Experiences in the supply of individual CAD manufactured and assembled trunk orthosis systems

Specialist contribution to hull orthotics production – from diagnosis, model creation, first try to finished orthosis

Functional orthoses

The influence or the correction of the sagittal profile of the spine with orthoses seems to be simple. But to achieve effect, the orthoses must meet important criteria.

Fig. 1: Condition of the orthosis module after fitting. Marks determine last minute changes. The technical requirements (contact zones and open spaces), which are due to the indication of the aid (M. Scheuermann, thoracal type) are all implemented.

The biomechanical design up to the material selection and the directly related strength properties are decisive for the function and the results. The goal of any orthopedic technology team is to provide patients with as little invasive as possible and yet still provide the maximum function with an orthopedic orthotic technique. This begins with the decision whether to work after plaster casting, with CAD technology systems or with pre-fabricated orthoses.

To fulfill the requirements of a corrective or statically altering orthosis, trunk orthoses must have high functional properties. Setting options for the course of therapy and for everyday situations are obligatory. If recliners are fitted, they must ensure absolute dimensional stability.

In the following, supply systems are shown that are performed without plaster cast, on the basis of body dimensions with individual, CAD-made or assembled trunk orthosis systems. The biomechanical orthotic design (individual or made-to-measure) is based on the same proven design and functional principles in the examples shown.

Preparation, procedure, fitting

The individual, CAD-produced and pre-fabricated orthoses require body measurements and photographs of the four clinical views. The orthoses are delivered ready-to-wear and can be applied directly to the first fitting.

Fig. 2: Completed orthotic module for the correction of M. Scheuermann, thoracic type. Clearly recognizable: The orthosis consists almost entirely of elements that form the correction zones.

The first step after applying the orthotic blank is to check the basic fit. Then it is checked whether the correction zones of the orthosis sit properly and apply the required correction forces. Then the blank of the orthosis is determined. It is important to define the exact height and area of ​​the correction equipment. If these are not set correctly, the correction movements are massively restricted or are not even possible. On the contrary, undesirable compression effects are produced. To protect the skin and to increase the correction pressures pads are to be attached. All overhangs on the base module that do not contribute to the functionality can be removed. It is important that the rigidity of the frame construction must be adapted to the correction forces to be applied.

The modules with recliner elements are followed by the positioning and attachment of the anatomically shaped and thermoplastically conformable reclining straps. According to the indication, it can be decided whether they are adaptably attached by a nylon fastener or firmly screwed. The advantage of the adjustable variant is that patients can adjust the correction pressure themselves.

Indication

The range of indications of the orthosis modules covers the treatment of malformations, degenerative as well as traumatological and neurological changes of the spine. In addition, the modules for influencing the lumbar spine for pain therapy are used in particular.

Supply Examples

Fig. 3: Orthosis for the treatment of M. Scheuermann, thoracolumbar type

Example 1: M. Scheuermann, thoracic type. The corrective principles of TLSO are: flexion / delordosation of the lumbar and extension / reclination of the thoracic spine.

The pressure zones for this are: the sacrum (as caudal as possible), medial to the anterior, superior spins. Ventral ribs (level: about nine and ten), thoracic vertex vertebrae, humeral head area. This results in the investment zones according to two three-point systems.

In order for the ribcage to expand laterally away from the correction zones while breathing, the orthosis must ensure sufficient expansion space. The expansion (ribbing of the ribs) of the chest when inhaled laterally is an essential part of the correction and must be ensured. The movement of the lumbar WS in the frontal plane is free (Figs 1 and 2).

Fig. 4: Patient after complicated thoracolumbar vertebral fracture. With the orthosis, the exercise of the profession is possible again. The adjustable reclining bars also allow driving. To fix the hull orthosis, a belt on the ventral frame is sufficient.

Example 2: M. Scheuermann, thoracolumbar type. The corrective principles of TLSO are: flexion / delordosation of the lumbar and extension / reclination of the thoracolumbar WS. The pressure zones for this are: the sacrum (as caudal as possible), medial to the anterior, superior spines, thoracolumbar vertex vertebra, and humeral head area.

Fig. 5: Patient with pronounced spondylolisthesis. The orthotic design is limited exclusively to the functional achievement. The pelvic erection and change in statics can be clearly seen with the orthosis applied.

The correction zones form two overlapping three-point systems: a short three-point system for lumbar correction and a long one for thoracolumbar erection. Due to the long levers (medial arrangement of the spines – thoracolumbar vertex vertebrae – humeral head area), the correction effect of the orthosis can be set very effectively. The lateral expansion of the rib cage (handle movement of the ribs) must be ensured. The lateral flexion of the lumbar spine is free (Figs 3 and 4).

Example 3: Spondylolisthesis / Delordosation of the lumbar spine in general. The correction principles of TLSO are: maximum flexion / delordosation of the lumbar WS. The pressure zones for this are: the sacrum (as caudal as possible), medial to the anterior, superior spines, thoracic or thoracolumbar attachment.

To be flexible, the modules are supplied with a ventral ribbed system. It can therefore be decided on the fitting, as the cut of the corset module is determined. The correction zones form a three-point system. The lateral flexion of the lumbar spine is free (Figs 5 and 6).

Results And Practical Experience

The primary fit and comfort at maximum function are outstanding features of all presented systems.

Fig. 6: Flexing orthosis for chronic pain symptoms of the lumbar spine. The biomechanical function of the orthosis is easily verifiable when looking at the sagittal profile.
The complete supply process is very effective and uncomplicated. The versatility of the basic modules through individual cutting variants is the basis for this.

These characteristics are crucial for the high compliance of the patients and thus are the basis for the fact that indication-dependent wearing times are achieved without unnecessary loss of time by fitting work due to fitting problems. These properties are particularly useful in the postoperative area and for pain therapy.

Advantages In Practice

Orthopedic technicians have highly functional modules with a wide range of applications at their disposal. The outstanding biomechanical design captivates through its simplicity and thoughtfulness with unlimited functionality. The orthosis modules consist exclusively of elements that are necessary to achieve the function of the respective indication area.

‘For orthopedic companies with little experience in complex restorations, horseshoe orthosis systems can expand the supply of care.’

Dino Gallo

Certified Orthopedic Technician (CPO), Ortholutions

Fig. 7: Orthosis for lordosis with marked flattening of the WS and associated pain. Upper row: Supply planning. The orthosis is in the raw state with pelvic enclosure and has generous material reserves to ensure the individuality and versatility of the cutting and thus the function. Lower row: completed orthosis.

All orthosis types can be adjusted in their function by the specific cutting exactly and at any time individually. The two-shell systems of the series are particularly suitable for setting the optimum correction pressure. The ventral and dorsal shells are adjusted exactly to each other when fitting the patient in the A-P direction.

The orthosis modules also allow the implementation of complex restorations after a certain learning phase of the system. Another important factor is the time savings. The measures and trial periods on the patient are reduced significantly. Likewise, the time spent on modifications and reworking is significantly lower. Other areas of competence and freedom can be expanded or deepened by saving time.

Fig. 8: Patient with scoliosis after removal of stabilizing implanted instruments due to incompatibility. The improvement of the sagittal statics and the associated physiologization of the sagittal profile are clearly recognizable. Result: The pain is significantly reduced and, in addition, the orthosis ensures external stabilization of the lower lumbar spine.

Conclusion

For specialized companies, the Ortholutions trunk orthotic system is a useful technique that contributes significantly to increasing its effectiveness. Especially for the orthopedic companies, who have less experience with complex rump orthotic restorations, the horseshoe orthosis systems make meaningful additions and expansion possibilities of the supply offer. The on-site service of the manufacturer is helpful here as a service.

The concept guarantees maximum security of supply and the technical support of the manufacturer’s competence team. Since no plaster cast is required and the modules are delivered ready-to-test, the supply system has proven itself for home visits and in particular for hospital supplies. The Ortholutions trunk orthosis system contributes to a contemporary and professional service to the patient.

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