Orthopedic devices (stifle braces, orthotics, etc.) (Proceedings)
In the field of small animal orthopedics, orthoses, prostheses and other assistive devices are an emerging technology that can aid in the well-being of our canine patients. These devices are used to either correct or accommodate the affected limb(s) following trauma or surgical intervention, and may be utilized as temporary or permanent modalities. The objective of this paper is to introduce new technologies in canine carpal and tarsal orthotics, forelimb and hind limb prosthetics, and other assistive devices including stifles braces, shoulder stabilization systems, and custom ehmer slings.
Dogs with cranial cruciate ligament (CCL) insufficiency can benefit from a custom hinged stifle brace in order to give support/stability to the stifle. Custom stifle braces can be used pre-operatively in dogs with bilateral CCL insufficiency in which the brace is applied to non-surgical limb as the operated limb is recovering from surgery or in juvenile patients with open proximal tibial growth plates awaiting surgery; post-operatively following stifle stabilizing techniques; or for dogs who are not surgical candidates for long-term use. Early partial CCL tears that are undergoing rehabilitation therapy, patellar tendon rupture repairs, and collateral ligament repairs can be accommodated with use of a custom stifle brace. "Tamarack" joints can be used to offload the stifle by mimicking the actions of a healthy ligament. "Ultraflex" joints can be used to increase range of motion where a contracture is present. A range of motion joint can also be used to set a desired range or to statically progressively aid in contracture management.For dogs requiring a limb or partial-limb amputation due to neoplastic conditions or severe trauma prosthetics may be used to replace a missing limb or portion of the limb. Prosthetics range from simple fillers to full limb amputations for the forelimb or hind limb. Prosthetics are extremely valuable for patients with other concurrent orthopedic conditions who could not tolerate a three-legged lifestyle.
Carpal injury in dogs may range from sprains and strains to complete "carpal collapse" or carpal hyperextension injury. Numerous devices have been developed to support and protect the carpus as the dog is progressing through rehabilitation therapy or as a long-term option for patients who are not ideal surgical candidates. Carpo-Flex neoprene wraps are ideal for mild sprains and strains, supporting the carpus following splint or cast removal, or protecting against re-injury for the canine athlete. Where additional support is required, low-temperature thermoplast and/or additional straps may be incorporated into the wrap. These wraps are easily removed and applied for rehabilitation therapy. Where complete immobilization is desired a solid posterior shell design or bivalve (clam shell) designs can be used for maximal support. "Tamarack" joints can be used to reduce hyperextension, while allowing range to assist in a more normalized gait pattern. Range of motion joints are used for more active dogs to allow full range of motion and only limit hyperextension.
Like the carpus, numerous devices have been developed to support and protect the tarsus and Achilles tendon following injury. Tarso-Flex neoprene wraps are ideal for mild sprains and strains, supporting the tarsus following splint or cast removal, or protecting against re-injury for the canine athlete. Where additional support is required, low-temperature thermoplast and/or additional straps may be incorporated into the wrap. Like the carpal wraps, these wraps are easily removed and applied for rehabilitation therapy. Where complete immobilization is required such as following Achilles tendon repair custom hock braces may be used. "Ultraflex" joints can be used to increase range of motion where a contracture is present. "Tamarack" joints can be used to reduce range of motion or assist motion of the tarsus.
Medial shoulder instability (MSI) has been shown to be a common cause of forelimb lameness in dogs. Depending on the severity of the instability conservative treatment utilizing a rehabilitation therapy program or surgical intervention has been described. As the patient is progressing through the rehabilitation or post-operative period protecting the shoulder is essential. DogLeggs Shoulder Stabilization System has proven to be a successful part of treatment for shoulder stabilization for both surgical and non-surgical patients. The device consists of removable breathable neoprene/polyester sleeves that attach over the shoulders of the patient and Velcro securely to each forelimb. An additional chest strap can then be applied to secure the device to the patient. One to two inch double-sided Velcro strips serves as a hobble strap to attach to the limbs together. Patients are able to bear weight immediately and adapt rapidly to the device. The device limits abduction, flexion and extension of the shoulder, but allows for full weight-bearing. The patient's gait is altered with a short limited stride, but can be worn continuously for several months with minimal irritation. The device can be removed and reapplied easily for rehabilitation therapy. In patients that have undergone arthroscopic treatment (radiofrequency treatment, imbrication, etc), the device is placed while under anesthesia just prior to recovery. Patients with severe MSI that have undergone surgical reconstruction are first placed in a custom Velpeau for 2-4 weeks followed by DogLeggs Support System for another twelve weeks of continuous wear.
Ehmer slings are commonly used to protect the hip following conservative or surgical treatment of coxofemoral luxations. Unfortunately, the standard Ehmer sling can not be easily removed and reapplied thereby limiting the ability to perform rehabilitation therapy. In addition, depending on the materials used Ehmer slings may cause secondary skin irritation and abrasions. DogLeggs VEST with Ehmer Sling is a custom form fitting sling which allows for proper positioning and immobilization while allowing access for rehabilitation therapy. The VEST and Ehmer Sling are manufactured utilizing Breath-O-Prene® Silvertec® a hook compatible "fabric" that is stretchable, breathable, antimicrobial, antibacterial and bactericidal. The VEST's hook compatible exterior provides the ability to adjust the garment to comfortably fit the patient. The design of theVEST allows for total range of movement of unaffected limbs. No discomfort or restriction of activity due to wearing the VEST is experienced by patient. The Ehmer Sling is attached directly to the VEST by use of Velcro® Hook fasteners. By supporting the Ehmer Sling with the VEST the patient tolerates the treatment over long term wear.