Axial Loading Orthoses - Module 6

What is the intention of axial loading?

unweight a specific joint/s

Other orthotic devices that use unweighting principles.

PTB

Axial Loading orthoses are used most in

tibial non-union fx

Quad brim is (usually) for 

muscular patients 

Ischial Containment brim is (usually) for

more fleshy patients

Quad is typically used with our patients for an axial loading orthosis why?

even though these patients are not muscular, a lot of them will be seated for long periods of time, therefore having a flat surface to sit on will be more comfortable.

What are the three approaches to casting a patient for an axial loading orthosis?

• anterior for smaller patients 

• posterior for larger patients 

• lateral 

Bony lock is in which brim design?

ischial containment 

An axial loading orthosis needs a

solid ankle with a locked knee

How do you address the functional LLD when you lock the patient’s knee?

heel adjustable wedge insert

What are the diagnoses that are indicated for Quad/IC brims?

• osteomalacia, 

• charcot knee

• femoral fracture/non-union

• DJD, osteochondromas

• cartilaginous damage at or above the knee

What are the weight distribution areas of a Quad Brim?

Gluteal musculature and the ischial tuberosity 

What is the medial hand positioning for casting of a Quad Brim?

fingers create the flat medial wall, and the thumb is pressed firmly into the Scarpa’s triangle

What is the lateral hand positioning for casting of a Quad Brim?

palm and fingers are held at 90° so that the fingers define the posterior shelf and the palm defines the lateral wall

What are the critical measurements for a Quad Brim?

• Sitting AP

• Ischial tuberosity to floor

• circumferences and ML along the entire thigh, starting at the ischial level

What are Ischial Containment advantages over the Quad Brim?

• improved anatomic congruency - increased comfort

• superior coronal and transverse plane stability

• decreased pressure over neurovascular bundle

What are the weight distribution areas for Ischial Containment?

• gluteal musculature

• adductor musculature 

• subtrochanteric pressure

Subtrochanteric pressure is 

force exerted along the entire lateral aspect of the femur

Medial hand positioning for casting of an ischial containment brim.

Index finger and middle finger on medial and distal aspects of ischial tuberosity. Thumb abducted to create adductor channel in first webspace.

Lateral hand positioning for casting of an ischial containment brim.

cup greater trochanter with palm, and provide upward and medially directed force. Fingers should define posterior margin of GT.