Guidelines for the use of the Orthoflex Long Brace

• The Long brace is indicated for the support of all injuries of the limbs together with the well-leg strap.
• The low volume feather light package and rapid application is ideal for ambulances, helicopters, and rescue team kits. It is quickly inflated to stiffness at 200-250 mm Hg pressure.
• The special buckles for fast fitting can be applied by one pair of hands (no help needed from second person).
• The Long brace can be applied over the footwear and clothing.
• Open wounds must be dressed first if suitable sterile materials are available.
• The Long brace inflated structure allows for shock absorption of the jolting forces during transport.

General:

The Orthoflex brace can be inflated to 760 mm Hg pressure. However this is never necessary: at 200-250 mm Hg the Orthoflex brace is stiff enough for passive support of the ankle at 90 degrees plantigrade, even without applying the plantigrade straps. When it is necessary to limit active plantar flexion the plantigrade straps must be used.

The treating physician, surgeon, or paramedic decides whether more or less stiffness is indicated for the particular condition requiring Orthoflex braces support. To assess stiffness and the degree of inflation required, the Orthoflex brace is tested during inflation by squeezing the tubes and assessing the ease of bending of the splint at its ankle location. The type and degree of inner padding required is also determined according to the condition being treated. The air pressure within the Orthoflex brace is well maintained over time and should not require any replenishment during the use in a single patient.

However, after two weeks, or if there is a leak from the valve because it was inadvertently compressed, the pressure can be increased back to the required stiffness at any time by using the hand bulb pump. The valve should always be pressed in so as not to protrude from the side of the splint, to avoid inadvertent escape of air. Many methods are available for the initial inflation and all are legitimate; the most convenient should be used. Over inflation is present if the pressed–in valve extrudes spontaneously. The pressure should then be reduced by squeezing the sides of the one way valve.

Emergency and Accident:

First aid in the field, at the site of an accident causing an injury to any limb: the splint is inflated to full stiffness. The injured limb is placed gently in the splint. (Shoes and clothes are optionally not removed). The straps are tightened firmly, including the plantigrade straps. An open wound must first be dressed. If the casualty is conscious, degree of comfort feedback from him is useful to achieve the optimal tightness of the straps. Ideally evacuation is by any means avoiding weight bearing on the injured limb. However if necessary the casualty may walk on the Orthoflex brace: avoid sharp objects on the ground.

In the ER the Orthoflex brace is not removed but retained for transport within the hospital to X-ray, ward, OR, etc. If the injury is such as not requiring surgery nor rigid fixation for maintaining the reduction of a displaced fracture, definitive support in the Orthoflex brace can be continued (minor foot fractures, foot wounds, fracture calcaneus not for operation, crush foot, upper limb injuries etc) If the injury requires surgery such as internal fixation of a fracture, a “nappy” padded Orthoflex brace is indicated as the post-operative temporary support which ensures plantigrade positioning, easy change of dressings, early movement option, and patient comfort, avoiding post operative plaster of Paris. Once swelling has receded and the stitches are out, the treating surgeon applies a plaster of Paris if rigid fixation or non-removable protection is needed.

Fracture of the neck of the femur

In pertrochanteric, subtrochanteric, and Garden type III and IV subcapital fractures, the leg lies in an external rotation deformity. The well padded Orthoflex brace plus outrigger is applied at the site of the fall by the ambulance paramedic, or – on arriving at the ER – by the trauma nurse or doctor, or failing these, on admission to the ward.

The task of the Orthoflex brace with the outrigger is to correct the rotation deformity and prevent pressure on the heel and lateral malleolus: pain is much reduced and transport to and within the hospital and nursing are facilitated. The Orthoflex brace is removed in the OR and its continued post-operative use is optional.

Fracture of the shaft of the femur

The famous classical Thomas splint which allows for traction in cases of femoral fractures is hardly used anymore because of its bulky size, difficulty of application, and the rapidity of modern casualty evacuation, which has made long term first aid splinting for fracture of the femur a rarity. Ordinary long leg splints cannot control a femur shaft fracture and therefore the usual treatment given is strapping the injured to the intact leg. However this does not correct the external rotation of the leg. Therefore Orthoflex brace plus outrigger is applied, much reducing pain and facilitating transport.

The Long Brace is indicated for the support of all injuries of the lower and upper limb. The low volume, feather light package and rapid application is ideal for ambulances, helicopters, and rescue team kits. It is quickly inflated to stiffness at 200-250 mm Hg pressure. The special click-clacks or zipper harness makes for very fast fitting by one pair of hands (no help needed from second person).

The Long Brace is optionally applied over the footwear and clothing. Open wounds must be dressed first if suitable sterile materials are available. The Long Brace inflated structure allows for shock absorption of the jolting forces during transport.

The Orthoflex Long Brace is also very convenient for post operative support after internal fixations of tibial injuries.