The most popular type of orthopedic device is a knee orthosis. The product fixes diseased or injured joints in a certain position, relieving them of excessive stress. This device is attributed to many patients for the prevention of diseases of the musculoskeletal system and the treatment of the musculoskeletal system. To select the correct orthosis, you need to familiarize yourself with its design features, functions, and varieties.
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Purpose of wearing the product
The orthosis is prescribed by an orthopedic doctor after examining the patient, collecting an anamnesis, and making a diagnosis. The device is used to prevent knee injuries and treat damaged joints.
Functions of knee orthoses:
- Full or partial fixation of the articular apparatus;
- Removing excess load from the knee;
- Correction of the correct position of the joint.
Fixation of the knee joint with an orthosis helps improve the functionality of the joint, stop or significantly slow down the development of pathologies during therapy and restoration of the musculoskeletal system. Wearing a brace prevents re-injury of the knee after surgery.
An orthopedic product is selected separately for each patient. The bandage must be selected in size and not cause allergic reactions or discomfort.
The problem of ununited fractures and false joints of long bones still occupies a large place in scientific research. Despite known advances in the treatment of patients in this group, the results leave much to be desired.
According to the literature, this complication occurs after treatment of open fractures in 8% to 35% of cases; after closed fractures, nonunion occurs in 5% to 11%.
The reasons for such a high incidence of complications of bone fractures most often come down to defects in local treatment - inaccurate reposition of fragments, short-term or unstable immobilization, incorrect choice of method for fixing fragments and performing an osteosynthesis operation, suppuration of the fracture site complicated by chronic postoperative osteomyelitis. In open fractures, nonunion may be associated with the nature of the injury - extensive crushing of soft tissues, vessels and nerves, infectious complications and the development of post-traumatic osteomyelitis.
The main methods of treating false joints remain various types of surgical treatment, well developed in recent years: stable intraosseous osteosynthesis, autologous bone grafting, compression-distraction osteosynthesis with the Ilizarov apparatus, external metal osteosynthesis in combination with autologous bone grafting. But, despite all the methods of surgical treatment used, in the future (with this pathology) a longer period of external immobilization is required, compared to fractures.
The main disadvantages of the widely used plaster cast include: heavy weight; fragility during use, especially under load (bandages on the lower limb); contamination of the dressing both outside and inside with skin secretions; When water gets on the bandage, it gets wet and loses all its fixing qualities. All this requires repeated dressing changes during long periods of treatment.
Custom orthoses made of thermoplastic for the upper and lower extremities must meet the following requirements:
- when using them, fixation and dynamic correction of damaged segments should be carried out in a functionally correct position;
- partial unloading of the damaged segment with transfer of the load to healthy areas of the body to allow restoration of limb function;
- hygiene (it must be possible to sanitize the product);
- aesthetics (the orthosis should be light, durable and, if possible, not protruding from under clothing);
- the possibility of early rehabilitation of the patient using an orthosis.
For this purpose, the following types of products have been developed and introduced into clinical practice at our enterprise:
Shoulder splint
It is used after fractures in the area of the shoulder joint and the upper third of the diaphysis of the humerus, during periods of instability; with traumatic lesions of the ligamentous-capsular apparatus; with humeroscapular periarthritis; after operations on the ligamentous apparatus of the shoulder joint.
Splint for the elbow joint
Used for immobilization of false joints of the upper third of the forearm and after surgical interventions on the elbow joint; for inflammatory and degenerative diseases of the elbow joint, as well as for paresis of the muscles of the forearm.
Tutor for the whole hand
Prescribed for false joints of the forearm; for immobilization of the elbow joint after surgery; with paresis of the muscles of the upper limb to give it a functional position; for inflammatory and degenerative diseases of the elbow joint.
Arm device with a hinge in the elbow joint
Used for immobilization of fractures and false joints in the middle and lower third of the diaphysis of the humerus, as well as the upper third of the forearm; after surgical interventions on the elbow joint in order to prevent deformities, stiffness and early activation; for inflammatory and degenerative diseases of the elbow joint, as well as for paresis of the muscles of the forearm.
Clinical example:
Patient Sh., 46 years old. D.Z.: Floppy consolidating comminuted fracture of the humerus
Radiographs of patient Sh. before using the device
Radiographs of patient Sh. after using the device
Appearance of patient Sh. in the apparatus and range of motion in the elbow joint
Abduction splint on the arm with a semi-corset
It is used for fractures of the surgical neck of the shoulder and fractures of the articular surface of the scapula to improve the development of movements in the shoulder joint in the post-immobilization period (makes it possible to wear outer clothing).
Splint for the wrist joint
It is used in patients with flaccid consolidating fractures of the forearm bones in the lower third and metacarpal bones; with inflammatory and degenerative diseases of the wrist joint; in patients with radial or ulnar deviation.
Splint for rigid fixation of the hip joint with a semi-corset
Prescribed for immobilization of the pelvis and hip joint in a certain position, during the period of consolidation of fractures in the hip joint area and the upper third of the thigh, in case of instability of the joint after endoprosthetics.
Splint for rigid fixation of the hip and knee joints with a semi-corset
Prescribed for immobilization of fractures and false joints of the middle and lower third of the femur; for inflammatory and oncological diseases of the hip joint, pelvis and thigh.
Clinical example:
Patient B., 14 years old. D.Z.: Condition after resection and autoplasty of the femur, pseudarthrosis in the third part of the graft.
Before using the orthosis, the patient was in bed rest. After making an orthosis from a polymer material, the patient was taught to walk with the help of a cane; the shortening of the lower limb was compensated by special orthopedic shoes.
Splint for rigid fixation of the knee joint
It is used during the rehabilitation period after injuries and operations in the area of the distal femur and proximal bones of the leg, for injuries of the capsular-ligamentous apparatus of the knee joint, hemarthrosis, arthrosis-arthritis, bursitis, synovitis, meniscitis, as well as for moderate valgus and varus deviation of the leg , with recurvation of the knee joint and paralysis of the muscles of the lower limb of various etiologies.
The splint provides immobilization of the knee joint with fixation of 2/3 of the thigh and 2/3 of the lower leg. If necessary, it is reinforced with metal bars, and the fastening system allows you to create the required degree of compression.
The product is not indicated if it is impossible to load the lower limb, as well as with local dermatitis, pustular infection and fixed flexion contractures of the knee joint.
Splint for rigid fixation on the entire leg and unloading under the tube
It is prescribed for flaccid consolidating fractures and false joints of the upper and middle third of the leg, as well as the lower third of the thigh, for inflammatory diseases of the knee joint, for flaccid and spastic paralysis of the lower extremities, and for a tendency to flexion contracture of the knee joint.
Clinical example:
Patient G., 23 years old.
D.Z.: Pseudarthrosis at the border of the middle and lower third of the thigh, chronic post-traumatic osteomyelitis. X-ray before immobilization.
X-ray 2 months after the start of immobilization
Ankle splint
It is used after fractures of the ankle joint and lower third of the leg when their consolidation is delayed; in case of damage to the ligamentous apparatus of the ankle joint; for arthritis of various etiologies; for destructive diseases of the ankle joint.
Clinical example:
Patient D., 56 years old.
D.Z.: Floppy consolidating fracture of the lower third of the leg. He has been ill for about 1.5 years. The patient has been walking all this time with the help of crutches without putting any weight on his sore leg. After making an individual orthosis, the patient is taught to walk without additional support.
Protective and unloading shin splint
Indicated for delayed consolidation and false joints of the upper third and middle third of the tibia, as well as after operations on the bones of the lower leg. Provides external fixation of the lower leg for the purpose of immobilization and creating the possibility of axial load on the limb.
Clinical example:
Patient B., 46 years old.
D.Z.: Pseudarthrosis of the upper third of the tibia, chronic post-traumatic osteomyelitis, fistulous form. Diabetes mellitus He has been ill for about 2 years, during which time he has undergone several osteosynthesis operations without a positive result. When presenting, the patient walks with the help of crutches. The patient was given an individual orthosis and taught to walk without additional support.
Full leg device with knee joint
Prescribed to patients with widespread paralysis or paresis of the muscles of the lower limb; after plastic surgery of the muscles of the knee joint; during recurvation of the knee joint, as well as for unloading and fixing the correct position of the lower limb.
Clinical example:
Patient E., 16 years old. D.Z.: Residual effects of cerebral palsy. Spastic adduction contractures of both legs. In the apparatus, contractures were eliminated, the patient was taught to walk without additional supports
Conclusions:
1. Modern materials and vacuum molding technology make it possible, through individual modeling of products, to bring their configuration as close as possible to the anatomical shape of a body segment and to ensure adequate immobilization of the pseudarthrosis site due to precise anatomical and physiological adaptation to the patient’s body, which makes it possible to carry out early loading of the damaged limbs. The weight of such a bandage is 10 times lighter than its plaster counterpart, which facilitates the functional use and social activity of the patient.
2. The necessary orthopedic products are manufactured within a period of a week to several hours.
3. The use of thermoplastic in traumatology and orthopedics makes it possible to fundamentally change the method of conservative treatment and rehabilitation of patients in the postoperative period. The manufactured orthosis allows, in the stages before consolidation of the fracture, to return the lost function to the limbs. For disabled people with deformities of the musculoskeletal system, dynamic correction should be carried out during treatment in the same orthosis, taking into account the restoration of lost function.
4. The service life of a polymer product is many times longer than the service life of a plaster bandage, it is more hygienic due to the ability to remove the bandage and carry out hygiene procedures, and is less susceptible to mechanical damage under load.
The article was published in the journal “Bulletin of Prosthetists and Orthopedists”, No. 2(8), 2002.
When is an orthosis prescribed?
It is allowed to wear an orthosis strictly as prescribed by the attending physician. Orthopedic bandages are used to prevent knee damage, accelerate the restoration of joint functionality after injury, and treat diseases of the musculoskeletal system.
Indications for the use of a knee orthosis:
- Damage to the external or internal meniscus in the knee area;
- Patella displacement;
- Sprain or injury to the collateral and cruciate ligaments;
- Arthritis (development of the inflammatory process) and arthrosis (chronic disease);
- Restoring knee function after illnesses and injuries;
- Prevention of joint damage during regular sports training, heavy physical activity, etc.
The main contraindications to the use of an orthosis are a violation of the circulatory system, severe swelling of the leg, inflammatory processes on the skin, dermatitis. For varicose veins, it is allowed to wear retainers after medical consultation. The doctor studies the patient’s medical history, compares the positive and negative effects of using the bandage, and assesses the risks. The doctor additionally prescribes special compression garments to prevent the development and progression of varicose veins.
Orthoses are strictly prohibited for thrombophlebitis (thrombosis with an inflammatory process on the walls of the vein and the formation of a blood clot that closes its lumen). Do not wear a bandage on injured skin (wounds, cuts, burns). It is prohibited to wear a medical device for skin diseases directly located on the leg. You must immediately stop wearing the orthosis if you experience an allergic reaction to the materials from which the medical device is made.
What is a splint and what is it for?
The modern brace is a lightweight and durable detachable bandage for immobilizing the knee. It allows you to step on your foot, but completely eliminates movement in the joint. The lower leg and thigh are stabilized by durable metal or thick plastic plates.
A splint is prescribed in cases where it is possible to step on the leg after an injury. Typically, the period of use of the product does not exceed several weeks. If the treatment requires a longer period, it is no longer splints that are indicated, but special functional orthoses.
Types of products
To choose the right orthosis, you need to familiarize yourself with the classification of devices. The division of orthopedic products is carried out according to several criteria.
Classification of knee joint orthoses by purpose:
- Preventive – used for patients at risk (athletes, people doing heavy physical work, etc.) or when diagnosing minor pathologies;
- Rehabilitation – used after injuries and operations, they fix the joint in the correct position, promoting the rapid restoration of knee function;
- Functionally permanent - prescribed for long-term treatment of various diseases of the knee joint.
Types of orthoses by functionality:
- Fixing – completely or partially limit the mobility of the knee;
- Corrective – when worn for a long time, they correct the incorrect position of the joint;
- Unloading – eliminates unnecessary loads on the joint apparatus;
- Compensating – maintain the correct position of the leg when the functionality of the knee joint is impaired.
By design, there are open, closed and articulated orthoses. The first option is used for injuries to ligaments and tendons, and for the treatment of chronic joint diseases. A closed brace is worn to keep the knee warm. The device is hinged and equipped with steel inserts to improve fixation. The hinged product is used for damaged tendons.
Depending on the degree of fixation, there are soft, semi-rigid, and rigid knee joint orthoses. The first type resembles a bandage, but is better at preventing unwanted movements. The semi-rigid device consists of tapes with stiffening ribs.
A rigid orthopedic product resembles a splint and is used for severe injuries. If there is an adjustment function, it is possible to accurately adjust the device to the anatomical shape of the knee.
Hip splint
The hip joint is the largest joint in the body. It provides movement and is involved in maintaining balance. Damage to the hip joint occurs due to injuries and various diseases. The hip splint is used to provide functional rehabilitation.
In combination with other rehabilitation methods, an orthopedic product helps eliminate symptoms, reduce recovery time, and prevent relapses and complications. A splint for the entire leg allows you to maintain the limb in a given position and compensate for lost function. For disorders of the hip joint, splints are used on the right or left thigh.
Specialists at the Yusupov Hospital use modern methods to restore motor function; for example, a splint for a fractured patella is an important addition to the main treatment. The Yusupov Hospital maintains the tradition of attentive and friendly treatment, and each patient receives high-quality medical services.
You can get advice from highly qualified specialists at the rehabilitation clinic and undergo comprehensive diagnostics at a convenient time, after making an appointment by calling the Yusupov Hospital.
Model selection
To achieve the maximum effect from wearing an orthopedic device, you need to choose the right medical bandage. The product is prescribed by an orthopedist, surgeon or traumatologist after a thorough examination of the knee.
To buy a knee brace that will promote a speedy recovery, you should strictly follow the recommendations provided by the doctor. The doctor prescribes a certain type of bandage to eliminate the problem.
The rigidity of the medical device must also be taken into account. The sports knee brace has a soft design. This product provides good support for the knee, but does not limit movement. Semi-rigid fixation devices are used in rehabilitation after surgery and injuries, and in the treatment of chronic and inflammatory diseases of the lower extremities. A rigid device is used for mechanical damage (fractures, sprains, ruptures) and severe injuries. It completely immobilizes the joint.
When choosing an orthosis for the knee joint, the sewing material is taken into account:
- Cotton. Used when sewing devices intended for long-term wear. Cotton is soft, hypoallergenic, does not irritate the skin, does not cause dermatitis and other skin diseases.
- Elastane and lycra. They guarantee a tight fit, allow air to pass through well, and provide a cooling effect.
- Spandex. Used when sewing fixing orthopedic devices.
- Neoprene. High-quality synthetic material that provides a tight fit. The material warms the knee joint well. Neopropene devices are not intended for long-term wear.
Purpose
An orthopedic knee brace helps to fix the damaged part of the body in the least dangerous position. It can be worn by a traumatologist or orthopedist to improve the condition after injury, provide treatment or preventive measures.
Athletes and other people who constantly experience severe physical activity receive the greatest benefit from the use of fixation devices. With this lifestyle, the risk of injury due to awkward movement, sprains or swelling increases. Elastic bandages help stabilize the area in need and speed up recovery. They also provide gentle warming and relief.
Often the doctor prescribes wearing a bandage in the following situations:
- Sprained knee ligaments.
- Joint diseases – arthritis, arthrosis, osteoarthrosis.
- Swelling, inflammation of the knees.
- Severe pain after injury or surgery.
Unlike more common elastic bandages, knee braces can provide enhanced fixation of the desired area of the limb. The greatest rigidity that can be obtained when putting on a product depends on the features of its design. Due to the correct increased tension, the clamps can remove some of the load from the damaged area, reduce pain and inflammation, and improve blood circulation. Thanks to the use of devices, it is possible to speed up recovery and ensure the knee is in the correct position when moving.
Sizing
When selecting a knee orthosis, the individual anatomical features of the leg structure are taken into account. Most devices are equipped with special lacing and Velcro fasteners so that the design can be adjusted to the required parameters. But due to limited adjustment options, you will need to calculate the size of the medical bandage before purchasing.
What measurements need to be taken:
- Knee circumference in the middle;
- Thigh circumference at a distance of 10 cm from the middle of the knee pad (the interval may vary depending on the brand of the orthosis);
- Leg circumference at a distance of 10 cm below the middle of the knee pad.
With the correct size, you will be able to achieve a positive result when wearing an orthosis. The size chart of orthopedic devices includes XS (children's version), S, M, L, XL.
An orthosis with hinges on the outside is much larger than on the inside. To select the device correctly, you need to take measurements on the inside. Similar rules are observed when purchasing a device with stiffeners.
How to dress and how to wear?
It is very important to provide the bandages with the required degree of tension. When loosened, the bandages are unable to provide the joints with the support they need. Improper tension can result in injury or increased stress on the knees. With intense fastening, the vessels are pinched, limiting the amount of oxygen and nutrients reaching the tissues.
It is better to fasten the bandages for the first time under the supervision of a competent specialist - this will allow you to better understand how to use the tension regulators. They will tell you the optimal level at which to install Velcro or straps. This will help ensure wearing comfort and protection for the joint area.
Those who have been prescribed a bandage should remember that they cannot be worn all the time. The exception is rigid orthoses that patients wear after operations and fractures. If you are planning to use bandages for preventive purposes or to help with recovery, consult a doctor. The optimal wearing time will be selected for you, based on the diagnosis, severity of the disease, and state of health.
When using fixation devices, you must carefully follow all doctor's instructions. Otherwise, you will harm the ligaments and muscles, which will be weakened due to low intensity of work. To prevent this, do not wear the bandages for more than the recommended time. If you experience severe pain when using the fixation devices, you should not continue wearing it. If you experience discomfort, inconvenience, or pain, consult your doctor.
Foot splints
The ankle joint constantly experiences severe stress and is often subject to mechanical damage. In case of injury, an ankle splint is used to fix the foot or to eliminate pain that occurs during movement. There are three main types:
- dynamic – for everyday wear;
- non-load – used during sleep;
- foot supports – prevent foot drop and other similar problems.
Functions of lower limb braces
With the help of a splint, swelling is reduced, blood supply to the sore limb is improved, and tissue restoration is accelerated.
The tutor performs the following functions:
- Provides complete immobilization of the leg joints during therapy and rehabilitation after surgery;
- Reduces pain;
- Creates peace for the affected limb;
- It is used as a preventive measure for a number of diseases (osteoporosis, cerebral palsy);
- Used to correct deformed joints;
- Useful when changing a splint or splint.