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Prosthetics and Orthotics 1155.e1

Prosthetics and Orthotics
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• Stockinette or self-adhesive plastic sheet
Difficulty level: ♦♦
well proximal to where the device will start.
• Fiberglass casting material (Scotchcast, 3M) this layer from the tips of the digits to a spot
Synonyms or semirigid fiberglass (Scotchcast Soft Cast, • Apply the casting material (at least 50%
Braces, orthoses, exoprostheses, endoprostheses 3M) overlap at each turn) to a point above where
• Cast saw (if rigid fiberglass is used) or heavy- the device will go.
Overview and Goal duty bandage scissors (if semirigid material • Allow the material to harden.
• Orthoses are braces placed on body parts to is used) • Make a longitudinal cut with a casting saw
support them and restrict their motion or • Adhesive tape or bandage scissors to allow you to pull the
limit them to movement in normal planes. cast off, and then tape it back together so
• Prostheses replace missing portions of Anticipated Time that the cast retains the shape of the limb.
limbs. Exoprostheses, also known as socket 20-30 minutes Send this cast to the device manufacturer. Procedures and Techniques
prostheses, are their most common form.
These are entirely external to the limb and Preparation: Important Postprocedure
are held on with a combination of a soft cup Checkpoints Fit the returned device, and make adjustments
into which the stump is fitted and straps to • Consult with the company that will be as necessary. Consultation with the orthotist/
hold the apparatus in place. Endoprostheses making the device about the animal’s needs prosthetist is recommended.
(transdermal osseointegrated implants) have and expectations. For orthoses, they can
a stem that is implanted into the remnant provide advice about what kind of device Alternatives and Their
bone. The internal material is designed to will work best for the patient’s situation, and Relative Merits
promote tissue ingrowth; there is also a for prostheses, they can guide amputation • For many injuries, surgical stabilization
portion that protrudes from the limb, onto levels and soft-tissue coverage suggestions. provides a more durable and maintenance-
which the rest of the prosthesis is attached. • Generic braces exist, but for best results, free result than orthotic support.
orthoses should be custom-fitted. Prostheses • Full-limb amputation is often a very func-
Indications are always custom made because each animal tional alternative, especially for proximal limb
Orthoses: and amputation level is different. problems.
• Carpal hyperextension (p. 145) • Clients should be made aware that multiple • For amputations distal to the carpus, carpal
• Tarsal hyperflexion and hyperextension (p. visits for device adjustment and revision will pad transposition may allow a useful limb
958) be necessary. without prosthesis, although the limb is short
• Collateral instabilities • Residual limbs must be well healed before and therefore held up at rest and intermit-
• Postoperative immobilization, especially for a definitive prosthesis is used. tently carried at faster gaits.
fracture and tendon repairs
• Nerve deficits Possible Complications and Pearls
• Treatment of contractures Common Errors to Avoid Communication with owners about costs (good
Prostheses: • Rub sores are common, especially if the assis- orthoses and prostheses are not necessarily much
• Partial amputations/absences up to the tive device is worn for long periods. Regular cheaper than surgery) and expectations before
proximal third of the antebrachium periods with the limb unencumbered by the using assistive devices is important for a good
• Partial amputations/absences up to mid-tibia device are needed; if rub sores are persistent, outcome.
• Joints proximal to the prosthesis must be device revision will be needed.
functional • Some animals take rapidly to orthoses and SUGGESTED READING
• The further distal the amputation, the better prostheses, but others do not. If an animal Marcellin-Little DJ, et al: Orthoses and exoprostheses
the function that can be achieved with a uses the limb well in a splint, it is more for companion animals. Vet Clin Small Anim
prosthesis likely to use it well in an orthosis. 45:167-183, 2015.
Contraindications Procedure ADDITIONAL SUGGESTED
• Animals with temperaments that prevent Custom orthoses and prostheses are generally READING
them from tolerating an external device made on a model of the patient’s limb. This Phillips A, et al: Clinical outcome and complica-
• Owners unable to provide vigilant mainte- model is formed by pouring plaster of Paris tions of thoracic and pelvic limb stump and
nance and troubleshooting of assistive devices into a mold formed by applying a light cast socket prostheses. Vet Comp Orthop Traumatol
• Widespread neurologic deficits in the limb to the affected limb. This cast should extend 30:265-271, 2017.
• For prostheses, amputations proximal to proximal to where the orthosis or prosthesis AUTHOR: Kathleen Linn, DVM, MS, DACVS
mid-radius or mid-tibia will be attached. EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
• The limb should be dry, with the hair left Thompson, DVM, DABVP
Equipment, Anesthesia in place.
• Fittings for assistive devices can be done with • Apply one layer of stockinette (or self-
the patient awake or under sedation adhesive plastic film) to the limb, extending

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