Static elbow orthoses are used for short-term immobilization after injury or surgery, typically for 8-12 weeks. Dynamic elbow orthoses are used to minimize contractures or regain range of motion after immobilization. They apply constant low-load, long-duration stretching. Static progressive orthoses incorporate a manual tensioning unit to incrementally stretch or hold gains. Significant advantages of fracture orthoses over casts are improved hygiene and adjustability to changes in volume.

1. Elbow orthoses

2. Objectives
• What is Elbow orthoses?
• Types
• Indication
• Function

3. Elbow orthoses
• Elbow orthoses in general fit neatly into the static or
dynamic classifications, with static devices primarily
used for acute periods after an injury or surgery for
the purpose of short-term immobilization after
fracture, trauma, or soft tissue injury.
• These devices are typically only prescribed for short
periods ranging from 8 to 12 weeks.

4. • If the acute fracture or soft tissue injury has healed,
effort should be taken to increase or maintain a
functional ROM.
• Dynamic elbow orthoses are typically used to
minimize contractures or regain lost ROM after
periods of immobilization, soft tissue damage, or
surgical intervention.

5. Static Elbow Orthoses
• True static elbow orthoses are limited, with most
being created by the orthotist with corresponding
polymer shells and hook-and-loop straps.
• These may include gutter-style splints that have a
molded plastic on the volar/dorsal surface of the arms
with corresponding hook-and-loop strapping to
maintain position.

7. Static Progressive Elbow Orthoses
• Static progressive refers to a specific classification
and bridges the gap between traditional static and
dynamic orthoses.
• Static progressive EOs incorporate a joint and a
manual tensioning unit.

11. • The tensioning unit is designed to apply force in
specific increments as directed by the wearer to
stretch or hold positional gains.
• Common mechanisms for this design are a dial or
ratchet, with the dial typically having infinite
positioning within the desired ROM.

12. Posterior Static Elbow (Wrist) Orthosis
Or
Sugar-tong splint
• 90 degree flexion immobilization
• Indications- Rheumatoid arthritis, CTD,
Forearm fractures, Post operative elbow
arthroplasty, Elbow surgery o Ulnar nerve
transposition, Tendon transfers, Nerve repairs

13. Functions
• Support and rest the elbow to relieve pain
• Immobilize the elbow to promote tissue healing
• Block elbow extension

14. Dynamic Elbow Orthoses
• Dynamic elbow orthoses are designed to
appropriately manage soft tissue contractures.
• This is typically most effective when low-load and
long-duration forces are applied to the joint
consistently over time.

15. • Because of the application of a three-point pressure
system above and below the joint, it is important to
maximize surface area between the orthosis and the
skin.
• The most effective method for accomplishing these
goals is to custom fabricate shells out of a structural
thermoplastic (copolymer or polypropylene) based off
a model of the patient’s limb.

16. • These shells are carefully aligned and matched to the
anatomical presentation of the arm, and anatomically
congruent joints are placed on the orthosis to
maintain medial lateral stability, prevent dislocation.
• The shells should extend as close to the elbow as
possible to prevent translation or dislocation of the
elbow under load.

19. • The dynamic orthosis applied a constant low-load
long-duration stretching throughout use of the device.
• Lining the shells and ensuring adequate flares at the
edges of the polymer shells will also help to eliminate
point pressures and increase comfort.

20. EO for Fracture Management
• Elbow orthoses and different fracture orthoses can be
of significant benefit over traditional methods
(casting) for fracture management.
• Casting, which has long been seen as the gold
standard for fracture management, is being replaced
in a very practical way with custom-made or custom-
fit orthoses.

22. • Principles of fracture management require that the
segment be immobilized, and this method typically
involves an increase in hydrostatic pressure, which
will stabilize the fracture site and hold the bone in a
suitable position for healing.
• Two significant advantages of fracture orthoses over
fracture casts are hygiene and adjustability.
• In most cases when an arm is put into a cast it will
atrophy and lose volume, resulting in a poor fit or the
need for a replacement cast.

23. • A fracture orthosis can be tightened or loosened based
on volumetric needs or changes of the patient.
• The fracture orthosis has bivalved shells that interlock
and are wrapped with secure hook-and-loop straps to
hold everything in constant compression.
• The soft tissue compression stabilizes the long bone,
allowing it to heal.

24. Review Questions
• Static elbow orthoses are primarily used for acute
periods after an injury or surgery for the purpose of
short-term immobilization. (T/F)
• Dynamic elbow orthoses are typically used to minimize
contractures. (T/F)
• Static progressive EO uses turn buckle mechanism to
restrict the joint ROM. (T/F)
• Dynamic elbow orthoses are most effective when low-
load and long-duration forces are applied to the joint
consistently over time. (T/F)
• Significant advantages of fracture orthoses over
fracture casts are hygiene and adjustability. (T/F)

25. Reference
• Joseph B. Webster, Douglas P. Murphy, Atlas of orthoses and
assistive devices, 5th ed, Elsevier; Chapter 12, p. 141-142.