adjustable hip orthosis (autosaved)

8/11/2019 Adjustable Hip Orthosis (Autosaved)

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ADJUSTABLE HIP ORTHOSIS

Presented by Guided bySHANTHINI. A Mr. Arul ThomasDPO Second year, Course coordinatorCMC, Vellore. P&O CMC,Vellore.


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ABSTRACT

This orthosis designed for congenital dysplasia of hip and it is a ball and socket hip

joint. I hope the design will help the patient for the normal gait.

It allows every normal movement similar to anatomical hip joint and its having

a adjustable mechanism. This is not available in the existing model.


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1. INTRODUCTION

Orthotic Hip Joint for congenital hip dysplasia:

This Orthotic hip joint is mainly prescribed for the congenital hip dislocation.

Function of this orthosis is support and encourage the hip joint movement and

allowing the normal gait. The hip joint can be repositioned (head of the femur is

placed to seat in the acetabulum cavity) while abduct the hip joint.

Indication: Congenital hip dysplasia .. Hip sublaxation Progressive contractures of all spastic muscles.

Adjustable hip orthosis:

Adjustable hip orthosis for congenital hip dislocation it will allow flexion,

extension, abduction, internal and external rotation like our normal anatomical hip

joint.

Existing orthosis have flexion extension and abduction movements only; in this

orthosis we can achieve all the movements so its works to support normal gait and

movement & its having adjustable components mechanism in pelvic band and

both thigh shell region so its helps to use long time.


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ANATOMY OF HIP JOINT

HIP JOINT

Hip joint is unique in having a high degree of stability and mobility.

TYPES Synovial joint, ball and socket variety.


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BONES

Articulating ends

Proximally Acetabulum of hip bone. The labrum acetabulare, afibrocartilaginous rim is attached to the margin of the acetabulum.

Distally- head of femur


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LIGAMENTS

1. Capsule2. Transverse ligament.3. Round ligament of the head of femur4. Iliofemoral ligament. (it is the strongest ligament in the boby).5. Pubofemoral ligament6. Ischiofemoral ligament

Intracapsular ligament. Left hip joint from within pelvis with acetabular floorremoved (left); right hip joint with capsule removed, anterior aspect (right).

The hip joint is reinforced by five ligaments, of which four are extracapsular

and one intracapsular.The extracapsular ligaments are the iliofemoral,

The hip joint is reinforced by five ligaments, of which four are extracapsular

and one intracapsular.The extracapsular ligaments are the iliofemoral,

ischiofemoral, and pubofemoral ligaments attached to the bones of the pelvis (the

ilium, ischium, and pubis respectively). All three strengthen the capsule and


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MOVEMENTS

Movements Muscles responsible for the movements

1. Extension - Gluteus maximus, hamstrings.2. Flexion - ijiacus, psoas major.3. Abduction - Gluteus medius, gluteus minimus.4. Lateral rotation - Piriformis, gamely, obdurate externs and

interns, quadrates femoras. 5. Medial rotation - Gluteus medius and minimus.

The hip muscles act on three mutually perpendicular main axes, all of which pass

through the center of the femoral head, resulting in three degrees of freedom andthree pair of principal directions: Flexion and extension around a transverse axis

(left-right); lateral rotation and medial rotation around a longitudinal axis (along

the thigh); and abduction and adduction around a sagittal axis (forward-backward);

and a combination of these movements (i.e. circumduction, a compound movement
http://en.wikipedia.org/wiki/Lateral_rotationhttp://en.wikipedia.org/wiki/Lateral_rotation


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in which the leg describes the surface of an irregular cone). It should be noted that

some of the hip muscles also act on either the vertebral joints or the knee joint, that

with their extensive areas of origin and/or insertion, different part of individual

muscles participate in very different movements, and that the range of movementvaries with the position of the hip joint. Additionally, the inferior and superior

gemelli may be termed triceps coxae together with the obturator internus, and their

function simply is to assist the latter muscle.

The movements of the hip joint is thus performed by a series of muscles which

are here presented in order of importance with the range of motion from the

neutral zero-degree position indicated:

Lateral or external rotation (30 with the hip extended, 50 with the hip

flexed): gluteus maximus ; quadratus femoris ; obturator internus ; dorsal

fibers of gluteus medius and minimus ; iliopsoas (including psoas major from

the vertebra

column); obturator externus; adductor magnus, longus, brevis, and minimus;

piriformis; and sartorius.

Medial or internal rotation (40): anterior fibers of gluteus medius and

minimus; tensor fascia latae; the part of adductor magnus inserted into the

adductor tubercle; and, with the leg abducted also the pectineus.
http://en.wikipedia.org/wiki/Gluteus_maximus_musclehttp://en.wikipedia.org/wiki/Gluteus_maximus_musclehttp://en.wikipedia.org/wiki/Quadratus_femoris_musclehttp://en.wikipedia.org/wiki/Quadratus_femoris_musclehttp://en.wikipedia.org/wiki/Obturator_internus_musclehttp://en.wikipedia.org/wiki/Obturator_internus_musclehttp://en.wikipedia.org/wiki/Gluteus_medius_musclehttp://en.wikipedia.org/wiki/Gluteus_medius_musclehttp://en.wikipedia.org/wiki/Gluteus_medius_musclehttp://en.wikipedia.org/wiki/Gluteus_minimus_musclehttp://en.wikipedia.org/wiki/Gluteus_minimus_musclehttp://en.wikipedia.org/wiki/Gluteus_minimus_musclehttp://en.wikipedia.org/wiki/Iliopsoashttp://en.wikipedia.org/wiki/Iliopsoashttp://en.wikipedia.org/wiki/Iliopsoashttp://en.wikipedia.org/wiki/Psoas_major_musclehttp://en.wikipedia.org/wiki/Psoas_major_musclehttp://en.wikipedia.org/wiki/Psoas_major_musclehttp://en.wikipedia.org/wiki/Obturator_externus_musclehttp://en.wikipedia.org/wiki/Adductor_magnus_musclehttp://en.wikipedia.org/wiki/Adductor_longus_musclehttp://en.wikipedia.org/wiki/Adductor_brevis_musclehttp://en.wikipedia.org/w/index.php?title=Adductor_minimus_muscle&action=edit&redlink=1http://en.wikipedia.org/wiki/Piriformis_musclehttp://en.wikipedia.org/wiki/Sartorius_musclehttp://en.wikipedia.org/wiki/Gluteus_medius_musclehttp://en.wikipedia.org/wiki/Gluteus_minimus_musclehttp://en.wikipedia.org/wiki/Tensor_fascia_lataehttp://en.wikipedia.org/wiki/Adductor_magnus_musclehttp://en.wikipedia.org/wiki/Adductor_tuberclehttp://en.wikipedia.org/wiki/Pectineus_musclehttp://en.wikipedia.org/wiki/Pectineus_musclehttp://en.wikipedia.org/wiki/Adductor_tuberclehttp://en.wikipedia.org/wiki/Adductor_magnus_musclehttp://en.wikipedia.org/wiki/Tensor_fascia_lataehttp://en.wikipedia.org/wiki/Gluteus_minimus_musclehttp://en.wikipedia.org/wiki/Gluteus_medius_musclehttp://en.wikipedia.org/wiki/Sartorius_musclehttp://en.wikipedia.org/wiki/Piriformis_musclehttp://en.wikipedia.org/w/index.php?title=Adductor_minimus_muscle&action=edit&redlink=1http://en.wikipedia.org/wiki/Adductor_brevis_musclehttp://en.wikipedia.org/wiki/Adductor_longus_musclehttp://en.wikipedia.org/wiki/Adductor_magnus_musclehttp://en.wikipedia.org/wiki/Obturator_externus_musclehttp://en.wikipedia.org/wiki/Psoas_major_musclehttp://en.wikipedia.org/wiki/Iliopsoashttp://en.wikipedia.org/wiki/Gluteus_minimus_musclehttp://en.wikipedia.org/wiki/Gluteus_medius_musclehttp://en.wikipedia.org/wiki/Obturator_internus_musclehttp://en.wikipedia.org/wiki/Quadratus_femoris_musclehttp://en.wikipedia.org/wiki/Gluteus_maximus_muscle


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Extension or retroversion (20): gluteus maximus (if put out of action,

active standing from a sitting position is not possible, but standing and

walking on a flat surface is); dorsal fibers of gluteus medius and minimus;

adductor magnus; and piriformis. Additionally, the following thigh muscles

extend the hip: semimembranosus, semitendinosus, and long head of biceps

femoris.

Flexion or anteversion (140): iliopsoas (with psoas major from vertebral

column); tensor fascia latae, pectineus, adductor longus, adductor brevis, and

gracilis. Thigh muscles acting as hip flexors: rectus femoris and sartorius.

Abduction (50 with hip extended, 80 with hip flexed): gluteus medius;

tensor fascia latae; gluteus maximus with its attachment at the fascia lata;

gluteus minimus; piriformis; and obturator internus.

Adduction (30 with hip extended, 20 with hip flexed): adductor magnus

with adductor minimus; adductor longus, adductor brevis, gluteus maximus

with its attachment at the gluteal tuberosity; gracilis (extends to the tibia); pectineus, quadratus femoris; and obturator externus. Of the thigh muscles,

semitendinosus is especially involved in hip adduction.
http://en.wikipedia.org/wiki/Gluteus_medius_musclehttp://en.wikipedia.org/wiki/Gluteus_medius_musclehttp://en.wikipedia.org/wiki/Gluteus_medius_muscle


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ARTICULATION

Radiograph of a normal human hip joint

The hip joint is a synovial joint formed by the articulation of the rounded

head of the femur and the cup-like acetabulum of the pelvis. It forms the primary

connection between the bones of the lower limb and the axial skeleton of the trunk

and pelvis. Both joint surfaces are covered with a strong but lubricated layer called

articular hyaline cartilage. The cuplike acetabulum forms at the union of three

pelvic bones the Ilium, pubis, and Ischium.

The Y-shaped growth plate that separates them, the triradiate cartilage, is

fused definitively at ages 14-16. It is a special type of spheroidal or ball and socket

joint where the roughly spherical femoral head is largely contained within the

acetabulum and has an average radius of curvature of 2.5 cm. The acetabulum

grasps almost half the femoral ball, a grip augmented by a ring-shaped fibro

cartilaginous lip, the acetabular labrum, which extends the joint beyond the

equator. The head of the femur is attached to the shaft by a thin neck region that is

often prone to fracture in the elderly, which is mainly due to the degenerative

effects of osteoporosis.
http://en.wikipedia.org/wiki/File:Hueftgelenk-gesund.jpg


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Femoral neck angle:

The angle between the longitudinal axes of the femoral neck and shaft, called

the caput-collum-diaphyseal angle or CCD angle, normally measures

approximately 150 in newborn and 126 in adults ( coxa norma ). An

abnormally small angle is known as coxa vara and an abnormally large angle as

coxa valga .

Because a change in shape of the femur naturally affects the knee, coxa

valga is often combined with genu varum (bow-leggedness), while coxa vara

leads to genu valgum (knock-knees).

Changes in trabecular patterns due to altered CCD angle. Coxa valga leads to

more compression trabeculae, coxa vara to more tension trabeculae .[9]

A change in CCD angle is the result of changes in the stress patterns applied to

the hip joint. Such changes, caused for example by a dislocation, changes the

trabecular patterns inside the bones. Two continuous trabecular systems emerging
http://en.wikipedia.org/wiki/Hip#cite_note-Thieme-Atlas-367-8#cite_note-Thieme-Atlas-367-8http://en.wikipedia.org/wiki/Hip#cite_note-Thieme-Atlas-367-8#cite_note-Thieme-Atlas-367-8http://en.wikipedia.org/wiki/Hip#cite_note-Thieme-Atlas-367-8#cite_note-Thieme-Atlas-367-8http://en.wikipedia.org/wiki/File:Coxa-valga-norma-vara-000.svghttp://en.wikipedia.org/wiki/Hip#cite_note-Thieme-Atlas-367-8#cite_note-Thieme-Atlas-367-8


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on auricular surface of the sacroiliac joint meander and criss-cross each other down

through the hip bone, the femoral head, neck, and shaft.

In the hip bone, one system arises on the upper part of auricular surface to

converge onto the posterior surface of the greater sciatic notch, from where

its trabeculae are reflected to the inferior part of the acetabulum. The other

system emerges on the lower part of the auricular surface, converges at the

level of the superior gluteal line, and is reflected laterally onto the upper part

of the acetabulum.

In the femur, the first system lines up with a system arising from the lateral

part of the femoral shaft to stretch to the inferior portion of the femoral neck

and head. The other system lines up with a system in the femur stretching

from the medial part of the femoral shaft to the superior part of the femoral

head.

On the lateral side of the hip joint the fascia lata is strengthened to form the

iliotibial tract which functions as a tension band and reduces the bending

loads on the proximal part of the femur.


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BIOMECHANICS OF THE HIP

The importance of the normal hip in any athletic activity IS emphasized by

the role this joint plays in movement and weight-bearing. An understanding of the biomechanics of the hip is vital to advancing the diagnosis and treatment of many

pathologic conditions. Some areas that have benefited from advances in hip

biomechanics include the evaluation of joint function. The development of

therapeutic programs for treatment of joint problems, procedures for planning

reconstructive surgeries and the design and development of total hip prostheses

[19]. Biomechanical principles also provide a valuable perspective to our

understanding of the mechanism of injury.

TWO-DIMENSIONAL ANALYSIS OF JOINT FORCES AT THE HIP

JOINT

Basic analytical approaches to the balance of forces and moments about the

hip joint can be useful in estimating the effects of alterations in joint anatomy or

different treatment modalities on the hip joint reaction force. The static loading of

the hip joint has been frequently approximated with a simplified, two dimensional

analysis performed in thefrontal plane. When the weight of the body is being borne

on both legs, the centre of gravity is centred between the two hips and its force is

exerted equally on both hips. Under these loading conditions, the weight of the

body minus the weight of both lgs is supported equally on the femoral heads, and

the resultant vectors are vertical


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In a single leg stance, the effective centre of gravity moves distally and

away from the supporting leg since the nonsupporting leg is now calculated as part

of the body mass acting upon the weight-bearing hip. This downward force exerts

a turning motion around the centre of the femoral head the moment is created by

the body weight, K , and its moment arm, a (distance from femur to the centre of

gravity). The muscles that resist this movement are offset by the combined

abductor muscles, M . This group of muscles includes the upper fibres of the

gluteus maximus

he tensor fascia lata, the gluteus medius and minimus, and the piriformis and

obturator internus. The force of the abductor muscles also creates a moment around

the centre of the femoral head; however this moment arm is considerably shorter

than the effective lever arm of body weight. Therefore the combined force of the

abductors must be a multiple of body weight.

The magnitude of the forces depends critically on the lever arm ratio, which is that

ratio between the body weight moment arm and the abductor muscle moment arm

(a:b ) Typical levels for single leg stance are three times Body weight,


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corresponding to a level ratio of 2.5. Thus, anything that increases the lever arm

ratio also increases the abductor muscle force required for gait and consequently

the

Force on the head of the femur as well (see Fig. 4). People with short femoralnecks have higher hip forces, other things being equal. More significantly people

with a wide pelvis also have larger hip forces. This tendency means that women

have larger hip forces than men because their pelvis must accommodate a birth

canal [21]. This fact may be one reason that women have relatively more hip

fractures and hip replacements because of arthritis than men do. It is also

Conceivable that this places women at a biomechanical disadvantage with respect

to some athletic activities, although studies do not always show gender differences

in

The biomechanics of running, particularly endurance running

Normally the tissues and bones of the hip joint function without causing

pain, but various diseases and injuries can damage the tissues so that the

deformations associated with loading are painful [20]. Management of painful hip


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MEASUREMENTS OF JOINT FORCES AT THE HIP

Walking transmits significant body weight to the hip joint, while jogging,

running and contact sports generate forces significantly greater. To verify the

estimates of hip joint forces made using free-body calculations, many in vivo measurements have been carried out using prostheses and endoprostheses

instrumented with transducers (staingauges). Rydell was the first to attempt

measuring direct hip joint forces using an instrumented hip prosthesis [24]; which

yielded force magnitudes of 2.3 to 2.9 times body weight for single leg stance and

1.6 to 3.3 times body weight for level walking [25]. More extensive studies have

recently been carried out, which are summarised. These studies have shown that

although patients in the early postoperative period can execute planned activities of

daily living with relatively low joint contact forces, unexpected events such as

stumbling or periods of instability during single leg stance can generate resultant

forces in excess of eight times body weight [25]. It is important to remember that

although the data from hip prostheses have established the magnitude of the loads

acting on the hip joint, the patients in these studies have undergone total hip

replacement and therefore the results cannot be directly correlated to the

physiology of the normal hip.


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newborns with developmental hip dysplasia or dislocation, the labrum is everted.

There is empiric evidence (such as the 95% success rate of devices like a Pavlik

harness) that these pathological changes are reversible.


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STATEMENT OF PROBLEM

DEFINITION :The patient having hip dislocation or sub laxation of hip. This is due to

the congenital problem at the time of birth.

CAUSES:

Risk Factors

1/1,000 born with dislocated hip 10/10,000 born with subluxation or dysplasia 80% Female First born children Family history (6% one affected child, 12% one affected parent, 36% one

child + one parent)

Oligohydramnios

CAUSES OF GENERAL SYMPTOM TYPES

Embryonic 7th week - acetabulum and hip formed from same mesenchymal cells 11th week - complete separation between the two Prox fem ossific nucleus - 4-7 months


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:

DIAGNOSIS

Ortolanis and Barlows maneuvers with a thorough history and physical Warm, quiet environment with removal of diaper Head to toe exam to detect any associated conditons (Torticollis,

Ligamentous Laxity etc.)

Baseline Neuro and Spine Exam

Key physical findings of hip dislocation

Asymmetry Limb length- Galeazzi Abduction ROM Skin folds Limp Waddilng gait / hyperlordosis - bilateral involvement

TREATMENT:

Regular follow up by the doctors. Regular muscle strengthening. Surgery

using orthosis.


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DESIGN OF THE ORTHOSIS

It is ball and socket hip joint. It maintains hip in abduction and external rotation so therefore it corrects the

hip dislocation therefore its a anatomical hip joint.

It is having adjustable mechanism in pelvic band and in both thigh shells. So we can use this orthosis for long period.


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FABRICATION PROCEDURE OF ADJUSTABLE

HIP ORTHOSIS

MATERIALS REQUIRED

S. no. Nomenclature Specification Quantity

1 Pop bandage 4 3

2 Pp Sheet 3mm 20 *20 3 Ethaflux 5mm 15*15

4 Pop 1 kg

5 Velcro (hook and loop) 1 40

6 Leather ( lining) 20 *20

7 Pelvic band 1 1 no

8 O ring 1 5 no9 Copper rivet 1/8 8 no

10 Aluminum rivet 1/8 10 no

11 Washer 1/8 15 no

12 Aluminum flat 1*1/8 20


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Thigh is maintained in extension

Final Finishing

After the trial we start to finish the orthosis proper padding orthosis should be cosmetically and functionally good, Straps are attached for easy donning

& doffing

Working Principle

It maintains the hip in abduction so that the head of femur goes inside and

works a normal hip joint.


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ADVANTAGES AND DISADVANTAGES

ADVANTAGES It is a supportive and functional device Low cost Easy maintenances Easy donning and doffing

DISADVANTES

Need more maintenance Workman ship is more


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INDICATION

For congenital dysplasia of hip

Hip sub laxation

CONTRAINDICATION

Scissoring gait

Hip bone and femur fracture Hip contracture


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CONCLUSION

Already there are many orthosis available but each having some short

coming but my orthosis adjustable hip orthosis will satisfy the patient

expectation and better functions.

This model is having adjustable mechanism in pelvic band and in both thigh

shells. So it helps to adjust in height and circumferential manner.

So it helps to use for long period.


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FUTURE PLAN

I hope this orthosis it is help for patient whos having congenital dysplasia of

hip and tried over the patient soon and I will get a successful out come from

this orthosis.


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REFRENCES

Prosthetics and orthotics in rehabilitation second edition Journal of Prosthetics and orthotics Journal of rehabilitation and development

adjustable hip orthosis (autosaved)

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