Chapter 36: Pediatric Hip orthoses Flashcards
What pathologies often are associated with hip surgery?
Developmental dysplasia of the hip (DDH) Legg-Calve-Perthes disease (LCP) Cerebral palsy (CP) Lower limb weakness or paralysis associated with neuromuscular disorders Myelodysplasia Spinal cord injury.
DDH encompasses what array of hip pathologies?
Hips that are stable but have dysplasia
Hip subluxation and dislocation
What are the goals for treatment of DDH?
Attain a concentric reduction of the hip
To provide normal acetabular and femoral head development
To avoid complications of treatment, including stiffness, infection and avascular necrosis (AVN) of the femoral head
To avoid unnecessary patient and parental hardship.
What are the different orthotic treatments for DDH?
Frejka Pillow Pavlik Harness Von Rosen Orthosis Ilfeld orthosis Plastazote hip abduction orthosis.
What is the Frejka pillow?
It is a pillow of foam that wraps around like a diaper with harnesses.
It is designed to hold the legs in abduction, but the soft nature of the pillow still allows infants to overcome the corrective force.
Not the best choice.
What is the pavlik harness designed to prevent?
Only extension of the hip.
He thought active motion of the hip helps with normal development.
What does the pavlik harness do?
It places the hips in the “rider position” which enables the adductors to relax with time and movement, allowing the head to spontaneously reduce.
The motion will prevent undue pressure on the head of the femur, preventing AVN.
How should the pavlik harness be placed?
There are two shoulder straps connected by a wide chest strap. The chest strap should be positioned at the nipple line, the anterior stirrups straps are located at the anterior axillary line, and the posterior straps overlie the scapulae.
The anterior straps should maintain the hips in 90-110 degrees of flexion.
They straps should be tensioned to maintain 20-30 degrees of abduction only.
What is the age a child can be to use a pavlik harness/
up to 12 months.
How long should the pavlik harness be worn during the day?
23 hours a day.
What is pavlik harness disease?
Persistent posterior dislocation maintained by the harness which erodes the posterolateral acetabular wall.
What are some complications associated with the pavlik harness/
Absence of an Ortolani sign Pavlik harness disease Skin irritation Femoral nerve palsy Inferior dislocation of the hip AVN of the femoral head.
What is the Von Rossen orthosis?
A passive restraining device that has a malleable frame with straps around the shoulders, waist, and thighs.
It is used in Scandinavian countries
What is the ilfeld orthosis?
A passive positioning device that holds the hips in abduction but does not create significant hip flexion.
It consists of two thigh cuffs attached to an adjustable crossbar and attached to a waist strap.
What is the ilfeld orthosis most effective for?
Postoperative abduction device than treatment of hip dysplasia or dislocation.
What are the orthoses position, designed to treat Legg-Calve-Perthes disease
Hold the hip in abduction and to permit varying degrees of internal rotation and flexion, directing the femur into the acetabulum.
What is the toronto orthosis?
An abduction orthosis with two thigh cuffs attached to a triangular frame, which attaches to horizontal bars to which plates are attached.
The hips are held in 45 degrees of abduction and are maintained in internal rotation by the fixed position of the shoes on the footplates.
It allows for hip and knee motion to allow ambulation with crutches.
What is the Newington orthosis?
An ambulatory abduction orthosis that is used with crutches.
Thigh cuffs are connected to a metal frame. The knees are held fixed in 10 degrees of flexion and shoes are attached to the footplates in a position that maintains the hips in internal rotation.
What is the scottish Rite orthosis?
Two thigh cuffs separated by an abduction bar. Thigh cuffs are susepnded from a waist band, which limits the tendency to widely abduct the unaffected leg while keeping the affected leg adducted.
It has no rotational control because it has no extensions below the knee.
What can a scottish Rite orthosis be used for?
Postoperative treatment
Or DDH control
What are the goals for treating the hips of patients with cerebral palsy?
Prevent painful hip subluxation/dislocation
Maintain or improve ROM for ambulation, sitting balance and hygiene.
What orthosis can be used to treat hip pathologies in patients with CP?
Resting abduction orthosis
SWASH orthosis
What is the resting abduction orthosis?
Nighttime abduction splinting to treat patients with early subluxation due to spastic quadriplegia or diplegia. It maintains stretch of the hip adductors and flexors.
One of the most common option is a foam wedge.
Another is the Hope 1 by ultraflex which allows adjustment of hip abduction.
What is the SWASH orthosis?
Standing, Walking, and Sitting Hip orthosis
It is designed to allows the wearer to transition from sitting, or crawling to standing or walking.
It provides variable hip abduction according to the degree of flexion or extension.
The SWASH orthosis is contraindicated for which patients?
Patients with dislocated hips or with hips having greater than 20 degree flexion contractures.
Also when lower extremity alignment results in excessive external foot progression angles.
What types of orthoses can be used for torsional deformities of the hip?
Twister cables.
What are lycra garments?
(TheraTogs)
Designed to provide a dynamic splinting to control abnormal tone, stabilize posture, and improve function in individuals with neurological disorders such as CP and spina bifida.
What are the different standing frame orthoses?
Vertical standers Standing braces A-Frame orthosis Parapodium Swivel walkers HKAFO
What is a vertical stander?
Patient rests on a stationary platform to improve stability.
It may include a sit to stand function to help with transfers
What is a standing brace?
It provides independent mobility using a walker and swiveling or hoping motion. It does not permit hip or knee flexion.
It has unhinged upright frame with footplates, knee supports, and a chest strap.
What is an A-Frame orthosis?
Supports patient in an erect posutre.
It has a pommel that provides for abduction of the hips and can support some of the patient’s weight.
Hip abduction and internal/external rotation can be controlled.
Who is the A-Frame orthosis indicated for?
Children 18months to 4 years
Children with a high incidence of hip subluxation and dysplasia.
What is the parapodium?
It allows patients to stand without crutches, leaving their upper limbs free.
It has locking and unlocking joints at both the hips and knees, which allows a child to sit in a wheelchair and stand.
It is worn over clothing and has an exoskeleton with a spring-loaded shoe clamp, aluminum uprights, foam knee block and a back and chest panel.
It ha a four-bar linkage in the hip and a telescope bar to allow the patien to roll and ratchet themselves from the sitting to the standing position.
Who is the parapodium indicated for?
Children older than 3 years
What is one problem with swivel walkers?
They cannot be used on uneven terrains.
Swivel walker is indicated for what?
Spina bifada
Spinal muscular atrophy
Multiple sclerosis
Muscular dystrophy
What were HKAFOs presecribed for?
Polio
Myelomeningocele
Spinal cord injuries.
What are the different hip joints?
Single-axis hip joint with lock, which allows only flexion and extension
Two-position lock hip joint, which can be locked at full extension or 90 degrees of flexion
Double-axis hip joint, which has a both a flexion-extension axis and an abduction-adduction axis.
What tends to happen to patients who use HKAFOs how have weak hip extensors?
They tend to fall into a flexed, lordotic posture.
What are hip quidance orthoses?
A brace with thrust-bearing hip joints that are connected by a rigid pelvic bar. The hip and knee joints can be unlocked for sitting.
What is the RGO?
Reciprocating gait orthosis
It consists of bilateral KAFOs attached through hinges to a rigid pelvic band with a thoracic extension.
The cable system helps prevent forward pelvic tilt and lordosis.
What are necessary to use an RGO?
Strong upper extremities and assistive devices.
What does the RGO provide?
A functional gait pattern and safe mobility over uneven terrain.
What is the RGO compatible with?
Wheelchair use.
The RGO cannot be used by who?
Children with significant hip flexion contractures because the device interferes with the child’s ability to initiate single-limb progression.
What is the ARGO?
Advanced Reciprocating gait Orthosis
It uses a single low-friction, push-pull cable to effect reciprocal gait location.
What is the IRGO?
Isocentric Reciprocating Gait Orthosis
It uses a centrally pivoting bar and tie rod arrangment in lieu of cables to link hip extension to contralateral hip flexion. This reduce friction by up to 300%.
What was the parawalker designedd for?
To overcome the disadvantages of the swivel walker and to allow patients with spinal cord lesions at the thoracic level to walk reciprocally with crutches.
What is the parawalker?
It has bilateral KAFOs with ball-bearing hip joint and a body brace.
Ambulation is performed through trunk motion transmitted to the lower extremities with hip flexion and extension via the brace.
Hip flexion is restricted by a stop.
Hip extension can be free or limited with a stop.
What is the multiaxial subperineal hip joints?
Medially mounted single-axis hinge joint to link two KAFOs.
What patients might benefit from multiaxial subperineal hip joints?
They have spinal stability without significant deformity, controlled muscle spasm, less than 5 degrees of hip or knee flexion contracture. achievable neutral ankle position, mobility of the thoracolumbar spine into lateral flexion, good upper limb strength, and motivation.
What are postoperative hip orthoses?
Hip spicas for after surgery. They are set in 30 degrees of hip flexion and 30 degrees of unilateral hip abduction (combined is 60 degrees).
What are the disadvantages of hip spicas?
They take awhile to put on
There is a need for PT and hospital readmission to regain ROM
