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Orthopedic devices and prostheses are technical means for correcting deformities and deficiencies of the musculoskeletal system, head, abdominal and chest walls, vision and hearing. Prosthetic and orthopedic products are designed to restore the functions of body parts, they can be used for cosmetic and working purposes. These funds are divided into groups and subgroups depending on the degree of damage or amputation.
Basic concepts and classification
Due to various factors, a person can lose the most important functions: movements of the arms and legs, loss of hearing, vision, and so on. This is due to trauma, cancer, circulatory disorders (diabetes, atherosclerosis, vascular stenosis). As a result, the patient’s life becomes inferior, he is not able to perform simple tasks on his own. To eliminate such problems, prosthetic limbs, eyeballs, and a hearing aid are used. Also, prosthetic and orthopedic products are intended for treatment, support and prevention, for example, bandages and corsets.
According to their purpose, they are divided into medical, fixing, prostheses and additional ones. Medical devices are designed to fix the limbs, joints, spine, they also perform the function of support. They are used after operations and during conservative therapy to consolidate the results and give proper fixation.
Therapeutic include: fixing devices; corsets; bandage; splint.
Fixing products help to maintain the correct position of the body, perform a supporting function, stabilize the joints, spine, limbs. They are prescribed for destruction of bone tissue and joints (after tuberculosis and osteomyelitis), with paralysis of muscle tissue, spastic paralysis.
The fixing ones include: fixing corset; lockless devices.
Prosthetics is an important part in the restoration of human functions. Today, there are prostheses for hands and feet, for restoring fingers, and prostheses for eyes, breasts, ears, etc. are also used. They can perform a working function or simply cosmetic to simulate a missing part of the body. In the prevention of serious diseases of the spine and its individual sections, orthopedic shoes are used to compensate for congenital or acquired deformities of the feet. Also, such shoes are prescribed for prostheses.
In addition, other products of this group include vehicles for patients. This includes wheelchairs, canes and crutches, “walkers”, manual cars. Let’s take a closer look at each group.
Prosthetics
Prostheses are artificial products that replace a missing body part for a patient. A direct indication for prosthetics is amputation due to trauma, destruction of bones and muscles after infections, removal of body parts in case of necrosis of blood vessels and muscles. Prostheses can make up for the lack of many parts: hands, fingers, legs, shoulders, eyes, teeth, etc. Restoration of the upper and lower extremities is considered the most requested service among patients.
The prosthesis can be:
- cosmetic – simply reproduces the appearance of a body part;
- cosmetic-functional – imitates the missing area, restores completely or partially the lost function;
- workers – with their help you can reproduce movements, walk and run.
The type of product is chosen individually for each, while focusing on the social orientation of the patient, the degree of damage and amputation, the condition of the stump. The stump is the remaining part of the removed limb. Any prosthesis has three main components: components, attachment and lining.
Components
The components of the product include metal rods that act as a former bone, as well as parts that replace joints and fingers. In the simplest specimens, small parts are motionless, while large ones move due to the strength of the body. The new generation of replacement products is powered by an electrical charge that is generated from the work of the muscles. Neurally integrated prostheses are also under development. The nerves that ran along the amputated limb are redirected to power the prosthesis. This innovation is most important for the replacement of hands and fingers.
Modern substitutes have not yet fully restored hand movements. The patient can grasp large objects, but the artificial hand cannot grasp small ones. Such products help patients perform some functions, but patients are not able to fully serve themselves. The development of prosthetics technology will lead to the restoration of a full life for patients. The replacement of the lower extremities has almost reached its apogee. Today, after amputation of one or two legs, people can go in for sports, go to work, climb mountains.
Mount
The fastening is necessary in order to attach the prosthesis to the body. The components are attached to the stump using a rigid frame and a receiving cavity. The cavity is made of laminated material or plastic, and the frame is made of graphite or its analogues. It is very important that the cavity fits the patient as much as possible, does not rub, does not slip off. To do this, before manufacturing, careful measurements are carried out with the advice of a prosthetist. When used between the cavity of the prosthesis and the stump, a special insert made of soft materials is worn. Such a case is made of silicone or polyurethane, which provides cushioning and does not cause friction.
Additionally, patients are advised to wear an orthopedic sock. These are covers that are put on the stump, which prevents it from swelling. During the day or night, the stump may swell and swell, which makes it impossible to put on a prosthesis later. To prevent this from happening, it is recommended to wear such a sock. Also, if the patient has lost weight or lost moisture in the body, several layers of the sock will help to fit the receiving cavity to the limb.
Suspension systems help to securely fix the prosthesis:
- Belt and belt. These are the oldest and simplest fastening options, they help to quickly connect the product to the stump, but they are hard, tinder and crush. Therefore, such a system is increasingly being avoided.
- The valve is a suction system on the receiving cavity. As the stump sinks into the cavity, air escapes through the opening and the one-way valve closes it. As a result, the limb firmly holds the prosthesis.
- Retainer. Using a notched pin, an insert is attached to the bottom of the cavity. The pin holds the limb, but is very tight to it. This close interaction can cause rashes, inflammation, and skin ulceration.
In view of the potential threat to the patient, modern manufacturers strive to make the mount as reliable and safe as possible. The type of system is also selected with an orthopedist and a prosthetist individually for each patient.
lining
The appearance of the prosthesis is determined by the cosmetic lining. It is not a functional part and does not improve the quality of the product in any way. However, for some patients, the appearance of the prosthesis plays an important role. Scientists also pay attention to the fact that after amputation it is difficult for a person to get used to a new entity. The more the product looks like a real limb, the easier it is for the patient to adapt to society. This positive attitude plays a key role in rehabilitation and treatment.
Facing today is made of soft polymers, synthetic materials are selected very responsibly. The manufacturer must choose the most realistic color and texture, there are specimens with imitation hairline and exact repetition of skin tone. However, such a modification is more considered a whim. Classic prostheses are sheathed with durable plastic in flesh-tone, many products are completely devoid of cladding.
Depending on the goals and activity of the patient, the doctor recommends the type of product, method of attachment and materials. For example, swimmers get two copies: one regular and one waterproof. There are ankle modifications that allow women to wear heels after a leg amputation. The prosthetist also explains what options the selected type of products has, how to wear and care for them.
Orthopedic devices
Orthoses or orthopedic devices are a group of medical devices for the rehabilitation of the musculoskeletal system, locomotor function, limb and trunk mobility. Unlike prostheses, this category is designed to restore their own functions. This includes corsets, bandage bandages, fixing devices and more.
Apparatus
Systems for fixation of the lower extremities consist of metal frames, splints and half rings. They are attached to the leg in order to relieve the load on the muscles, joints and bones of the leg. Such designs are lockless and castle. The lock includes the movement of hinges that are installed at the joints: knee, ankle, hip.
Fixing devices for hands consist of the same parts, they are attached to the limb with splints and sleeves.
These products are of two types:
- The first group is used to limit movements, they are needed to fix and correct individual segments. Such a device removes the load from the bones and joints, prevents deformation, and immobilizes. With such an apparatus, the patient retains only a part of the motor function.
- The second group is designed to perform the same functions (fixation and correction), but with the preservation of movements. Such products are therapeutic, they are used after reconstruction and recovery operations, with paresis of muscle tissue.
The choice of apparatus depends on the clinical picture and is established by the doctor. Such funds are either full or for several hours a day, which also depends on the goals of treatment. Lockless are considered a kind of gymnastics for the muscles, they are usually not worn all day. For patients with paralysis of the lower extremities, the positive effect of such devices on the nervous system has been proven, it accelerates the recovery of the musculoskeletal system.
Castles are used only for widespread paralysis, cerebral palsy, delayed consolidation in fractures. The constant wearing of such a device accelerates muscle atrophy. Therefore, its use is combined with passive and active movements, massage.
Tutor
The splints serve as the previous fixator, while they are more like bandages. They completely exclude passive and active movement in the joints. They are prepared according to a cast of resin, leather or polyethylene, today synthetic materials are increasingly being used. The splint fits snugly to the affected area, removes the load from it, reduces pain, and prevents deformation of the bone tissue. They can be used in combination with devices or alone with conservative therapy. Such products help after operations, reconstructions, with arthrosis of the III degree.
Bandage
Bandage – an elastic bandage or lining to support the walls of the abdomen. Such a bandage is made of durable material, elastic bands are sewn on the sides for additional support. A surgeon, orthopedist or gynecologist prescribes finished products or individual ones. The latter are considered more effective due to the ideal fit according to the volume of the patient.
They are used for different purposes and situations:
- with hernias of the anterior wall of the abdomen;
- to raise and maintain the abdominal organs (liver, stomach, kidneys, intestines), if they are lowered;
- with a divergence of the pubic joint;
- the period of pregnancy and after childbirth;
- on fragile scars after operations to prevent discrepancies and hernias;
- prolapse of the pelvic organs (rectum, uterus, vagina);
- after the artificial withdrawal of the anus to the anterior wall of the abdomen.
The doctor sets the number of hours to wear. Depending on the complexity of the bandage, the patient can put it on on their own or with the help of outsiders. The complexity of such a system depends on the condition of the patient. So, with an artificial anus, a bandage with a colostomy bag is needed; in case of prolapse of the rectum, underwear-bandage is prescribed; for an inoperable hernia, a bandage with a pelota (additional pressure pad) is shown. Most types of this bandage are worn in the supine position, they are used until complete rehabilitation.
Corset
Orthopedic corsets are designed to unload and fix the vertebrae, improve the functions of the trunk muscles, eliminate congenital or acquired deformities. They consist of a strong frame and soft elastic stripes, fastened to the body with laces or rubberized inserts. The effect of wearing such a tool is better if the corset is made according to individual measurements.
There are two types of corsets:
- Corrective. Designed to correct spinal deficiencies, curvature, return posture and gait.
- Fixing. They are designed to create immobility of a separate section of the spine or neck. This type is in demand for scoliosis, fractures, paralysis of the muscles of the neck and trunk, benign tumors of the spine, etc.
At the same time, the medical corset has many shapes and cuts; a different cut is used to correct each pathology. So, in case of damage to the neck, a vest with a head holder is prescribed; to correct and support the lumbar region – a short belt for the pelvis and lower chest, etc.
Corsets are worn until full recovery, the doctor sets the number of hours of wear per day.
Other products
The considered devices, prostheses and bandages are emergency and mandatory means. Some of them are therapeutic (bandage, splint), and some are supportive and additional (prosthesis). But besides them, there are more than 600 items in the group of prosthetic and orthopedic products. The most popular aids are crutches and canes. These are support products that are prescribed to protect bones and joints from body pressure. They are also prescribed to elderly patients for unloading the musculoskeletal system and additional stability when walking. Canes for visually impaired people are also included in this group.
Arch supports and orthopedic shoes are designed for people with foot defects. The arch support is a dense insole with a stripe in the middle of the flat feet. Shoes can be for different problems with the feet: congenital shortened foot, clubfoot, deformity or absence of toes, deformities after inflammation and injury. Proper footwear should be prescribed by an orthopedist or prosthetist. For problems that do not require special shoes, special parts are prescribed: insoles, liners, arch support, pads. These details complement regular shoes.
In general, everything that can reduce the load on the skeleton and fix a separate part of the body belongs to the prosthetic and orthopedic series. These are breast prostheses, which prevent the curvature of the spine after breast removal. The product looks like an overlay in the form of a breast; special supporting bras are recommended for them. Due to the increase in cases of breast cancer, such drugs are becoming more and more in demand.
The history of prosthetics and orthopedic systems began long before our era. The oldest prosthetic thumb belongs to a New Kingdom mummy in Egypt (1551-1069 BC). To this day, this technology has undergone many changes, modern prostheses allow people to live just like the rest. Various bandages, devices, splints are simple tools and mechanisms that speed up rehabilitation and return important functions to the patient. At the same time, the technology is being improved, pads and bandages are not felt thanks to new materials, and artificial parts of the body become even more perfect than relatives.