss of wrist and MCP joints dorsiflexionjoints dorsiflexion

Nerve function Nerve function recovers with passage recovers with passage of time (if not cut)of time (if not cut)

Prevention of deformity Prevention of deformity is importantis important

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

Prevention of Deformity in Prevention of Deformity in Brachial plexus PalsyBrachial plexus Palsy

Brachial Plexus Palsy Brachial Plexus Palsy usually leads to loss of usually leads to loss of shoulder Abduction and shoulder Abduction and External RotationExternal Rotation

If not treated it leads to If not treated it leads to Adduction & Internal Adduction & Internal Rotation deformity Rotation deformity (taking a tip position)(taking a tip position)

Abduction Orthosis is Abduction Orthosis is used to prevent this used to prevent this deformitydeformity

Prevention of Deformity in Prevention of Deformity in Brachial Plexus PalsyBrachial Plexus Palsy

Brachial Plexus injury is Brachial Plexus injury is usually a stretching injuryusually a stretching injury

Shoulder should be Shoulder should be splinted in functional splinted in functional position awaiting nerve position awaiting nerve recoveryrecovery

Also Active and Passive Also Active and Passive exercises and electrical exercises and electrical nerve stimulation should nerve stimulation should be donebe done

Correction of Deformity : Foot Correction of Deformity : Foot Orthosis= Shoe Raise& Heel Orthosis= Shoe Raise& Heel CupCup

Shoe Raise is a Shoe Raise is a simple orthosis which simple orthosis which corrects limb length corrects limb length asymmetryasymmetry

Heel cups inserted Heel cups inserted into shoes may into shoes may prevent development prevent development of varus or valgus of varus or valgus heel deformityheel deformity

Correction Of Deformity : Correction Of Deformity : Spinal orthosisSpinal orthosis

Are used in deformities in Are used in deformities in excess of 25excess of 25 degreesdegrees of cob’s angle of cob’s angle

Are used in Are used in Growing individualsGrowing individuals To be effective they have to be usedTo be effective they have to be used for for

23 hours daily23 hours daily They have to be used till bone growthThey have to be used till bone growth

ceasecease

Spinal OrthosisSpinal Orthosis

Many types :Many types : Can be Rigid or Semi-RigidCan be Rigid or Semi-Rigid Most comprehensive form is Most comprehensive form is Milwaukee Milwaukee

Brace= Cervico- Dorso - Lumbosacral Brace= Cervico- Dorso - Lumbosacral OrthosisOrthosis

Boston brace or Jewett brace is a type Boston brace or Jewett brace is a type of rigid Dorso-lumbosacral orthosis of rigid Dorso-lumbosacral orthosis

Spinal Orthosis = DLSSpinal Orthosis = DLS

May be concealed May be concealed under the clothesunder the clothes

Can control deformities Can control deformities or injuries at lumbar or injuries at lumbar spine as well as dorsal spine as well as dorsal spine up to level D6spine up to level D6

Can control scoliotic or Can control scoliotic or kyphotic deformitieskyphotic deformities

Spinal Orthosis = CDLSSpinal Orthosis = CDLS

Milwaukee braceMilwaukee brace

Correction of Deformity : Correction of Deformity : ClubfootClubfoot

Maintenance of Correction of Maintenance of Correction of Deformity: Clubfoot OrthosisDeformity: Clubfoot Orthosis

Plaster of Paris is a type Plaster of Paris is a type of Temporary Orthosis of Temporary Orthosis following surgical following surgical correction of clubfootcorrection of clubfoot

Later it is replaced by Later it is replaced by backslap foot-ankle backslap foot-ankle orthosis or Dennis brown orthosis or Dennis brown night bootsnight boots

Maintenance of Correction of Maintenance of Correction of Deformity: Dennis-Brown night Deformity: Dennis-Brown night bootsboots

They are used to They are used to maintainmaintain correction correction AT NIGHT following AT NIGHT following surgical correction surgical correction and removal of and removal of Plaster of ParisPlaster of Paris

Once the child is Once the child is walking his body walking his body weight will weight will maintain maintain correctioncorrection

Instability control : Instability control : Knee OrthosisKnee Orthosis

Knee Orthosis is a knee Knee Orthosis is a knee brace which controls of brace which controls of knee instability following knee instability following Ligaments injuries like Ligaments injuries like collateral ligaments or collateral ligaments or cruciate ligamentscruciate ligaments

They stop lateral They stop lateral instability and control instability and control knee movements knee movements between certain between certain degreesdegrees

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

Weight Relief function of Weight Relief function of Orthosis : Thomas SplintOrthosis : Thomas Splint

It is an orthosis which It is an orthosis which transmits the weight transmits the weight from the ground to from the ground to Ischial Tuberosity (so Ischial Tuberosity (so weight is relived from weight is relived from affecting the hipaffecting the hip

In Perth's disease a In Perth's disease a similar orthosis has to similar orthosis has to be used for up to 2 be used for up to 2 yearsyears

Weight relief function of Weight relief function of OrthosisOrthosis

Weight relief Foot-Ankle Weight relief Foot-Ankle orthosis may be used orthosis may be used following comminuted following comminuted fractures of lower tibia fractures of lower tibia ( Pylon Fractures)( Pylon Fractures)

Weight is transmitted Weight is transmitted from the ground to from the ground to patellar tendon and patellar tendon and upper flare of tibiaupper flare of tibia

Pain Relief function of OrthosisPain Relief function of Orthosis

Lumbar corset, Lumbar Lumbar corset, Lumbar brace or soft, semi-rigid brace or soft, semi-rigid or rigid Lumbar or or rigid Lumbar or Lumbo sacral orthosis is Lumbo sacral orthosis is commonly used for commonly used for acute pain or following acute pain or following injuryinjury

Pain relief Function of orthosis= Pain relief Function of orthosis= Cervical collar or Cervical OrthosisCervical collar or Cervical Orthosis

Functions Of orthosis: Functions Of orthosis: Facilitates MobilisationFacilitates Mobilisation

Paralysed or weak Paralysed or weak limbs Will be able to limbs Will be able to support weight support weight bearing if fitted with bearing if fitted with suitable orthosissuitable orthosis

This is very important This is very important in cases of Polio or in cases of Polio or other paralytic other paralytic disordersdisorders

Functions of orthosis: Functions of orthosis: Facilitates mobilisationFacilitates mobilisation

ParaplegicParaplegic patients patients may be able to may be able to mobilise if fitted with mobilise if fitted with adequate Orthosis adequate Orthosis and received the and received the necessary trainingnecessary training

Functions of ProsthesisFunctions of Prosthesis

Restores functionRestores function (Weight Bearing) (Weight Bearing)

Restores Shape ( Cosmetic )Restores Shape ( Cosmetic )

StumpStump

Is the part of the limb Is the part of the limb remaining following remaining following amputationamputation

Weight bearing is Weight bearing is normally normally NOT NOT at the at the end of the stumpend of the stump

StumpStump

In Above Knee In Above Knee amputation weight amputation weight bearing is at Ischial bearing is at Ischial TuberosityTuberosity

In Below Knee In Below Knee amputation weight amputation weight bearing is at Patellar bearing is at Patellar Tendon and upper Tendon and upper flare of tibiaflare of tibia

The SocketThe Socket

The socket is the The socket is the immediate part the immediate part the stump has to be stump has to be placedplaced

It is usually made of It is usually made of plastic material and plastic material and padded at pressure padded at pressure pointspoints

A venting opening is A venting opening is made at the end to made at the end to ease getting stump inease getting stump in

Lower Limb ProsthesisLower Limb Prosthesis

May be Below knee or May be Below knee or Above kneeAbove knee

It consists of the socket It consists of the socket and the additional partand the additional part

Picture shows above Picture shows above knee artificial limb knee artificial limb ( Above Knee ( Above Knee Prosthesis)Prosthesis)

Weight bearing is at the Weight bearing is at the Ischial TuberosityIschial Tuberosity

Ideal Orthosis / Ideal Orthosis / ProsthesisProsthesis

FunctionalFunctional

Fits wellFits well

Light in weightLight in weight

Easy to useEasy to use

Cosmetically acceptableCosmetically acceptable

Easily maintained/repairedEasily maintained/repaired

Ideally locally manufacturedIdeally locally manufactured