This document provides an overview of prosthetics and orthotics. It defines prosthetics as the replacement of missing body parts and orthotics as devices that support, align, or correct deformities of movable body parts. The document describes various types of prosthetics and orthotics for the upper and lower limbs, including components, materials, and designs. It also discusses indications and functions for different orthotic devices used in the cervical, thoracic, and lumbar spine regions.

1. DR BIPUL BORTHAKUR
PROFESSOR & HEAD
DEPT. OF ORTHOPEDICS
SILCHAR MEDICAL COLLEGE AND HOSPITAL

2. LEARNING OBJECTIVES
 INTRODUCTION
 PROSTHETICS AND ORTHOTICS ; AN
INTRODCUTION
 UPPER EXTREMITY PROSTHESIS.
 LOWER LIMB PROSTHESIS
 UPPER LIMB ORTHOSES
 LOWER LIMB ORTHOSES
 TRACTION AND TYPES

3. DEFINITION
 PROSTHETICS- Is a branch of surgery covered with
the replacement of the missing part of the body and
the science which deals with prostheses.
 ORTHOSIS- It refers to an orthopedic appliance or
apparatus used to support, align , prevent or correct
deformities or to improve function of movable parts of
the body.

4. TYPES OF PROSTHESES
EXOSKELETAL
 Durable but not adjustable.
 Part of exoskeletal
prosthesis-
 1. Socket
 2. Shank
 3. Foot and ankle assembly

5. ENDOSKELETAL
PROSTHESIS
 Cosmetic and adjustable.
 Parts of
endoskeletalprosthesis-
 1.Socket
 2.Socket adapter
 3.Pylon
 4.Ankle adapter
 5.Foot


6. MATERIALS USED IN PROSTHESIS
FABRICATION
 Plaster of paris.
 Wood(whilock)
 Plastic and rubber
 Metal and alloy
 Various types of fabrics

7. COMPONENTS OF PROSTHESIS
 INTERFACE COMPONENTS- These are those parts
which are directly in contact with the body tissues.
 They are subdivided into socket and suspension.

8. SOCKET
 Part of prosthesis into which stump is inserted.
 Depending on part of stump coming in conctact with the
socket it can be classified into-
End bearing
Side bearing
Total contact: Laminated socket; most popular.
Depending on the method of preparation, they are classified
into-
Carved from wood : conventional socket
Molded from leather
Shaped from metal

9. SUSPENSION
 Part of the prosthesis which attaches prosthesis to the
body.
 The various methods are-
Suction socket.
Suspension by body contour
Muscle grab socket: Myoplastic stump
- Control; Intrinsic control. Voluntary control.

10. SPECIFIACTIONS FOR IDEAL
PROSTHESIS/ ORTHOSIS
 Function-
meet user need
simple
easily learned
dependable
 Comfort-
fit well
easy to put on and take off
light weight
adjustable
 Cosmesis
looks, smells, sounds normal
easily cleaned
strain resistant.
Fabrication
fast, modular
readily and widely available
Economics
affordable
cost effective.

11. UPPER LIMB PROSTHESIS
 COMPONENTS OF UPPER LIMB PROSTHESIS
Power system.
Terminal device.
Wrist and elbow section.
Arm and forearm system.
Socket and suspension.

12.  POWER SYSTEM :-
Body powered: It utilises
body movement to control
the action of prosthetic
components.
Electrically powered:
Commonly myoelectric
prosthesis. It uses the action
potential of musclr in action
for prosthetic functions.
Hybrid : Combination of
bodypowered and electrically
powered prosthesis.

13.  TERMINAL DEVICES
It is replacement of normal
hand.
 Two types:-
Cosmetic- nonfunctional
Active functional – in the
form of hand and hook
that perform voluntary
opening and closing.

14.  WRIST UNIT
 It provides attachment to
terminal devices with
forearm section.
 Three types
1.Friction wrist unit.
2. Quick change wrist
unit
3.Locking wrist unit.

15.  FOREARM SECTION
 Found in two forms-
1. Forearm shells- for
above elbow prosthesis.
2. Socket- for below
elbow prosthesis.

16.  PROSTHETIC SOCKETS
1. Harness suspended socket –
here socket is suspended by
figure of 8 hareness or cross chest
straps harness from shoulder.
2. Self suspended socket-here
suspension is provided by some
bony parts of residual limb or
atmospheric pressure and skin
traction.
Soft inserts are applied in sockets
to absorb the pressure effect of
socket- its indications are-
Peripheral vascular diseases.
Escessive scarring of stump.
Stump with minimal
subcutaneous tissue.

17.  ELBOW JOINT UNIT
These are available for both
below elbow or above elbow
prosthesis.
BE prosthetic elbow joint
It attaches socket of prosthesis
with cuff fitted on upper arm.
It provides stability and suspension
ability
It may be rigid or flexible type.
AE prosthetic elbow joint
It consists of elbow joint and cable
system.
It can be fixed in various degree of
elbow flexion

18.  MYOELECTRIC PROSTHESIS
1. Principle- The signals or
action potential of
functioning muscles are
picked up by electrodes on
surface of skin, which activate
a baterry driven motor that
operates the prosthetic
components.
2. Components-
Socket
Sensor electrodes
Electrical motor
Battery
Terminal device

19. LOWER LIMB PROSTHESIS
 Prosthesis foot.
 Prosthesis shank.
 Prosthesis socket and suspension below knee
prosthesis.
 Prosthetic knee joint above knee prosthesis.
 Prosthetic socket and suspension.

20. Prosthetic foot
 Classification-
a) Non articular
b) Articular.
Non energy storing foot- most
commonly used
Eg- Jaipur foot, solid ankle
cushioned foot(SACH) etc
Single axis foot- commonly
used in transfemoral
amputees
Multi axis foot- used for
exessively scarred and
sensitive stump.

21.  Prosthetic shank-
1. Endoskeletal- durable ,
but little scope for
alignment changes
after finishing.
2. Endoskeletal- lighter
cosmetic and easily
adjustable.

22.  Prosthetic socket and
suspension-
1. SOCKET-
 Patellar tendon bearing-
most commonly used
 Bent knee type- used in
severe contractures.
2. SUSPENSION-
with suction action
without suction action

23.  Prosthetic knee joint-
1. Axis- Single axis and
polycentric.
2. Stability- Manual locking
type and weight activated
stance control.
3. Motion control- constant
friction type and variable
friction type.
4. Sensor controlled
microprocessor knee.

24.  Prosthetic socket and
suspension (AKP)-
 Socket type-
Quadrilateral type.
Ischial component type.
 Suspension type-
1. With suction action- with
one way air valve to produce
negative suction during
weight bearing.
2. Without suction type-
Pelvic band
Selesian band.

25.  Leg extension
prosthesis- mainly used
for weight bearing.
 It supports the limb and
transfer the weight to
main prosthesis
inefficiently.
 It gives ugly look to
prosthesis.

26. ORTHOSIS
 An orthosis is an orthopedic appliance used to modify the structural
and functional characterstics of body parts.
 Classification of orthosis on anatomical basis-
Lower limb orthosis-
1. Hip knee ankle foot orthosis
2. Knee ankle foot orthosis
3 . Ankle foot orthosis
4. Foot orthosis.
Upper limb orthosis-
1. Shoulder orthosis
2. Elbow wrist hand orthosis
3. Wrist hand orthosis
4. Hand orthosis

27.  Spine orthosis-
1. Cervical orthosis.
2. Cervical thoraco lumbar sacral orthosis.
3. Thoraco lumbar sacral orthosis.
4. Lumbosacral orthosis.
Classifcation of orthosis on mechanical basis-
1. Dynamic orthosis- allowss movement to splinted part.
2. Static orthosis- does not allow movement to splinted
part.

28. UPPER LIMB ORTHOSIS
 It may be static or dynamic.
 It is made up of metal sheets, thermoplastics, rubber,
fabrics, rubber leather etc.
 Functions of Orthosis-
 It restricts the movement of interphalangeal
joints and some of the metacarpal phalangeal joints.
It also acts as a corrective splint.

29. HAND ORTHOSIS
Finger cot Long finger extension splint
 It immoblises the
interphalangeal joints in case
of sprain, strains and
phalangeal fractures.
 It immoblises the metacarpal
phalangeal joints along with
interphalangeal joints.

30. HAND ORTHOSIS
 Mallet finger splint- it
immoblises the distal
interphalangeal joints of the
finger and interphalangeal
joints of the thumb.
 Ring and figure of 8 splint- it
is used for correction of
rheumatoid hand deformity.
 Capner Spring coil Splint-
used for mobilisation of
interphalangeal contractures.

31. WRIST HAND ORTHOSIS
 Wrist hand stabilizers or resting
splint.
 Cock up splint- splint maintains
wrist in extension with help of
volar support.
Eg- In sparin, arthitis, carpal
tunnel syndrome , tendinitis etc.
Thumbspica- an immobilization
splint which maintain the wrist in
10°–20° of extension and thumb in
slight flexion and palmar abduction.
It is used for immobilisation of
thumb.

32.  Kunclekle-Bender splint-
deformity correction splint. It
is used in claw hand.
 Dynamic cock up splint- It is
a functional splint . It is used
in wrist drop.

33. ELBOW ORTHOSIS
Elbow ROM orthosis Elbow extension orthosis
 It is used forpost operative
immobilisation of elbow.
 It is used for stabilisation of
Unstable joints.
 It is commonly used in
spastic elbow like in cerebral
palsy.

34. SHOULDER ORTHOSIS
 Air plane splint -shoulder
abuction orthosis. It is used in
brachial plexus injury, post burn
contracture .
 Figure of 8 brace(cervical collar)
– it is used for clavicle fracture.
 Sling and swanthe immobiliser(
universal shoulder
immobiliser)- it is used for
shoulder dislocation and
proximal humerus fracture.

35. SPECIAL ORTHOSIS
Turn buckle splint
 Dynamic splint
 It is used for gradual
streching over contracted
joints.
 It is used in
-spastic elbow
-volksman ischemic
contracture

36. LOWER LIMB ORTHOSIS
Surgical shoe
 Components of surgical shoe:
Toe box
Upper : vamp (anterior),
quarter (posterior) and throat.
Sole: insole and outsole.
Counter
Heel

37. Some external shoe
modifications
Some internal shoe
modifications

38. Shoe inserts
 May be accommodative or
corrective.
 Soft insert- made up of of
foam polyethylene or foam
rubber. Eg- heel pad, sole pad
and metatarsal pad.
 Rigid insert- Mainly
composed of thermoplastics.
It keeps the calcaneum in
position because of 3 wall
design.

39. FOOT ORTHOSIS
 It may be dynamic or static.
 It consist of foot piece- toe
piece and straps.
 It immoblises the
metatarsophalangeal joint
and interphalangeal joint.

40. SOME FOOT ORTHOSIS
 Halux valgus or varus
correcting orthosis.
 Rings or splint for toe
deformity correction.

41. ÀNKLE FOOT ORTHOSIS DESIGN
Conventional type ankle
foot orthosis
 Components are as:
Surgical shoe with stirrup
Ankle joint
Metal uprights
Calf band
Straps
Functions- It is used in foot
drop, neuropathic feet, post
polio residual deformity and
equinus contracture.

42. Total contact AFO
 These are thermoplastic
madd AFO moulded over
negative of plaster of paris leg
foot cast.
 Floor reaction AFO is a
speciap type of AFO.
 Prerequisite – healthy and
fair functioning quadriceps.

43. KNEE ANKLE FOOT ORTHOSIS
Conventional knee ankle
foot orthosis (KAFO)
Total Contact KAFO
 Function-
1. Prevent buckling of knee
and facilitate ambulation.
2.Maintain atability of knee.
3. To relieve weight on bone
and joint of lower limb.
 Made up of thermoplastics
attached to the knee joint.
 Ischial weight bearing type
KAFO- a variant of KAFO
- here body weight is
transferred from ischium to
the orthosis and relieve the
distal part of the limb.

45. HIP KNEE ANKLE ORTHOSIS
Conventional hip knee ankle
foot orthosis.(HKAFO)
Total contact hip knee ankle
orthosis(THKAFO)
 Function-
1. Maintain standing
posture of person and ensure
the mobility.
2. Maintain stability of the
hip joint.
 Fabricated with
thermoplastics attached with
hip and knee joints.
 Reciprocating gait orthosis- a
special HKAFO
 It is used in cases of spina
bifida and spinal cord injury.

47. SPECIAL ORTHOSIS FOR DDH
 Pavlik- harness.
 Von Rosen splint.
 Frejka pillow.
 Ilfeld orthosis.
 Tripple diaper

48. SPECIAL ORTHOSIS FOR PERTHES
 Trilateral Orthosis
 Toronto Orthosis
 Newington Orthosis
 Scottish rite Orthosis

49. ORTHOSIS FOR CTEV
 AFO.
 CTEV shoe.
 Dennis Brown Splint.
 Steinback foot abduction
brace.

50. CERVICAL ORTHOSIS
Soft cervical collar;
Thomas collar
 It extends superiorly from
base of mandible and
superior nuchal line to
manubrium and C7 spine
inferiorly
 Indications- mild soft tissue
sprain, spasm, spondylosis,
disc disease etc.

51. Hard cervical collar
 It is same as soft collar but
made up of hard
polyethylene.
 Indications- moderate soft
tissue sprain, spondylosis, ,
disc disease etc.

52. Philadelphia collar
 Semi rigid or rigid variety.
 Functions-
Kinesthetic reminder.
Motion control.
Indications- Temporary
stabilisation in cervical spine
injury.

53. EXTENDED CERVICAL ORTHOSIS
CERVICO THORACIC
ORTHOSIS; MINERVA
JACKET
 A rigid frame, custom made
total contact orthosis
 Function- provide maximum
motion control at lower
cervical levels and cervico
thoracic junctions.
 Commonly used in traumatic
and pott spine cases.

54. CERVCO THORACIC
LUMBO SACRAL
ORTHOSIS

 Halo pelvic brace
 Functions-
 1. Limits all spinal motion.
 Correction of deformity by
differential distraction.
 Indications-
 1. Spinal stabilisation in
fractures or pott spine.
 Correction of deformities in
scoliosis or TB

55. CERVICAL HALO
 A rigid frame invasive
bracing where screws are
directly inserted into the
skull.
 Function used in unstable
fracture dislocation of spine.

56. THORACOLUMBOSACRAL
ORTHOSIS
TAYLOR BRACE
 Semi rigid design
 Functions-
 1.Principle of 3 point pressure
 2. Limits flexion and extension
 3, It converts intraabdomial
pressure and convert abdominal
cavity into semi rigid cylinder.
 Indications- spine osteoporosis,
spinal trauma, degenrative disc
disease, pott spine.

57. Anterior hyper extension
orthosis
 Cruciform type.
 Function-
 1. Three point pressure fixation
 2.Limits flexion and extension
 Indications- PIVD, moderate
soft tissue sprains and strains,
pre and post operative
immobilisation of fracture of
spine.

58. SPECIAL ORTHOSIS FOR SCOLIOSIS
MILWAUKEE BRACE
 Rigid frame design
 First used for post polio
residual deformity.
 Functions-
 1. Longitudinal distraction of
whole spine.
 Three pressure point fixation.
 Indications- Scoliosis
treatment.

59. BOSTON BRACE
 Rigid frame device
 Functions-
 1. It allows transverse loading
of spine by three pressure
point from convex to concave
side
 Indications- Treatment of
scoliosis.

60. TRACTION
 Traction -A mechanical force applied against a resistance to overcome
deforming forces on fractured fragment or pathological joint.
 Traction weight- On an average traction weight is equal to 10% of body
weight.
 Counter traction- A force applied opposite to traction force is called
counter traction.
 On this basis of counter traction, traction can be divided ointo two
groups-
1. Fixed traction- Here leg of the couch need not to be elevated.
2. Sliding traction- Here leg of couch is elevated with the help of
wooden blocks.

61. TYPES
FIXED TRACTION
SLIDING TRACTION
 When counter traction
obtained by an appliance
which takes the purchase on a
part of a body.
 Traction weight – 2.3kg
 Uses- Maintain undisplaced
fracture and for
transporatation.
 When counter traction is
obtained by weight of all or
part of body under influence
of gravity.
 It can be given by both skin
and skeletal traction.
 Uses- for fracture reduction
and pathological joint
immobilisation.

62.  BUCKS TRACTION-
here skin traction is kept
over pillow.
It is used in fracture neck of
femur and acetabulum
fracture.
No splint is used here
 PERKIN’S TRACTION-
here skeletal traction is kept
over pillow.
It is ised in fracture neck of
fewur and acetabulum
fracture.
No splint is used here.

63. SKIN TRACTION
 Traction force applied over a large area of a skin is
called skin traction.
 Two types of skin traction are commonly used-
1. Adhesive(max. wt- - 6.7kg)
2. Non adhesive(max.wt- 4.5kg)

64. BRYANTS/GALLOW
TRACTION
DUNLOP’S TRACTION
 Indication- Fracture shaft of
femur
 Indication – for
supracondylar and
intercondylar fracture
humerus.

65. SKELETAL TRACTION
 Traction force applied directly through a part of a bone
is called skeletal traction.
 It is applied distal to the fracture site.
 It is applied through a pin or k wire.
 More traction weight can be given.

66. LATERAL UPPER
FEMORAL TRACTION
DISTAL FEMORAL TRACTION
 Entry point- 2.5cm below the most
prominent part of GT , midway
between anterior and posterior
border of shaft of femur.
 Indications-
1.Central fracture dislocation of
hip.
2. Acetabular fracture.
 Entry point- medial to lateral.
 One line along anterior border if head of
fibula.
 Another line along upper border of
patella.
 Enter from corresponding junctional
point.
 Indications-
1. Fracture shaft of femur
2.Acetabular fracture dislocation.

68. UPPER TIBIAL TRACTION DISTAL TIBIA TRACTION
 Entry point of pin-
1. medial to lateral.
2. 2cm below and behind the
tibial tubercle
Indications- Intertrochanteric
fracture femur, supracondylar
femur fracture, shaft femur
fracture.
 Entry point of pin-
1. Medial to lateral.
2. One point- 5cm above ankle
joint.
3. Other point- midway between
anterior and posterior border of
tibia.
Indications- Proximal tibia fractures
or knee fracture dislocations.

70. CALCANEAL TRACTION OLECRANON TRACTION
 Entry point-
1. Medial to lateral
2. 3cm belowand behind the medial
malleolus
3. 2cm below and behind the lateral
malleolus.
Indications-
Distal tibia fracture.
Ankle fracture dislocation.
 Entry point-
1. Medial to lateral.
2. 3cm distal to the tip of olecranon
process.
Indications- supracondylar and
intercondylar distal humerus
fracture.

71. METACARPAL TRACTION
 Entry point-
1. Lateral to medial.
2. Transversely perpendicular
to long axis of radius.
3. 2-2.5cm proximal to distal
end 2nd metacarpal.

72. HEAD HALTER TRACTION
 Two types-
1. Canvas head halter- with
chin and occiput rest.
2. Crili head halter- with
forhead and occiput rest.
Total effective traction- 10-15%
body weight.
Uses- cervical spondylosis.
- cervical trauma.

73. PELVIC TRACTION
 Components-
-canvas harness
- Side straps
- metal spreader with
hook
Total effective weight- 20-30%
body weight.
Uses- PIVD

74. CERVICAL SKELETAL
TRACTION
 Ways of traction application-
- by crutchfield tong.
- by barton tong.
- by garden well.
- by cervical halo.
Traction weight- 9.1- 18.2kg.
Indications-
1. For reduction of fracture dislocation
of cervical spine
2. Maintenance of reduction
3. 3. After operative fusion.
Contraindications-
1. C2 fracture type.
2. Cervical flexion distraction.

75. BOOT AND BAR
 Components-
1. Well padded boot cast
2. Wooden scale as derotation
bar
3. POP bandage loop for
traction.
Indications-
1. Conservative treatment of
inter trochanteric fracture
2. Impacted neck fracture.

76. CHARNLEY’S TRACTION
 Components-
1. Upper tibial traction kit
with Bohlers stirrup.
2. Below knee plaster cast
3. Derotation bar
Indications- fracture shaft
femur.

77. NINETY –NINETY
TRACTION
 Combination of two traction
that maintain both the hip in
90 degree of flexion.
 Traction 1- it is the main
traction which acts on the
pathology.
 Traction 2- supportive
traction unit which holds the
leg in air.
 Indications- proximal
onethird femur fracture.

78. RUSSEL TRACTION
 Component of traction-
- skin traction in leg
- Knee sling
-System of pulley
Effective traction- resultant force
which acts in the line of
direction of long axis of femur.
Indications- fracture shaft of femur
in pediatric cases
- triple deformity of knee

79. AGES HUNT TRACTION
 Components-
- single hip spica
- leg sling
- skin traction over thomas
splint.
Indications- for fixed flexion
deformity if hip.