Final Review
Orthopedic Appliances
Orthopedic Technologist:
- Extension of the orthopedic surgeon and assists in the care of sick and disabled
- NBCOT- National Board for Certification of Orthopedic Technologists
- NAOT- National Association of Orthopedic Technologists
- Certification: 150 questions, Cue’s
OTC- 2 yrs on the job training full time orthopedic technology, completion of NAOT or
Ortho Tech School, ATC with minimum 6 month experience
OT-SC- OTC, Orthopedic PA
Orthopedic Coding:
- ICD-10, International Classification of Disease, maintained by World Health
Organization, Used to track disease and epidemics, mortality rates
- CPT codes are written and maintained by the American Medical Association
- Accepted by Medicare and most 3rd party providers
- E&M- Evaluation and Management: Can’t bill for initial cast,
- Modifiers: used when an E&M or other procedure is billed in conjunction with
another procedure
- Modifier 24- you indicate a separate unrelated service that was preformed during
the same time period.
- Modifier 25- Separate service by same Dr on the same day of the procedure or
other service
- DME- Durable Medical Equipment, must withstand repeated usage
Ambulation:
- Elbow crease to tips of fingers
- 2 inches up and 6 inches out
- 2-3 fingers from axilla
- 30 deg elbow flexion
- 77% of height (height inches- 16 inches)= height of the crutch
- Crutch Palsy effects the radial and axillary nerve, paralysis of triceps, anconeus,
and extensors of the arm, wrist drop, poor grip, supination is still possible due to
biceps brachii, paralysis of elbow extensors
- Canes- Greater trochanter to the floor, cane moves with the injured leg
- Crutch- down bad leg down first then the crutch (bad go down to hell, good go up
to heaven)
- Tripod: L crutch, R crutch, then drag both legs to the crutches (paraplegia
learning to swing gait pattern), Non Weight bearing
- Two-Point: L crutch and R foot, R crutch and L foot (faster then 4 pt, assisted full
wt bearing)
- Three Point: move both crutches and injured leg, 12-15 inches ahead of good leg,
then swing good leg ahead of crutches (non weight bearing)
- Four Point: L crutch, R foot, R crutch, L foot (basically walking with crutch),
weakness and poor coordination in both legs
Casting Complication:
- you can cast with external fixators
- Pre cast: check for sensitivity to material, allergies to under wrap, skin
breakdown/abrasions, and if there are any other medical procedures
- Plaster: 7-10 min to harden, 24-48 hrs to dry, NWB for 24 hrs
- Fiberglass: 3-4 min to harden, 30-60 min to dry
- Drying time depends on water temp, the warmer the faster the material sets
- Post cast: capillary refill, swollen fingers or toes, skin blanching, poor pulse, skin
redness, parasthesia or pain
- Post cast joint position: Throbbing pain>4hrs, remove cast, reposition in sub
maximal stretch and then re-cast
- Maceration- serious skin breakdown, infection may develop
- Compartment Syndrome- compression of nerves and blood vessels within a
closed space, S&S pain or prosthesis Cut off immediately
- Cast window: bites or liquid burns
Upper Extremity Casting:
- SAC:
- Wrist fx, carpal fx, dislocation,
- Dorsal: to end of knuckles
- Volar; to palmar crease
- 1 inch below the ACS
- Stockinet length: same expect ½ inch below ACS
- Neutral positioning, like holding a can of soda
- Mold in an oval shape
- THUMB SPICA CAST:
- Gamekeepers, fx distal radius, scaphiod fx, dislocation of 1st MCP
- Dorsal: 1st to nailed, 2-5 to end of knuckles
- Volar: palmer crease
- 1 inch below ACS
- Position of function
- Make sure opposition is maintained
- BOXER CAST:
- Ulnar gutter cast, 5th MC fx, Boxer’s FX
- 4 & 5th up to nail beds, 1 & 3 to MCP jt, 1 inch below ACS,
- Wrist in neutral or 25 deg or extension, 4 & 5th MCP jt at 45 or 90 deg of flexion
Lower Extremity Casting:
- SLC:
- Foot, ankle, lower leg fx, ligament injuries, Achilles rupture, sprain and strain
- Ankle 90 deg and subtalar neutral, end of toes to poplital space (stockinet)
- Fiberglass, toes to two inches below the fibular head or 1 finger width below the
tibial tubercle
- Long Leg Cylinder Cast:
- Patellar fx, tibial platue fx, dislocations, quad rupture
- Stockinet groin to maleolli
- Fiberglass high on grain to two inches above malleoli
-
Long Leg Cast
Tibial fx, gastroc strain, post op,
Pt positioning: knee in no more than 5 deg of flexion, pain occurs in an amount of
time in a 180 deg position
Short leg cast done first, two strips medial and lat to knee
Orthoplast Splinting:
- Thermo moldable plastic (160-170 deg) working time is 4 to 5 min, used for
bracing, splints, shielding the body
- Material is reactive to heat to cause a change in shape to form to the desired
surface
- Ideal for LARGE orthoses including fracture braces, leg shells, and sport specific
devices
- Ulnar Gutter Splint: cover two thirds of the forearm to the tip of the 5th digit, form
it to the ulnar side of the arm, cover with an ace wrap starting proximal covering
all of the orthoplast, 20-30 deg wrist extension, 50-90 deg MCP flexion, IP in
slight flexion
- Thumb Spica Splint: hand shake position, 2/3 of 1st metacarpal joint to distal
thumb
- AC Splint: Circle or oval, cover 1-2 inches lateral to acromion process, cover
spinous process of scapula, cover to or over the clavicle, 2 to 3 inches from the
neck, mold a golf ball where the AC would be elevated
- Other uses for orthoplast: shin, thigh, forearm, ribs guards, stirrups for ankle
support
- Sugar Tong Splint: elbow bent to 90 deg, 4 inch width length from 3-4 finger
from axillary fossa under the arm to come over the acromion process
Orthopedic Bracing:
Purpose:
- Prophylactic- protect a joint and surrounding soft tissue (ankle brace instead of
tapping)
- Functional- provide support & protection to existing injury or post surgery (ACl)
- Rehabilitative- used for post surgery to immobilize, some allow you to control
ROM through adjustable hinges (Elbow brace to allow certain flexion and
extension ROM)
Objectives:
- Support and protect when preventing injury, treating and rehabilitating existing
injury
- Compression to reduce effusion and swelling
- Control ROM during rehabilitation
Brace Migration:
- To reduce migration
- Take brace on and off and reapply step by step
- Use of neoprene sleeve under
- Tape adherent spray
Types:
- Spider pad: shock absorber, volleyball knee pad
- Neoprene Sleeve: warmth and compression, thigh compression
- Shin splint calf sleeve: pressure on the medial tibia
- Patellar Femoral Strap: pressure on patellar tendon, ChoPat, patellar tendon strap
- Patellar Femoral Stress Syndrome Brace: Donought, lateral J on lat side of patella,
H brace, true pull- lat hinge
- OA brace- osteoarthritis brace, relieves friction of bone on bone
- AS0: ankle stabilizing orthotic
- Air Heel: recommended for treatment of plantar fascitiis, air pocket over the
Achilles tendon
- Playmaker: ROM brace, can control ROM, mcl, acl, meniscus
- DonJoy: derotational brace, to measure 6 inches above the patella
- Custom Fit: hollow carbon fiber, can break lifetime warranty, hinge absorbs
shock
Orthotics:
- Therapeutic device placed in the show to Dec stress to the foot and LKC??
- Brings the foot to the ground
- Indications: imbalances in the foot, shock absorption, pressure sensitive areas,
reduce shearing forces, special conditions
- Pes Cavus- High Medial Long Arch (tibia externally rotates), Pes Planus- Flat
Feet
- Running shock= 2 to 3x body weight
- Cavus Foot- Excessive Supination
- Soft orthotic to inc shock absorption
- Pronate the talus, tibia internally rotates (knock kneed)
- Turf Toe- want forefoot ridgity
Parts:
- Shell: primary material (ridged, semiridgid, soft)
- Post: brings floor to foot, used to control the abnormal mvmt, rear foot controls
calcaneus, forefoot controls subtalar and metatarsal mvmt
- Arch pad- flat foot, cavus foot
- Metatarsal pad- plantar callosities, forefoot pain
- Rear foot post- heel varus and valgus
- Forefoot post- forefoot varus and valgus
- Forefoot extension- covers the entire plantar surface of foot, most athletic ones
are only 3/4ths the length (calcaneus to metarsal heads)
- Cover- shock absorption, attractiveness and durability
Types:
- Ridged: usually sent out, nonflexible acrylics, slipper made with the casting stuff
- Semirigid: majority, made from low temp thermoplastics, cork, foam, and leather,
used with extrinsic post, combine support and shock absorption, easy to modify,
medial and lateral flares prevent slippage, can be used as temporary for trials, or
they can end up keeping them
- Soft: Shock absorption, relief of pressure areas and relief from shearing forces
-
Turf Toe- excessive hyperextension of the 1st MTP joint—half steel plate—full
length orthotic
-
Sesamoiditis- j pad- down 2 MT and hooks proximal to sesamoids
-
Metatarsalgia- Pain in the forefoot, metatarsal pad, placed proximal to MT heads,
can also be used to treat interdigital neromas, ---tear drop pad- spread the
transverse arch- spreads the metatrsal heads increasing the distance btw them
-
Morton Neuroma- occurs at 3-4th digit, nerves get impinged, poke on it to recreate symptoms
-
Plantar Fasciitis- control rear foot mvmt, semiridgid orthotic, deep heel cup—
night splint
Questions to Review:
-Patellar Fx- healing time 8-12 weeks
-Deg of flexion that an olecranon fx should be splinted in is 90 deg
-Forearm nightstick fx is a MOI from a direct blow
-Boxers’ fx is a fx of the 5th
-Lis Fran fx is fx/dislocation of the 1st MT joint
-An Orthopedic Technologists functions under the supervision of a physician that is
involved in the musculoskeletal care of patients
-Intramedullary rods are used for unstable fractures
-Arm sling is the preferred method of stabilization of a clavicle fx
-ORIF- open reduction internal fixation
-Sitting cross-legged is something elderly pt should avoid if they have sustained hip FX
-Purposes of braces- prophylactic, functional, rehabilitative
-Ridged orthotics are sent to a manufacturer
-Plaster takes 1-10 min to harden
-Kocher method is a shoulder reduction technique
-Sesmoid bone fx- a splitting of one of the 2 small bones within the flexor hallicus longus
tendon
-Walking stairs with crutches- Good go Up the Bad go Down
-Ac splint- covers 1-2 inches lateral to acromion and 2 inches from neck
-Thermomodable plastic is plastic that when heated is mobile, one type is orthoplast
-A shell is the material that is used when making an orthotic it takes into consideration
the weight, demands, and type of shoe
-Positive Variance is when the radius is communited in a Colle’s Fx and it can effect
ulnar deviation
-The center of gravity when crutches are fitted correctly is between the legs and crutches
-Poor grip strength, parasthia, and wrist drop are S & S of axillary nerve palsy
-WHO is the organization that maintains the ICD 10
-AMA is the organization that maintains CPT codes
-Maceration is a serious skin breakdown
-Orthogel is a gel used to pad orthesis
-Olecranon Fx occurs from falling on flexed elbow when the triceps are contracted
-3 types of orthotics are rigid, semirigid, and soft
-A posterior beak fx is also known as a calcaneal fx
-2 pt gait is used when there is weakness in both legs and poor coordination
-NBCOT- is the certifying body for OT’s (national board for certification of orthopedic
technologists)
-NAOT (National association of Orthopedic Technologists)- is the governing body
-Things to do prior to casting Reduction, documentation, medical procedures, and
check for allergies
-Dense foam is foam that is hard to penetrate and mold—it has more particles/area
-Position of function for the wrist is when it is in slight extension
-A pad is placed between the 4th and 5th digits when making an ulnar gutter splint
-A semirigid orthotic is made out of leather, low temp thermoplastics, and foam
-Schatzker classification- is for tibial plateau fractures
-Silver Fork sign- volar angulation of the radius and dorsal displacement of the distal
segment
-Thumb spica cast is used for a scaphoid fracture
-Metatarsalgia is the catchall term for pain in the forefoot
-Compartment syndrome is pain and parasthesia as symptoms, which could result as a
complication from casting
Joint Reduction:
- Shoulder Reduction: Kocher Technique- reduction of an anterior dislocation, you
can also use the Stimson technique, this is with the pt laying down and holding a
wt
- Finger Reduction: distract, place a towel over joint, send for x rays, rot fx can
require surgery
- Anterior Instability- in men in early 20s, “dead arm”
- Posterior Instability- seizure or severe electric shock, repetitive subluxation, post
shoulder pain
- Multidirectional Instability- in athletes with congenital hyperlaxity of multiple
joints in sports requiring overhead arm motions, vague symptoms with activity
- Posterior shoulder reduction- place in sling or 4s spica method, ice bag, x-ray-fx
and lesions
- Patellar reduction- laterally dislocated, move knee into extension while applying
an anteriomedial force to lift the patella over the femoral condyle and back into
the groove.
- For patellar dislocations be aware of distal pulse, due to the genicular arteries that
wrap around the knee
Colle’s Fx:
- Fx of the distal radius—silver fork sign—dorsal displacement of distal fragment
and volar angulation
- Ulnar styloid fracture can occur
- X ray views- AP and Lateral
- Zero Variance- normal
- + Variance- ulna is higher than radius (problem with supination and pronation)—
LAC to limit the amount of supination and pronation
- - Variance- ulna is sitting below the radius
Casting with Colle’s Fx:
- nondisplaced- SAC- 4-6wks unreduced, 6-8wks reduced
- Intrarticular Fx- LAC with thumb spica 3-6wks SAC
- Elderly Pt’s always in a SAC because if not they will never regain full extension
- External Fixator- comminuted, displaced, or open fx—6wks
- Open Reduction Internal Fixation- Intraarticular fx- post op cast 2-6 wks
- Nerve block- injection that blocks sensation—awake during surgery
- Median nerve contusion—leads to carpal tunnel
Flexmeter- brace you can use like a wrist guard for snow boarding/skiing