Have you noticed that you take more time than allotted to make an orthosis? Do you feel rushed and/or nervous when you see that you have to make an orthosis during a 30 minute treatment time? Do you take forever to fix an orthosis that leaves pressure areas on the patient?
Do you need some tricks to cut down on time without compromising the fit, function and look of the orthosis? I hope that this blog will help you with some tricks that I have learned over the 35+ years of practice and teaching orthosis fabrication.
Let’s start by looking at PRESSURE AREAS and PADDING
Does it take you forever or maybe never to get the orthosis to fit correctly without causing pressure areas? Do you add padding AFTER you fabricate the orthosis or after your patient has worn the orthosis for a while and then complains about a pressure area? The reason for this pressure problem is that you actually INCREASE the pressure if you add the padding after the fabrication. There are a few ways to easily prevent pressure areas and save time and effort.
You must prepare the extremity BEFORE the fabrication. Here are 2 ways to do this! One with padding, and one with putty.
You see in photo A that the extremity has a stockinette in place and then a round pad over the Ulnar Head. I use stockinet before padding if the patient has a dressing or sensitive skin. If not, I place the pad directly on the patient’s skin. I use adhesive backed, thin padding. The softened thermoplastic is placed and formed directly over the padding. A small imprint (see Photo B) will occur on the inside of the orthosis, and a tiny bulge will occur on the outside (see Photo C).
When the thermoplastic is cooled, the piece of padding is removed from the stockinet and placed into the imprint on the inside of the orthosis. This increases the comfort by adding space for the padding, rather than taking up space with the padding. The placement of the pad also helps the patient understand how to don the orthosis correctly. Once the orthosis is completed, instruct the patient which bony prominence corresponds to which padding.
You see in photo D that the extremity has a “blob” of putty over the Ulnar head. This is a quicker and less expensive way to prepare the extremity for orthosis fabrication. Take a small piece of high density putty and make it into a ball. Then flatten it on the table and apply over the bony prominence. Place the heated thermoplastic directly over the putty, but ONLY if you are using coated material! If you are using non-coated (self-stick) material, you need to place a wet paper towel over the putty first. Once the thermoplastic has cooled, remove the splint and the “blob” of putty and the orthosis is ready to go! You can see the outside bulge in the photo C.
In my next blog, I will share some ideas for splint straps.