PTB AFO for Fracture Patient at PT.
Ottobock
Healthcare Indonesia
Moh. Irfan R
Mr. B is 67 Yo Man with body height
169cm and weight 69kg came to PT. Ottobock
Healthcare Indonesia with his family. He use
wheelchair to mobile from outside into assessment
room because he has problem with his left leg. He
fall in the school during pick up his children. He
feel little bit pain on their left leg, then he go to
traditional clinic to get some massage. After
massage the pain is not healing, continue he go to
another traditional clinic and the leg became
swelling. After 1 week the swelling not gone, so he
go to the traditional again and during massage there
is sound of crack in the left leg after that he go to
the doctor and he was diagnosed fracture by
doctor.
The type of fracture is a bit
complicated, he got surgery to stick a pen into the
bone. After surgery the suture line like opening
little bit make the fluid came out and not stop until
3 month he do surgery again. The second surgery
the doctor put the pen outside body. The fluid also
still come out from the wound of surgery. Then
after the doctor take off the pen and give
instruction to make orthosis that can help him to
promote healing his leg. Patient expect that orthosis
can help him to do promote healing, standing and
walking a view step. Patient also has diabetes that
make the wound take a long time to heal.
During objective assessment, the
patient leg is oedema, when we observe the x-ray,
the bone already almost healed and stick together.
The fracture of the bone is in superior medial tibia
with type oblique fracture. The fracture is oblique
split depression, we can see on the picture below.
The real prescription is custom made
left side PTB-AFO panel opening Polyprophylene
and soft liner with straps. Alignment is 5 degree
anterior tilt (sagittal) calcaneus vertical (coronal) 5
degree of external rotation, because the PTB-AFO
will be use for stand and walking so the alignment
should mimic with the late mid stance. Material is 5
mm PP is enough to support the weight of the
patient with liner by EVA 6mm to provide a liner
for protect the leg because of the pathology. The
orthotics goals is to romote healing by immobilize.
The weight bearing put into PTB and counter force
by Popliteal area.
The alternative prescription is: Custom
made left side IWB-KAFO. Alignment is 5 degree
anterior tilt (sagittal) calcaneus vertical (coronal) 5
degree or natural external rotation. Material is 5
mm PP enough to maintain the weight bearing of
the patient with liner by EVA 6mm for make the
soft liner for maximum protect the skin. The Side
Bar bail locking system patient can get very good
immobilize to promote healing. Goals is to promote
healing by immobilize the bone by shift the weight
bearing into the ischial tuberosity.
The follow up plan need to be done in
one month after delivery, three month after delivery
and six month after delivery.
Resources:
adrian, kevin. (n.d.). Cara Merawat Luka Diabetes untuk Mencegah
Risiko Berbahaya - Alodokter. Retrieved July 21, 2019, from
Einhorn, T. A., & Gerstenfeld, L. C. (2015). Fracture healing:
mechanisms and interventions. Nature Reviews. Rheumatology,
11(1), 45–54. Novick, A., Stone, J., Birke, J. A., Brasseaux, D. M.,
Broussard, J. B., Hoard, A. S., & Hawkins, E. S. (1993). Reduction
of plantar pressure with the rigid relief orthosis. Journal of the
American Podiatric Medical Association, 83(3), 115–122.
Wanamaker, A. B., Andridge, R. R., & Chaudhari, A. M. (2017).
When to biomechanically examine a lower-limb amputee: A
systematic review of accommodation times. Prosthetics and
Orthotics International, 41(5), 431–445.