Arthrogryposis, pediatric
Troy Fink, C.O.
Description
Collection
Title:
Arthrogryposis, pediatric
Creator:
Troy Fink, C.O.
Text:
I have a patient, a 6 month old girl with a diagnosis of arthrogryposis. I
have been treating her for the past 4 months. I have provided KOs, EOs and
WHFOs for her. Her mother and PT have been very aggressive with stretching. I
have re-fabricated and adjusted the systems several times to accommodate for
growth and increased ROM. I have been using low-temp plastic and molding
directly to the patient. This has been working reasonably well, but it has
its limitations. Also, we (mother, PT, MD & myself) have elected not to
treat the ankles orthotically -- as she has an extreme equiinovarus deformity
bilaterally. The MD states that ankle correction is the first surgery he will
perform.
It is now time to replace the EO and WHFO. The mother states the pt.
tolerates both systems throughout the night. Unfortunately, she cannot wear
them both (EO & WHFO) at the same time, as they both cover the lower arm.
My goal is to provide EWHFOs. Part of the challenge is the trim lines. The
WHFO section should cover the Palmer region to provide extension forces at
the wrist and MCP joints. But with the wrist at neutral in the transverse
plane, as the trimlines approach the elbow, the plastic will cover the medial
portion of the lower arm. The trimlines are at the center of the anterior and
posterior aspects of the lower arm. Now, if I haven't lost you, you will see
the challenge arises as I integrate this into the elbow portion. At the elbow
I need to prevent extension, so the plastic should be either anterior or
posterior with the trimlines medial and lateral. Perhaps it could be more
simply stated: the WHFO portion is rotated ninety degrees relative to the EO
portion.
Any suggestions on how to accomplish this while maintaining maximal lever
arms and still practical and possible to don?
The other part of the challenge is I believe I could provide a better
orthosis if I could mold to a positive model. Any tips for casting an infant?
she is tiny!
Thanks for taking the time to read this. Any and all replies would be greatly
appreciated. In fact, any comment regarding pediatric arthrogryposis would be
great.
Sincerely,
Troy Fink, C.O.
email: <Email Address Redacted>
have been treating her for the past 4 months. I have provided KOs, EOs and
WHFOs for her. Her mother and PT have been very aggressive with stretching. I
have re-fabricated and adjusted the systems several times to accommodate for
growth and increased ROM. I have been using low-temp plastic and molding
directly to the patient. This has been working reasonably well, but it has
its limitations. Also, we (mother, PT, MD & myself) have elected not to
treat the ankles orthotically -- as she has an extreme equiinovarus deformity
bilaterally. The MD states that ankle correction is the first surgery he will
perform.
It is now time to replace the EO and WHFO. The mother states the pt.
tolerates both systems throughout the night. Unfortunately, she cannot wear
them both (EO & WHFO) at the same time, as they both cover the lower arm.
My goal is to provide EWHFOs. Part of the challenge is the trim lines. The
WHFO section should cover the Palmer region to provide extension forces at
the wrist and MCP joints. But with the wrist at neutral in the transverse
plane, as the trimlines approach the elbow, the plastic will cover the medial
portion of the lower arm. The trimlines are at the center of the anterior and
posterior aspects of the lower arm. Now, if I haven't lost you, you will see
the challenge arises as I integrate this into the elbow portion. At the elbow
I need to prevent extension, so the plastic should be either anterior or
posterior with the trimlines medial and lateral. Perhaps it could be more
simply stated: the WHFO portion is rotated ninety degrees relative to the EO
portion.
Any suggestions on how to accomplish this while maintaining maximal lever
arms and still practical and possible to don?
The other part of the challenge is I believe I could provide a better
orthosis if I could mold to a positive model. Any tips for casting an infant?
she is tiny!
Thanks for taking the time to read this. Any and all replies would be greatly
appreciated. In fact, any comment regarding pediatric arthrogryposis would be
great.
Sincerely,
Troy Fink, C.O.
email: <Email Address Redacted>
Citation
Troy Fink, C.O., “Arthrogryposis, pediatric,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/213802.
