UPPER EXTREMITIES ORTHESA

Upper extremities orthesa design

Static No mechanical axis, no motion Molded / applied directly to the hand that maintains the hand / joints in one

position Indikasi orthosis statik:

1. Immobilize, stabilize, and support a joint in a desired position2. Protect weak muscles from overstretch3. Prevent contractures4. Support structures following surgical repair5. Facilitate the healing of soft tissue injuries and fractures

Dynamic Provide a constant force to the joint. The force is generated either by a stretched

rubber band or a wire spring coil via an outrigger attached to the base. The outrigger assures that the force is directed at or close to a 90’ angle to the long axis of the bone. While the splint is worn by the px, there is a constant force applied and even as motion improves, the splint force continous

Selain imobilisasi/membatasi pergerakan sendi, orthosis dinamik juga berfungsi meningkatkan fungsi dengan menggunakan tuas, katrol, sendi-sendi yang dapat bergerak & alat penyimpan tenaga (per, pita, baterai, tangki berisi gas yang dikompresi)

Serial staticMolded in a stationary position with the tissue at max length. They are changed frequently to accommodate the decreased resistance in the tissues. Ideally the serial cast is changed every other day, or at least 2x/week with brie periods of supervised exercise when out of splint

Static progressive May be identical with dynamic splints in contruction of the splint base and

outrigger, but the application of force is not dynamic. The force may be applied via the same outtrigger and finger loop system or by another means. Instead of a rubber band or spring, tension is maintained once fitted ( commonly with velcro or mechanical componenets which can be adjusted in small increments )

The theory of static progressive splinting ( holding the joint at easty maximum available length ) is the same as that for serial static splinting. The primary difference is the way in which forces are applied. When serial static casting is used, force is evenly distributed over all surfaces. Static progressive splinting

concentrates the force through the surface area of splint part applying the pressure

Algorythm for the use of splints

Fase inflamasi : ± 1 miggu Immobilization splint Segera setelah terjadi cedera

Fase proliferasi : 1 – 6 minggu Pembentukan scar , “ moveable tissue “ dengan tegangan Dynamic type splint

Fase remodeling : 8 – 12/24 minggu Jaringan padat, keras dan tidak elastis Pemendekan jaringan Serial static atau static progresiv splint

Biomechanic of splint ( mechanical principles )

Splint are 1st class leverThis wrist splint shows :FA : force armRA : resistance armFLA : force line of actionRLA : resistance line of action

a longer forearm bar decreases the resultant pressure transferred by proximally weight of the hand to the anterior forearm