The halo-Milwaukee brace. Case series of a revived technique

Halo Fixator and Halo Traction - Value for the Treatment of Spinal Disorders in Childhood

The application of the Halo fixateur in case of spinal pathologies in childhood is a standardized technique. The halo fixateur may be used for treatment of injuries of the cervical spine, for additional stabilization following extended surgery at the cervical spine and their transitional regions as well as to achieve preoperative reduction in case of severe and rigid deformity. These indications are, referred to the early age, rare. However, the successful use of the Halo fixateur presumes a certain familiarity with the device and experiences regarding the underlying diseases to minimize related risks and to avoid possible complications. In this article the use and specific features regarding the application of the halo fixateur in childhood based on presented cases and the literature will be discussed.

Orthopaedic surgery for patients with central nervous system lesions: Concepts and techniques

Since ancient times, the aim of orthopedic surgery has been to correct limb and joint deformities, including those resulting from central nervous system lesions. Recent developments in the treatment of spasticity have led to changes in concepts and management strategies. The increase in life expectancy has increased the functional needs of patients. Orthopedic surgery, along with treatments for spasticity, improves the functional capacity of patients with neuro-orthopaedic disorders, improving their autonomy. In this paper, we describe key moments in the history of orthopedic surgery regarding the treatment of patients with central nervous system lesions, from poliomyelitis to stroke-related hemiplegia, from the limbs to the spine, and from contractures to heterotopic ossification. A synthesis of the current surgical techniques is then provided, and the importance of multidisciplinary evaluation and management is highlighted, along with indications for medical, rehabilitation and surgical treatments and their combinations. We explain why it is essential to consider patients' expectations and to set achievable goals, particularly before surgery, which is by nature irreversible. More recently, specialized surgical teams have begun to favor the use of soft-tissue techniques over bony and joint procedures, except for spinal disorders. We highlight that orthopedic surgery is no longer the end-point of treatment. For example, lengthening a contractured muscle improves the balance around a joint, improving mobility and stability but may be only part of the problem. Further medical treatment and rehabilitation, or additional surgery, are often necessary to continue to improve the function of the limb. Despite the recognized effectiveness of orthopedic surgery for neuro-orthopedic disorders, few studies have formally evaluated them. Hence, there is a need for research to provide evidence to support orthopedic surgery for treating neuro-orthopedic disorders.

Shape modification of the Boston brace using a finite-element method with topology optimization

STUDY DESIGN

Using a finite-element (FE) method to reshape the Boston brace, and evaluating the correction effect of the modified Boston brace in terms of Cobb angle.

OBJECTIVE

This study aimed to reduce the weight of the Boston brace using a FE method with topology optimization.

SUMMARY OF BACKGROUND DATA

The Boston brace is widely used to correct an abnormal spinal curve in adolescent idiopathic scoliosis. However, patients wearing the brace usually complain about discomfort caused by its bulkiness.

METHODS

An FE model of a traditional Boston brace was constructed using the software ANSYS 9.0. The loading condition was taken from an X-sensor measuring contact pressures between torso and brace. Topology optimization was conducted to modify the Boston brace. Three patients wearing a traditional brace and then the modified brace were examined in terms of Cobb angle.

RESULTS

For the patient with King Type III scoliosis, this modified brace was able to offer the same correction effect as the traditional brace, but the modified brace was lighter by about 12.4%, with the potential to be up to 18% lighter.

CONCLUSION

Based on the traditional Boston brace, this FE model, combined with topology optimization, can effectively estimate redundant material distribution and accordingly custom-design a lighter brace without any loss of its corrective effect.