Question
Are there differences in the types of braces you chose based on age or fracture type? What is the most common orthosis you use?
Answer
Braces can be made with many different materials, many different trim line variants, and many different other parameters. For any fracture in the spine, I believe it really needs to be a TLSO. A TLSO can be made in many different ways. It can be made shorter, low profile, high profile, or it can be made with extension. A custom-made TLSO is considered the best orthotic intervention for most of the spinal fractures. The TLSO can be different by brand, by trim line and by materials. For example, if I have a patient who is a child or an older woman, I might choose a different material. I might choose a thinner plastic for that patient rather than going with a thicker plastic that I might choose for a 250-pound, 55-year-old male. For an older woman, I might use a flex foam material with reinforcements with plastic to make it lighter for her and still provide appropriate forces. The rigidity of the plastic is not what creates the stability or hyperextension. Usually it is the cylinder created around the patient’s body through a total contact TLSO that reduces the axial loading. An example I use is to take a piece of paper and shake it. You see it is very flexible. However, as soon as you roll it, the same thin piece of paper becomes hard to push on. This is the principle of a TLSO. When you create a cylinder around a patient's body, the axial loading can be reduced much more effectively. It does not matter if it is thick or thin as long as it is appropriately fabricated.
