Orthosis for children with congenital tibia pseudarthrosis III

Third, Results

Patient can stand and walk freely after wearing orthosis.Bilateral pelvis maintains in the horizontal plane and pseudarthrosis is effectively protected.Patient can operate the device of knee joint locking freely through the training. The work staff needs to adjust the height of orthosis according to their height of growth with follow-up once every six months, and replace surrounding part of the thigh and portion part of shank according to the situation of adaptation. So far, the patient have worn orthotics for seven years, as the underneath pseudoarthrosis of  tibia and fibula stops growing, bilateral unequal length changes from 5cm to 16cm. Bilateral pelvis maintains in the horizontal plane and the growth of spine is normal through compensating the unequal length by orthosis. The patient can live a normal life and learn although the figuration is non-aestheic.

Fourth, Discussion

We will see the following benefits by wearing the MEDI-REHATEK orthosis:tibia and fibula are effectively protected, no need to worry about the new damage caused by the collision force; shank bearing free load, no need to worry about the deformation of the tibia and fibula due to bearing load; bilateral pelvis maintains balance, no fear for deformation of the spine and other complications; no need of amputation.

We understand that the process of formation of congenital pseudarthrosis of the tibia by reviewing documents - the lower part of shin bone bending forward - post-traumatic nonunion - formation of pseudarthrosis. We can assume that: in the early period pediatric patient should wear suitable orthosis designed by us, have the tibia and fibula with reasonable protection.Shouldn’t we have to worry about pseudarthrosis due to post-traumatic fracture and failure of operations in multiple times? With the extensive communication between medical and orthotics circle along with the close relationship between medical rehabilitation and rehabilitation engineering, we will be able to find a better way of the treatment for many diseases. The patient will be able to receive better therapeutic effect, return to society faster and better.

Relative blog:The Application of Spinal Orthosis II

Orthosis for children with congenital tibia pseudarthrosis II

Second, Design of Orthosis

1) Design Ideas

MEDI-REHATEK Orthosis is designed for compensating unequal length of lower extremities,maintaining pelvis in the horizontal plane and avoiding the occurrence of spinal scoliosis; pseudarthrosis bears free of load and is protected ; realizing walking function.

The pseudarthrosis in the proximal tibia.The fabrication of orthosis of free-load on shank and patellar tendon bearing load,which has a small stress area with greater pressure in part that would exceed the tolerance of the skin. We will design an orthosis with free load on ischial tuberosity and soft tissue of thigh according to the specific circumstance (Fig. 2), although the orthosis has more weight than orthosis of free-load on shank and patellar tendon bearing load, it greatly improves the stress condition as well as offers significantly more comfort.

Taking into account that soft tissues of thigh change as age increases, we use opening type at the front of plastic plate with the fasteners in order to adjust the tightness;Orthosis has bilateral metal bars which increases its intensity. It also has a locking device of mechanical knee joint so that knee joint is stabilized when standing and the joint can be opened and bent down naturally when sitting down; There is a shank protection part put on the proximal leg protection for increasing the protection for lesion;The height can be adjustable between knee joint and stirrup as the growth of patient’s height.

2) Material Selection

Polyethylene plate on thigh part is suitable for the skin, which increases comfort and stability; bilateral bars and joint are made of metal that increase the intensity; The bottom of orthosis is connected with metal stirrup under which has rubber in order to increase the comfort level and the slip coefficient during walking.

3)Fabrication Process

The first step: Take the plaster cast from patient(guarantee of wearing comfort); The second step: modification of the positive plaster cast; The third step: the high temperature polyethylene sheet needs heating to be transparent and spreading on the surface of positive plaster cast.Then  get a vacuum molding; The forth step: cut the ideal shape of orthosis and edge polishing after the material is cooled; The fifth step: installation of metal bars, joints, stirrup, and determine the height of the orthosis according to the length of patient’s limb; The sixth step:The patient tries to wear the sample; The seventh step: install velcro straps and complete.

Relative blog:The Application of Spinal Orthosis I

Orthosis for children with congenital tibia pseudarthrosis I

Abstract 

Congenital pseudarthrosis of the tibia is a bone disease being difficult to treat.Many methods of treatment have little effect. Patient's pelvis and torso canmaintain the balance after wearing orthosis.It will avoid a lot of complications, and help the patient standing and walking.

Key words 

Congenital pseudarthrosis of the tibia;orthosis

Congenital pseudarthrosis of the tibia is one of rarest deformity and difficult to treat, and its incidence is about 1: 19000. [1] few children appear pseudarthrosis of the tibia at birth, but most children born without obvious deformity or with only the lower tibia bending forward.The diagnosis is usually determined along with the pain caused by fracture. Fracture is unhealed for a long time, partial pseudarthrosisoccurs in angulation deformity. [2]

No ideal treatment is for congenital pseudarthrosis of the tibia.Repeated surgery stillcan not be cured in the progress of treatment, that may result in lower limb being shortened or disabled , and even in amputation. [2] Surgery is based on yearly treatment.The younger the patient is ,the higher failure rate is. Once the patients wear orthosis, and regular follow-up is necessary. [3].

First,Case Analysis

Children with Surname of An, female, was born August 11, 1995, has the deformity of proximal leg during walking.In 2002 she was diagnosed with congenital proximalpseudarthrosis of the tibia and fibula, her lower limb was shortened after surgery(Fig. 1). In 2004, she came to MEDI-REHATEK Rehab Center to check.Bilateral lower limb was measured with unequal length, the length difference is 5cm.knee is normal where pseudoarthrosis is located below 3cm.Spine are normal. 

Relative blog:Flatfoot and Orthopedic shoes

Flatfoot and Orthopedic shoes

Today MEDI-REHATEK will introdue you the symptom and cause of flatfoot.

A symptom

1, symptoms: 

There are two types of flatfoot,that is renewable and stiff.The medial longitudinal arch can be observed in normal foot when sitting and standing.If the arch is disappeared when sitting,saying renewable flatfoot. If we can not see longitudinal arch of the foot, that is stiff flatfoot. It can be separated into postural and spastic type.

1.1 Postural flatfoot: 

The onset of the arch is no abnormal appearance. But it feels tired and pain after walking and foot fatigue.The outside ankle of shank has a sense of pain, sole center and instep may have swelling.The navicular tuberosity hasswelling and tenderness, local skin with redness as well as mild foot varus limitsstanding. Symptoms and signs of flatfoot and foot valgus may disappear after rest.

1.2 Spastic flatfoot: 

It occurs most in young adults, some evolve due to be mishandled from postural flatfoot.It feels severe pain when standing or walking and the footstep is like Chinese character “八”. Peroneus longus has tonic spasm, footvarus and valgus, abduction movement is limited. Heel is widened, sole turnsoutwards, the achilles tendon deflects outwards. Navicular tuberosity of forefoot abduction completely collapses and projects outwards. Much worse,the footbecomes stiffness. The movement of foot varus and valgus, abduction and dorsiflexion is limited.It is difficult to improve symptoms even after a long time of resting, it, partial patients may has secondary  low back pain and hip-knee pain.

According to the clinical severity of the disease,it can also be separated into three types. But the change needs to be observed when the longitudinal foot arch bearsweight:

① Light: longitudinal foot arch reduces;

② Medium: longitudinal foot arch disappears;

③ Heavy: longitudinal foot arch disappears with the projection of medial edge. The head of the talus is shifted to plantar side that is below the front of malleolus. Sometimes patients presents with shortened achilles tendon and heel turns outwards.

2 Complications: 

Early symptoms have the anteromedial ankle pain. Long time of standing or walking exacerbates the pain.Rest relieves pain. The pain joint has swelling around,much wore like scaphoid tubercle causes staggering step, achilles tendon splays like the Chinese character “八” .

Through footprints inspection, the vacancies of longitudinal arch disappear.The middle of foot becomes wider, and sometimes as well as heel does.The arch disappears after X-ray examination. The angle increases between the longitudinal axis of the calcaneus and talus.Bone bridge forms after 12 years old.

B  Cause of Disease

It has not been elucidated, but epidemiological studies have found that the disease has a significant genetic predisposition. Pathological inspection shows that tarsal has no developmental abnormalities, but the ligaments connection with joint capsule of articulationes subtalaris,articulationes talonavicularis,boat wedge joint is more flabby than normal people.Calcaneus beneath talus turns inwards when foot bears load,its front moves to back and outer side.The talus moves to plantar and interior side. It will cause with more slack ligament that can’t support the head of talus.Longitudinal foot arch is lowered.The slack calcaneal ligament makes the calcaneus turn inwards and exacerbates the decline of longitudinal foot arch.

Clinically the cause of disease is separated into four factors:

① genetic factors;

② congenital deformities of foot bone ;

③ foot trauma or chronic fatigue;

④ Intrinsic or extrinsic muscles of foot is weak or spastic or paralyzed.

Relative blog:Finger Bender

Orthopedic insoles for diabetic foot ulcers

Diabetic foot ulcers is one of the common chronic diabetic complications, that is the main reason of amputation on diabetics. The feet of diabetics are particularly vulnerable to vascular and neurological diseases. 

Diabetic vascularity and nerve diseases affect each other and cause a series of clinical foot disease, including toe disease, callus formation, foot ulcers and skin lesions, musculoskeletal lesions causing deformities of the feet. The neuropathy of diabetics often causes loss or reduction of foot that is vulnerable to injury.Minor trauma can quickly cause ulcers, infections and gangrene, and eventually to be amputated.

MEDI-REHATEK Orthopedic insoles have treatment and prevention of diabetic foot ulcers.It redistributes plantar pressure,absorbs shock,stabilizes the foot and limits joint activities. 

At the same time patient can wear with the orthopedic shoes that are fit for their own feet ,have inner depth and can decrease foot pressure andaccommodate foot deformities. 

Relative blog:Rigid palm orthosis

Arm sling for three common injuries

Arm sling,also known as upper extremity sling,that is used in rehabilitation phase after with injury of upper limb.

Three major symptoms of MEDI-REHATEK arm sling as below:

First, to limit the joint after with fracture and injury of upper limb;

Second, to limit the joint with stroke, paralysis;

Third, to limit the joint with paralysis of deltoid muscle

Arm sling is mainly used for joint limit and protection when sitting and standing. 

More relative blog: Five clinical indications of shoulder abduction orthosis

Rigid elbow orthosis

MEDI-REHATEK Rigid elbow orthosis, also known as fixed shoulder-elbow-wrist brace ,which is widely used in limit protection for elbow injury of upper extremity.

First, rigid elbow orthotics has functional fixation of elbow fracture;

Second,rigid elbow orthosis offers functional fixation of muscle injury on elbow;

Third,rigid elbow brace provides functional fixation of tendon injury on elbow;

Fourth,rigid elbow immobilizing orthosis is for functional fixation of nerve injury on elbow.

Relative blog:External fixation device for injured upper limb