Orthopedic devices (stifle braces, orthotics, etc.) (Proceedings)

In the field of small animal orthopedics, orthoses, prostheses and other assistive devices are an emerging technology that can aid in the well-being of our canine patients. These devices are used to either correct or accommodate the affected limb(s) following trauma or surgical intervention, and may be utilized as temporary or permanent modalities. The objective of this paper is to introduce new technologies in canine carpal and tarsal orthotics, forelimb and hind limb prosthetics, and other assistive devices including stifles braces, shoulder stabilization systems, and custom ehmer slings.

Devices

Dogs with cranial cruciate ligament (CCL) insufficiency can benefit from a custom hinged stifle brace in order to give support/stability to the stifle. Custom stifle braces can be used pre-operatively in dogs with bilateral CCL insufficiency in which the brace is applied to non-surgical limb as the operated limb is recovering from surgery or in juvenile patients with open proximal tibial growth plates awaiting surgery; post-operatively following stifle stabilizing techniques; or for dogs who are not surgical candidates for long-term use. Early partial CCL tears that are undergoing rehabilitation therapy, patellar tendon rupture repairs, and collateral ligament repairs can be accommodated with use of a custom stifle brace. "Tamarack" joints can be used to offload the stifle by mimicking the actions of a healthy ligament. "Ultraflex" joints can be used to increase range of motion where a contracture is present. A range of motion joint can also be used to set a desired range or to statically progressively aid in contracture management.

For dogs requiring a limb or partial-limb amputation due to neoplastic conditions or severe trauma prosthetics may be used to replace a missing limb or portion of the limb. Prosthetics range from simple fillers to full limb amputations for the forelimb or hind limb. Prosthetics are extremely valuable for patients with other concurrent orthopedic conditions who could not tolerate a three-legged lifestyle.

Carpal injury in dogs may range from sprains and strains to complete "carpal collapse" or carpal hyperextension injury. Numerous devices have been developed to support and protect the carpus as the dog is progressing through rehabilitation therapy or as a long-term option for patients who are not ideal surgical candidates. Carpo-Flex neoprene wraps are ideal for mild sprains and strains, supporting the carpus following splint or cast removal, or protecting against re-injury for the canine athlete. Where additional support is required, low-temperature thermoplast and/or additional straps may be incorporated into the wrap. These wraps are easily removed and applied for rehabilitation therapy. Where complete immobilization is desired a solid posterior shell design or bivalve (clam shell) designs can be used for maximal support. "Tamarack" joints can be used to reduce hyperextension, while allowing range to assist in a more normalized gait pattern. Range of motion joints are used for more active dogs to allow full range of motion and only limit hyperextension.

Like the carpus, numerous devices have been developed to support and protect the tarsus and Achilles tendon following injury. Tarso-Flex neoprene wraps are ideal for mild sprains and strains, supporting the tarsus following splint or cast removal, or protecting against re-injury for the canine athlete. Where additional support is required, low-temperature thermoplast and/or additional straps may be incorporated into the wrap. Like the carpal wraps, these wraps are easily removed and applied for rehabilitation therapy. Where complete immobilization is required such as following Achilles tendon repair custom hock braces may be used. "Ultraflex" joints can be used to increase range of motion where a contracture is present. "Tamarack" joints can be used to reduce range of motion or assist motion of the tarsus.

Medial shoulder instability (MSI) has been shown to be a common cause of forelimb lameness in dogs. Depending on the severity of the instability conservative treatment utilizing a rehabilitation therapy program or surgical intervention has been described. As the patient is progressing through the rehabilitation or post-operative period protecting the shoulder is essential. DogLeggs Shoulder Stabilization System has proven to be a successful part of treatment for shoulder stabilization for both surgical and non-surgical patients. The device consists of removable breathable neoprene/polyester sleeves that attach over the shoulders of the patient and Velcro securely to each forelimb. An additional chest strap can then be applied to secure the device to the patient. One to two inch double-sided Velcro strips serves as a hobble strap to attach to the limbs together. Patients are able to bear weight immediately and adapt rapidly to the device. The device limits abduction, flexion and extension of the shoulder, but allows for full weight-bearing. The patient's gait is altered with a short limited stride, but can be worn continuously for several months with minimal irritation. The device can be removed and reapplied easily for rehabilitation therapy. In patients that have undergone arthroscopic treatment (radiofrequency treatment, imbrication, etc), the device is placed while under anesthesia just prior to recovery. Patients with severe MSI that have undergone surgical reconstruction are first placed in a custom Velpeau for 2-4 weeks followed by DogLeggs Support System for another twelve weeks of continuous wear.

Ehmer slings are commonly used to protect the hip following conservative or surgical treatment of coxofemoral luxations. Unfortunately, the standard Ehmer sling can not be easily removed and reapplied thereby limiting the ability to perform rehabilitation therapy. In addition, depending on the materials used Ehmer slings may cause secondary skin irritation and abrasions. DogLeggs VEST with Ehmer Sling is a custom form fitting sling which allows for proper positioning and immobilization while allowing access for rehabilitation therapy. The VEST and Ehmer Sling are manufactured utilizing Breath-O-Prene® Silvertec® a hook compatible "fabric" that is stretchable, breathable, antimicrobial, antibacterial and bactericidal. The VEST's hook compatible exterior provides the ability to adjust the garment to comfortably fit the patient. The design of theVEST allows for total range of movement of unaffected limbs. No discomfort or restriction of activity due to wearing the VEST is experienced by patient. The Ehmer Sling is attached directly to the VEST by use of Velcro® Hook fasteners. By supporting the Ehmer Sling with the VEST the patient tolerates the treatment over long term wear.

Construction and fitting

The most important step in creating a custom stifle brace or prosthesis is to take a proper cast mold of affected limb(s). The functional angle must be reflected in the cast as accurately as possible, however, casts themselves can be modified to some degree. The cast is then poured with plaster of Paris to create a positive model of the affected limb(s). The mold is modified to accommodate for boney prominences and sensitive areas and sculpted to fit the affected limb(s). Foam and high temperature thermoplastics are heated and vacuum formed around the mold in varying layers/designs to create the most functional custom product for each pet. For complicated prostheses, sometimes check sockets are needed to create a more intimate fitting device. These are clear plastic shells used as diagnostic sockets (created from vacuum forming clear high temperature thermoplastics). Check sockets can be modified and used to create the definitive prosthesis. The shank and feet are created from aluminum/steel/carbon fiber/wood, etc depending on size and activity of the animal. A "rocker bottom" foot is usually used to mimic the normal gait cycle. The shank/foot is aligned under the weight line and abducted five degrees for contralateral limb clearance. A toe out of about 5-7 degrees is also added for stability and lateral movements.

For the support systems such as carpal and tarsal wraps, shoulder stabilization system, custom vest Ehmer sling, and A-Trac stifle brace obtaining proper measurements for construction is imperative.

The custom orthosis/prosthesis must be worn in short, increasing increments in order to build up a tolerance to the device. Both the length of the break-in period and the time of each increment will depend on the dog's diagnosis. For best results, the brace is applied for only 1 hour the first day and increase by 1 hour per day. If there is any irritation or skin break-down, discontinue use for 1 full day. A short period of time is required before the dog accepts the orthotic/prosthetic device. In order to facilitate the dog's acceptance of the device, the orthosis/prosthesis should be associated with positive reinforcement. Unlike the custom orthosis/prothesis, the support systems are typically placed on the patient immediately following injury or surgery for long periods of time. These systems have been designed to allow for easy removal/assess of the affected limb for rehabilitation therapy and inspection for soft tissue irritation. These devices can easily be modified to relieve any areas of irritation. It is also important to inspect the device regularly for any cracks or tears. Padding and Velcro can be replaced. Patients are able to wear their devises comfortably for extended periods of time without discomfort or irritation that is a common problem with the use of adhesive tapes and wraps.

Most dogs adapt to the devices within days to weeks, however, this is largely dependent on owner supervision and compliance. If the device is worn and broken in properly most animals experience very few skin complications because of the custom fit. The development of these devices has helped treat and maintain many orthopedic conditions and injuries with great success, with and without surgical intervention. They often provide an alternative to surgery when combined with proper introduction, maintenance and rehabilitation. The success rate is a harder to predict with the prostheses. Animals who have already adapted to the three-legged gait pattern reject the device at a greater rate.

Devices contact information

     • Paw Support/Protection

          • Thera-Paw; http://therapaw.com, 908-439-9139

     • Extremity Splints

          • OrthoVet Splints; Orthovet, http://orthovet.com, 866-207-9205

     • Carpal Wraps

          • Carpal Brace; Canine Icer, http://canineicer.com, 434-975-5939

          • Carpal Brace; DogLeggs, http://dogleggs.com, 800-313-1218

          • Carpo-Flex Sports Wrap; Thera-Paw, http://therapaw.com, 908-439-9139

     • Tarsal Wraps

          • Hock Holder; Orthodog, http://orthodog.com, 828-298-0885

          • Hock Sock; DogLeggs, http://dogleggs.com, 800-313-1218

          • Tarso-Flex Sports Wrap; Thera-Paw, http://therapaw.com, 908-439-9139

     • Elbow Protectors

          • Dogleggs; DogLeggs, http://dogleggs.com, 800-313-1218

     • Stifle Supports

          • Animal Orthocare, http://animalorthocare.com, 703-474-6204

          • A-Trac Dynamic Brace; Woundwear, http://woundwear.com, 800-443-4055

     • Shoulder Stabilizers

          • Hobbles; DogLeggs, http://dogleggs.com, 800-313-1218

     • Hip Stabilizers

          • Ehmer Sling; DogLeggs, http://dogleggs.com, 800-313-1218

          • Hip Hound; Orthodog, http://orthodog.com, 828-298-0885

     • Neck Braces

          • NBT Brace; Agri-Pro Enterprises, http://agri-pro.com, 800-648-4696

     • Mobility Aids

          • Biko Physio Brace; ARWI, http://arwi.com, 919-861-5868

          • Dorsi-Flex Assist; Thera-Paw, http://therapaw.com, 908-439-9139

     • Dynamic Splints for Reducing Contracture

          • Dynasplint; Dynasplint Systems, http://dynasplint.com, 800-638-6771

          • Joint Active System; Joint Active Systems, http://jointactivesystems.com, 800-879-0117

     • Air Splints

          • Urias Air Splints; Sammons Preston, http://sammonspreston.com, 800-665-9200

     • Paw Supports

          • DogLeggs, http://dogleggs.com, 800-313-1218

          • Thera-Paw, http://therapaw.com, 908-439-9139

     • Carpal Wraps

          • Thera-Paw, http://therapaw.com, 908-439-9139

     • Tarsal Wraps

          • Thera-Paw, http://therapaw.com, 908-439-9139

     • Orthoses

          • Animal Orthocare, http://animalorthocare.com, 703-474-6204

          • NTD Orthopedics, http://dogbrace.com, 209-688-4047

          • Orthopets, http://orthopets.com, 303-953-2545

          • Orthovet, http://orthovet.com; 866-207-9205

     • Prostheses

          • Animal Orthocare, http://animalorthocare.com, 703-474-6204

          • Orthopets, http://orthopets.com, 303-953-2545

     • Mobility Aids

          • Thera-Paw, http://therapaw.com, 908-439-9139

     • Thermoplastics, Padding, Strapping

          • Thera-Paw; http://therapaw.com, 908-439-9139

          • Jorvet; http://jorvet.com, 800-525-5614

          • Sammons Preston; http://sammonspreston.com, 800-665-9200

     • Neoprene

          • Thera-Paw; http://therapaw.com, 908-439-9139

          • Sammons Preston; http://sammonspreston.com, 800-665-9200