We are all accustomed to the fact that for fractures the doctor prescribes plaster. However, now on the medical goods market you can find a more practical and convenient alternative - orthoses.
Orthoses are therapeutic and prophylactic products that are worn for injuries of varying complexity: from sprains and dislocations to joint injuries and fractures. They are made from hypoallergenic and softer materials than plaster. They are:
- for the knee joint
- for the shoulder joint
- on your finger
- wrist
- ankle
- elbow
Plaster is a universal product because it is molded into a certain shape that is needed in a particular case. While the orthosis is more functional and comfortable.
Now we will review and compare both products and help you decide which is better to choose - a cast or an orthosis.
“Everything we talk about next is for informational purposes only and is not practical advice. Before replacing a cast with an orthosis, ALWAYS consult a traumatologist or orthopedist.”
Gypsum: pros and cons of use
Plaster is the most common orthopedic product for fractures. Because it has a number of important advantages:
- Low cost
- Availability - available in any hospital, traumatology and clinic
- Reliable bone fixation
This is where the advantages of gypsum end.
But there are many more shortcomings.
- Unattractive appearance - bulkiness and rapid contamination.
- Uncomfortable to wear under clothing or with shoes.
- Constantly rubs and almost completely limits the movement of the injured limb.
- It is destroyed upon contact with water, which makes it difficult to take a shower or bath comfortably.
- Inability to take an x-ray or necessary medical procedures.
- Prolonged wearing of a cast negatively affects joints, muscles, tendons and impairs blood circulation in the damaged area. Partial muscle atrophy often occurs, so after removing the cast the limb has to be developed.
Now let's look at how things are with orthoses.
Femoral neck fracture. Treatment and rehabilitation
Unfortunately, it is not so much the fracture itself that is dangerous, but its complications. Therefore, after an injury, every effort must be made to save the patient’s life. In addition to the derotational boot, the following medical products are required to be purchased:
- Anti-embolic jersey. Improves venous outflow in the shin area and prevents the formation of blood clots. The peculiarity of the fabric allows you to wear it for up to 7 days without taking it off. Medical knitwear is distinguished by graduated compression - it presses on different parts of the leg with different, scientifically calculated forces.
- Anti-decubitus mattress. An infected bedsore is a serious condition. In older people, this pathology can occur already on the second or third day of bed rest. Mattresses with air compressors protect the skin and muscles and greatly reduce the risk of complications.
- Nice walkers. The primary goal of treatment is to mobilize the patient as early as possible. Support means must be reliable, high quality and comfortable.
Medtechnika Orthosalon always has comfortable, effective and lightweight derotational boots in stock. Their difference is minimal weight, maximum strength, removable breathable lining. Consultants at the salon or online store will help you choose the size of the product and advise on related products.
Orthoses: advantages and disadvantages of use
The advantages of orthoses include the following.
- Preservation of motor activity of the injured limb.
- Possibility to adjust the degree of fixation of the product.
- Convenient use - for example, some models allow you to wash with them, since the materials do not absorb water or dry very quickly.
- The ability to carry out any medical manipulations at the fracture site or take an x-ray.
The advantages of orthoses are more significant than those of plaster. However, they are not without drawbacks.
- Not suitable for treating open ankle fractures.
- There is always a risk of an allergic reaction to the orthosis material.
- With prolonged wear, muscle atrophy is possible.
- Only a doctor can choose an orthosis correctly.
- High cost of the product.
We also note that an incorrectly selected orthosis can cause a lot of discomfort for the entire period of wearing it. And then the difference from plaster will not be so noticeable.
Ankle injuries: new orthoses versus old casts
“I slipped, fell, woke up - a cast...” Everyone knows that a broken leg is rigidly fixed in a cast for several weeks. But not everyone knows that several years ago orthoses appeared in Russia, which allow patients after a fracture to walk almost immediately without crutches.
Vasily Aleksandrovich Shurov, a traumatologist-orthopedist and chief consultant for orthopedic products at Medi, talks about new methods of treating ankle injuries
Ankle is a joint connecting the lower leg and foot. It plays an important role when walking, carrying out the so-called roll - the redistribution of weight from the heel to the forefoot. The ankle bears the entire weight of the body, so it is very strong and inactive, it has a powerful ligamentous apparatus.
- Since it is so durable, it probably rarely gets injured?
Vice versa. The ankle joint is constantly under very heavy loads. Especially in winter when it’s icy, when it’s very easy to twist your leg. Those with a strong ankle get off relatively easily - with a simple sprain.
- What stretches?
Ligaments: their elasticity is impaired, micro-tears occur, if blood vessels rupture, a hematoma can form. The leg swells, it hurts so much for several days that it’s difficult to walk, but then everything goes away. More complex ankle injuries: broken ankles, torn ligaments, severe sprains.
- You can’t do without the help of a doctor...
If the ligaments are torn, surgery is necessary. The torn ligament must be stitched, and then the joint must be fixed with a plaster cast or a dynamic orthosis. If several ligaments are torn at the same time, a dislocation can occur - this is a very unpleasant injury in which the affected leg does not function at all until the dislocation is set.
- What if the bone is damaged?
Most often, if the leg “tucks” unsuccessfully, the outer ankle breaks. Here, too, rigid fixation will be required for a period of three to six weeks. Then the person will have to undergo long-term development of the ankle joint.
— Vasily Aleksandrovich, you said that a diseased joint can be fixed either with a plaster cast or a dynamic orthosis. What is a dynamic orthosis? Alternative to plaster?
Yes, this is a very interesting development, which in the West at one time made a revolution in traumatology. A dynamic hinge orthosis is a device for fixing the site of injury, much more comfortable than a cast. The main advantage of orthoses is that they allow you to adjust the degree of fixation, which means they can be used effectively at different stages of treatment.
- How is that possible?
At the initial stages of treatment, the orthosis is set to complete immobilization and works like a plaster, reliably fixing the site of injury. Then, during the recovery process, his mobility gradually increases. All hinged structures are designed for multi-stage long-term rehabilitation, thus, when wearing an orthosis, gradual development of the damaged segment occurs.
It is very important that orthoses allow the patient to almost immediately engage in physical activity and maintain muscle tone. This means you won’t have to learn to walk again, like after a cast. In addition, it has been proven that if the area of injury is carefully loaded, then blood flow and trophism in it improves - everything heals much faster.
— What do such orthoses look like?
The German company Medi has an ankle orthosis called medi WalkerBoot. WalkerBoot orthoses are professional orthopedic products. The orthosis looks like a boot, the sole of which has a special rocking shape, due to which a roll from heel to toe occurs, as during natural walking. In this case, the weight is not concentrated at one point, so the patient can begin to walk almost immediately. If, in case of a complex ankle injury, a plaster cast is applied, then the person will be deprived of this opportunity; he will have to move on crutches without stepping on the sore leg.
Agree, it is much more pleasant to walk in an orthosis than in a cast with crutches. Do not forget that the orthosis can always be carefully removed in order, for example, to wash the leg. This trick won't work with plaster.
— How long ago have such orthoses appeared?
Orthoses appeared in Russia less than ten years ago. Even earlier, in some institutes that dealt with prosthetics and orthotics, there were workshops that made such orthoses on an individual order, but only a few could take advantage of this.
- And in the West?
In the West, this trend has been around for over a hundred years, so the technology has been worked out to the smallest detail. Today, they produce a wide variety of orthoses; you just need to choose the right one. And this kind of ready-made orthoses are suitable for 95% of consumers.
- This is a lot, but what about the other five percent?
If the anatomical features of the ankle and the degree of injury do not allow the use of a ready-made orthosis, it is necessary to either make it custom-made or use plaster. I’ll say right away: for complex combined injuries, an orthosis is not recommended. But in all other cases, its use makes life much easier for the patient.
— Orthoses are produced by various companies. What to choose?
In terms of functionality, products from foreign companies are much better than domestic ones. I don’t want to offend anyone, but Russian manufacturers of orthoses, as a rule, try to make their products “to suit the West.” But since they do not have patents, their cuts are similar to Western ones only in appearance. Cheap, but not very high quality. And the same orthoses from the German company Medi have everything patented: special hinges, especially strong alloys, breathable materials that allow air to pass through well, but at the same time have increased strength.
Considering that in case of a complex ankle injury, an orthosis must be worn constantly, the conclusions suggest themselves.
— Who should select an orthosis? Attending doctor?
It's not always the same. Sometimes the hospital itself has a place where you can choose the necessary orthopedic product together with your doctor. But most often the doctor simply writes out a prescription for an orthosis. By the way, I would like to draw your attention to the fact that it is better to purchase orthoses in special orthopedic salons, and not in pharmacies. An individual approach is important here: you need to take measurements, select the right product, try it on, figure out how to use it correctly. This requires time and highly qualified sellers.
— Let's return to Russian realities. Let's say a person breaks his ankle and ends up in the emergency room. How can he convince the doctor to give him an orthosis instead of a cast?
I don't think there will be any problems with this. Now there are fewer and fewer traumatologists who are new to this technique. Orthoses are gaining popularity and are beginning to replace the good old plaster cast. Once at the emergency room, simply ask the doctor if he thinks it is possible to use an orthosis for this injury. But, in general, it is the doctor who is responsible for the patient’s health, so if he says that in this case it is more advisable to put on a cast, it is better not to argue with him.
As an advertisement
Indications for wearing orthoses
If everything is clear with plaster, then it’s worth telling a little about the indications for the use of orthoses.
So, orthoses are worn in the following cases.
- For fractures of extremities, except open fractures.
- During the rehabilitation period after surgery, for example, on a joint.
- Chronic or other diseases: arthritis, arthrosis, ankle dysplasia, paralysis, etc.
- In case of incomplete healing of the damaged limb, for example, after removing a cast.
- In case of sprain or rupture of ligaments, tendons, joints.
We would also like to note that orthoses are not always worn for any injuries or illnesses. They are worn before playing sports or heavy physical work to eliminate the risk of injury.
Femoral neck fracture. Peculiarities
When a fracture occurs, the blood vessels of the neck are torn, and joint fluid gets between the fragments. In the vast majority of cases, the fracture does not heal on its own. Only 3-4 months after the injury, a scar forms at the fracture site, which is still unable to withstand the weight of the body.
A fracture of the femoral neck is an indication for surgery. Depending on the age and type of fracture, fixation with screws or joint replacement - endoprosthetics - is chosen. If there are contraindications, bed rest is prescribed, and then walking on crutches or a walker.
What is a derotation boot and why is it needed?
Immediately after injury, before and after surgery, patients with a femoral neck fracture are prescribed a derotation boot. This product often surprises patients - they believe that fractures can only be treated with plaster. However, in most cases, a derotational boot is the best option for immobilizing a broken femoral neck.
A modern derotational boot – a plastic ankle bandage with a breathable hypoallergenic lining. A plate or stick is placed in the heel area perpendicular to the length of the foot. The purpose of the bandage is to keep the foot in a stationary position and prevent hip rotation.
But where is the foot and where is the hip? The fact is that rotation (rotation) of the entire leg occurs only in the hip joint. Straighten your leg and try to twist it from side to side - it does not rotate either at the knee or at the ankle. Therefore, to stabilize the femoral neck, it is enough to hold the leg in the foot area.
Of course, sometimes full-fledged dressings are used. They allow you to walk, as they also limit flexion and abduction of the leg. The disadvantage of such devices is their large mass and discomfort during use. Therefore, a derotational boot is the most convenient and effective remedy for fractures of the femoral neck.
So what to choose for a fracture: plaster or orthosis?
Unfortunately, we cannot say what exactly you need to choose in your case. Only your attending physician, orthopedist or traumatologist can answer this question.
If you have a complex injury, such as an open fracture, then you should not refuse a cast. In any case, you will have to wear it for 7 to 10 days. And after this period, you can always change the cast to an orthosis.
And in the end, we would like to remind you once again that before buying an orthosis, consult your doctor.
Well, if you have already done this, and now it’s time to choose and buy an orthosis, then go to our catalog and choose the right model for yourself. We work in Grodno and deliver goods to your home.
Application of plastic plaster
Immobilization with plastic plaster in the clinics of JSC Family Doctor
Turbocast plastic gypsum is a low-temperature thermoplastic. When heated to 60-100° C, the material becomes plastic. In a few seconds it cools down to 35-45° C on the surface, which makes it possible to apply a bandage to the body. If necessary, it can be reheated - this allows you to set the required shape of the orthosis in accordance with your clinical situation. Within 6-8 minutes, Turbocast hardens, turning into a strong, rigid structure.
Immobilization with plastic plaster in Moscow is carried out by traumatologists from the Family Doctor clinic network.
Make an appointment Do not self-medicate. Contact our specialists who will correctly diagnose and prescribe treatment.
Is it possible to replace a cast with an orthosis?
In most cases, a modern medical device is a better replacement for a plaster cast. Plaster is a classic method of fixing broken limbs. It has a number of disadvantages and often causes inconvenience and discomfort to the patient. An orthosis is a modern way to immobilize injured joints. It reliably fixes the damaged area, weighs little, causes minimal inconvenience, but its use is ineffective and unreliable for particularly severe fractures. After examination, only a traumatologist, having determined the severity of the injury, can prescribe a suitable and necessary method of fixation.