What are Orthotics?

It refers to the general name of external devices that are assembled on the limbs, trunk, and other parts of the human body. Its purpose is to prevent or correct deformities of the limbs, trunk, or treat bone, joint, and neuromuscular diseases and compensate their functions.

Orthosis

It refers to the general name of external devices that are assembled on the limbs, trunk, and other parts of the human body. Its purpose is to prevent or correct deformities of the limbs, trunk, or treat bone, joint, and neuromuscular diseases and compensate their functions.

Orthotics basic functions

It mainly includes the following aspects:

(1) Stability and support: By restricting abnormal movements of the limbs or torso to maintain the stability of the joints and restore the load-bearing or athletic ability.

(2) Fixation and correction: For deformed limbs or trunks, fix the lesions to correct the deformity or prevent the deformity from getting worse.

(3) Protection and freedom from load: By fixing the diseased limb or joint, restricting its abnormal activities, maintaining the normal alignment relationship of the limb and joint, and reducing or eliminating the long bearing weight for the load-bearing joints of the lower limbs.

(4) Compensation and assistance: provide power or energy storage through certain devices such as rubber bands, springs, etc., to compensate for muscle functions that have been lost, or to give some assistance to weaker muscles to assist physical activity or Movement of paralyzed limbs.

Orthotics classification

According to the installation site, it is divided into three categories: upper limb orthosis, lower limb orthosis and spinal orthosis.

Orthosis names in Chinese and English

Upper limb orthosis

Shoulder Elbow Wrist Hand Orthosis (SEWHO)

Elbow Wrist Hand Orthosis (EWHO)

Wrist Hand Orthosis (WHO)

Hand Orthosis (HO)

Lower limb orthosis

Hip Knee Ankle Foot Orthosis (HKAFO)

Knee Orthosis (KO)

Knee Ankle Foot Orthosis (KAFO)

Ankle Foot Orthosis (AFO)

Foot Orthosis (FO)

Spinal orthosis

Cervical Orthosis (CO)

Thoraco-lumbo-sacral orthosis Thorax Lumbus Sacrum Orthosis (TLSO)

Lumbo-sacral orthosis Lumbus Sacrum Orthosis (LSO)

1. The upper limb orthosis is divided into two categories according to function: fixed (resting) and functional (movable). The former has no moving device and is used for fixing, supporting and braking. The latter have exercise devices that allow limb movement or control and assist limb movement.

Upper limb orthosis can be basically divided into two categories, namely, fixed (static) orthosis and functional (active) orthosis. The fixed orthosis has no movable parts. It is mainly used to fix limbs and functional positions, limit abnormal activities, apply to inflammation of upper limb joints and tendon sheaths, and promote fracture healing. Functional orthotics are characterized by allowing a certain degree of movement of the limbs, or through the movement of braces to achieve therapeutic purposes. Sometimes, an upper limb orthosis can have both fixed and functional effects.

Upper limb orthosis is mainly used to compensate for lost muscle strength, support paralyzed limbs, maintain or fix limbs and functional positions, provide traction to prevent contractures, and prevent or correct deformities. Sometimes it can be used as an additional device for patients. With the development of orthopedics, especially hand surgery, and rehabilitation medicine, the types of upper limb orthotics are becoming more and more complicated. Among them, various hand braces are more difficult. It requires the joint efforts of doctors and producers to obtain applications Effective.

The power source of a functional upper limb orthosis can come from itself or from the outside. Self-power is provided by muscle movements of the patient's limbs, either through voluntary movement or electrical stimulation. Exogenous force can come from various elastic materials such as springs, rubber bands, elastic plastics, etc., and can also be controlled by pneumatic, electric or cable. The latter refers to the use of a traction rope to move the orthosis, for example, through the movement of the scapula. The shoulder strap moves and tightens the traction rope to move the hand orthosis. ^[1]

2. The main role of the lower limb orthosis is to support weight, assist or replace limb functions, limit unnecessary movements of lower limb joints, maintain lower limb stability, improve posture during standing and walking, and prevent and correct deformities. When choosing an orthosis for lower limbs, care must be taken to ensure that there is no significant compression on the limbs. For example, when KAFO is used to bend the knees at 90 °, the popliteal fossa cannot be compressed, and there is no compression on the medial perineum. Orthosis for patients with edema of the lower limbs should not stick to the skin.

3. Spinal orthosis is mainly used to fix and protect the spine, correct the abnormal mechanical relationship of the spine, reduce local pain in the trunk, protect the lesion from further damage, support paralyzed muscles, prevent and correct deformities, and support the trunk. , Exercise restrictions and realignment of the spine alignment to achieve the purpose of correcting spinal disorders.

Orthopedic procedures

1. Examination and diagnosis include the general condition, medical history, physical examination of the patient, the range of motion and muscle strength of the joint where the orthosis is to be made or worn, and whether the orthosis has been used.

2. The orthosis prescription states the purpose, requirements, variety, material, fixed range, body position, force distribution, use time, etc.

3. The pre-assembly treatment is mainly to strengthen muscle strength, improve the range of joint movement, improve coordination ability, and create conditions for using orthotics.

4. Orthosis production includes design, measurement, drawing, mold taking, manufacturing, and assembly procedures.

5. Before training or using the orthosis, you should try it on (preliminary inspection) to find out whether the orthosis meets the prescription requirements, whether the comfort and alignment are correct, whether the power unit is reliable, and make corresponding adjustments. Then, teach patients how to put on or take off the orthosis, how to put on the orthosis for some functional activities. After training, check whether the assembly of the orthosis conforms to the principles of biomechanics, whether it achieves the expected purpose and effect, and understand the patient's feelings and reactions after using the orthosis. This process is called final inspection. After passing the final inspection, the patient can be officially used. Patients who need to use the orthosis for a long time should be followed up every 3 months or half a year to understand the effect of the orthosis and the changes in the condition, and modify and adjust if necessary.

Orthosis effect

In medicine, external fixation is a method for treating fractures, and it has its best effect and corresponding indications. In order to properly use the orthosis in the indications of fracture application, it is necessary to correctly understand the advantages and disadvantages of using various orthotics in the treatment of fractures.

First, the advantages of orthotics in external fracture fixation

1, can quickly propose a good external fixation for fractures, adjuvant treatment and surgical external fixation. External fixation can quickly fix the fracture, which is beneficial to reduce pain, reduce blood loss, and facilitate moving the patient for necessary examinations or immediate surgery to control related injuries that threaten the patient's life.

2, easy to observe and manage the wound without interfering with fracture reduction and fixation. For patients with fracture defects, open autologous cancellous transplantation can be performed after wound infection control.

3. The stiffness of the external fixation of the orthosis is adjustable and can be adjusted as the fracture heals.

4. Modern external fixation is flexible to the bone rotation force. It can press the axis of the fracture rotation end according to the type of fracture or give lateral force to fix it. Traction maintains the length of the injured limb.

5. The upper and lower joints of the fracture can be moved early, with less stress shielding, which is conducive to fracture healing.

6. Orthoses are used for external fixation of bones, especially suitable for treating infectious fractures and nonunion.

7. The orthosis is used for external fixation to facilitate the lifting of the injured limb, which is beneficial to improve blood circulation and avoid compression of the tissue on the back side of the limb. This is particularly important when fractures are accompanied by limb burns or extensive skin peeling.

8. Easy to wear and remove.

Second, the indications of orthopedics on external fixation of fractures

Orthopedics external fixation of fractures is not the only method for treating fractures, and their applications are mostly relative. They are different due to the knowledge of orthopedics and the knowledge and experience of external fixation of fractures. Decide what orthoses to use to fix the fracture. The indications for orthopedic external fixation can be divided into two categories, the best and the relative.

1.The best indication for orthopedic external fixation

1) Open limb fractures with severe soft tissue, especially calf fractures with extensive soft tissue injuries.

2) Firearm fractures require multiple debridements due to soft tissue inactivation changes. The use of orthotics is convenient for observing and treating wounds and carrying patients multiple times.

3) Severe burns are accompanied by fractures. The orthopedic treatment can not only provide a firm fixation for the fracture, but also facilitate the observation of the treatment wound, and prevent compression of the skin graft area and joint scar contracture.

4) Open fractures or multiple fractures with multiple injuries, the orthosis can also quickly brake the fractures, which can reduce pain and reduce the risk of further blood loss, which is conducive to anti-shock and time-saving surgery for life-threatening injuries. .

5) Infectious fractures and nonunion of infectious bones, the use of orthopedics is conducive to wound treatment, at the same time, the fractures can be firmly fixed, and the treatment can be effectively taken into account.

6) Fractures are accompanied by nerve and vascular damage.

7) Limb extension.

8) Arthrodesis.

9) Femoral, tibia, and fibula fractures were fixed after surgery.

10) All spine fractures are fixed after surgery.

11) Fixation of humerus fracture after reduction.

2. Relative adaptation of orthoses to external fixation of fractures

1) For certain pelvic fractures and dislocations, the use of orthotics can stabilize pelvic fractures, control blood loss and reduce pain, relieve heavy care, and supplement the deficiencies of traditional therapies.

2) The comminuted fracture of the bone joint end, such as the unstable fracture of the lower end of the radius, is better than other treatments with orthopedic braking on the basis of ligament restoration and fixation.

3) The ulna olecranon fracture and patella fracture. The fixation of the orthosis can prevent the biceps brachii and quadriceps from contracting, prevent the fracture from relocating, and can move the joints early.

4) For multiple closed fractures, it is difficult to use other treatment methods. Orthotics can be used as an alternative method.

5) Patients with femoral rotor fractures should not be surgically fixed. The use of orthosis to fix the treatment can meet the needs of fracture fixation and early movement. The indications of orthopedics for external fixation of fractures are mostly relative, and to a considerable extent depend on the knowledge of orthopedic surgeons and the application technology.

Third, the principle of external fixation of orthoses

An orthosis is a method of fixing bones or joints. First, you should choose an understanding of the structure and mechanical properties of the orthosis, and become familiar with its operation technology to obtain a good therapeutic effect. There are many types of orthotics, each type has its own characteristics, which can be selected according to the needs of the disease. However, the application of various orthotics has their common principles and basic technical requirements, and reasonably grasps the indications of using orthotics in external fixation of fractures, strictly implements operation techniques and postoperative fixation, and avoids disadvantages as far as possible. Give full play to the role of orthopedics in orthopedic external fixation for fractures.