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Figure 1. Anterior view of Orthoplast® anterior shell orthosis. Figure 2. Posterior view of Orthoplast® anterior shell orthosis. Figure 4. Lateral view of patient wearing orthosis. Note Jewett type posterior pad and strap arrangement. Figure 3. Anterior view of patient wearing orthosis.
Figure 5. Patient in supine position donning orthosis. Figure 6. Patient, lying down, rolls to side and fastens the posterior pad and strap. Allowing for the posterior pad and strap to fasten on the same side facilitates donning and doffing in the lying position. L5; however, a cervical extension can be added to the orthosis to extend its support to the upper thoracic region. Originally designed for postoperative spinal management following Harrington rod instrumentation secondary to traumatic injury, the anterior shell orthosis permits the cast impression to be taken with the patient comfortably supine without the need for proning or other patient movement. ADVANTAGES In addition to the advantage of not having to move the patient while casting, the anterior shell orthosis is felt to be superior to the bivalved and circumferential TLSO designs for postoperative management in other respects. Additional .advantages offered by the anterior shell orthosis include ease of donning and doffing the orthosis initially for the nursing staff and later, the ability to independently don and doff the orthosis by the patient while in the supine position (Figures 5 and 6), ease of inspection of the surgical wound site without having to doff the orthosis, increased air circulation to the surgical wound site, and more efficient cooling due to less body containment within the orthosis. The anterior shell orthosis provides anterior, posterior, lateral, and rotary control, however, because there is no posterior section, the lateral aspects are slightly more flexible than in a circumferential design. This quality of slight flexibility facilitates maneuverability during transfers and activities of daily living, yet the orthosis provides sufficient external stabilization to protect the Harrington rod instrumentation. INDICATIONS As the advantages of the anterior shell design were proven with experience with postoperative patients, opportunities were sought for its use with other spinal diagnoses (Table 1). Indications for use of the anterior shell orthosis now include various vertebral fractures, treated surgically or non-surgically; vertebral degeneration and pain due to diffused malignancy; progressive kyphosis due to osteoporosis, ankylosing spondylitis, and neurological conditions; degenerative joint disease; and postoperative management of spinal stenosis. EXPERIENCE Over a period spanning 1979-1985, 232 patients were treated orthotically with the anterior shell; 137 of these patients were treated postoperatively (Tables 2 and 3). Over this seven year period, no postoperative patients experienced failure of surgical instrumentation while in the orthosis. During the initial development phase in 1978, only one postoperative patient experienced failure of his surgical instrumentation while in the orthosis.
Page 2 and 3: ONE SOURCE! It Sounds Like A Who's
Page 4 and 5: We Don't Count Them Even After They
Page 6 and 7: FEATURES Letters to the Editor Cale
Page 8 and 9: Orthotic and Prosthetic Parts and S
Page 10 and 11: AUTHOR INFORMATION OinicaL ^prosthe
Page 12 and 13: Reprints of (^lİnİCal ^prosthetic
Page 14 and 15: A Physiologic Rationale for Orthoti
Page 16 and 17: Knee wobble can be a sign of impair
Page 18 and 19: Figure 2. Average velocity in norma
Page 20 and 21: Figure 5. Average distances necessa
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Page 24 and 25: quiring rest or sleep, and local mu
Page 26 and 27: fects of Poliomyelitis," Late Effec
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Page 30 and 31: Wheelchairs for Paraplegic Patients
Page 32 and 33: Figure 2. Dimension ranges for the
Page 34 and 35: Figure 5. Basic wheelchair with sta
Page 36 and 37: mass produced and are widely availa
Page 38 and 39: Figure 10. Schematic showing adjust
Page 40 and 41: Figure 1. Conventional metal and le
Page 42 and 43: tion and fitting skills, along with
Page 46 and 47: TECHNICAL INFORMATION Material Sele
Page 48 and 49: metal anchor plates for the posteri
Page 50 and 51: Figure 2. Female couple of air hose
Page 52 and 53: Figure 6. Removing socket from cast
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Page 64: The American Academy of Orthotists

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