Prosthetics and Orthotics Manufacturing Guidelines - 3 ... · The aim of this document is to...

Physical Rehabilitation Programme

Patellar tendon-bearing orthosis

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Manufacturing guidelines

MISSION

The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of war and internal violence and to provide them with assistance. It directs and coordinates the international relief activities conducted by the Movement in situations of conflict. It also endeavours to prevent suffering by promoting and strengthening humanitarian law and universal humanitarian principles. Established in 1863, the ICRC is at the origin of the International Red Cross and Red Crescent Movement.

Acknowledgements:

Jean François GallayLeo GasserPierre GauthierFrank JoumierJacques LepetitBernard MatagneJoel NiningerGuy NuryPeter PoestmaHmayak Tarakhchyan

and all prosthetists-orthotists who have worked in ICRC-assisted physical rehabilitation centres.

International Committee of the Red Cross19 Avenue de la Paix1202 Geneva, SwitzerlandT + 41 22 734 60 01 F + 41 22 733 20 57E-mail: [email protected]© ICRC, September 2006All photographs: ICRC/PRP

�Manufac tur ing Guidel ines Patel lar Tendon-B ear ing O r thosis

Table of contents

Foreword 2Introduction 4Choosingbetweentwomethods 41.Castingandrectification 52.PTBOwithanterior-closingshell 6

2.1EVApreparationforincreasedweightrelief 62.2MouldingofEVA 72.3Orthosistrimline 82.4Plasticreinforcement 92.5Posteriorshell 102.6.Anteriorshell 122.7Preparationforinitialfitting 142.8Initialfittingandfinishing 17

3.PTBOwithposterior-closingshell 193.1EVApreparationforincreasedweightrelief 193.2MouldingofEVA 203.3Orthosistrimline 213.4Plasticreinforcement 223.5Anteriorshell 223.6Posteriorshell 253.7Preparationforinitialfitting 263.8Initialfittingandfinishing 27

Listofmanufacturingmaterials 28

� ICRC Physical Rehabi l i tat ion Programme

Foreword

The ICRC polypropylene technology

Sinceitsinceptionin1979,theICRC’sPhysicalRehabilitationProgrammehaspromotedtheuseoftechnologythatisappropriatetothespecificcontextsinwhichtheorganizationoperates,i.e.,countriesaffectedbywarandlow-incomeordevelopingcountries.

Thetechnologymustalsobetailoredtomeettheneedsofthephysicallydisabledinthecountriesconcerned.

Thetechnologyadoptedmustthereforebe:

• durable,comfortable,easyforpatientstouseandmaintain;• easyfortechnicianstolearn,useandrepair;• standardizedbutcompatiblewiththeclimateindifferentregionsoftheworld;• low-costbutmodernandconsistentwithinternationallyacceptedstandards;• easilyavailable.

Thechoiceoftechnologyisofgreatimportanceforpromotingsustainablephysicalrehabilitationservices.

Forallthesereasons,theICRCpreferredtodevelopitsowntechniqueinsteadofbuyingready-madeorthopaediccomponents,whicharegenerallytooexpensiveandunsuitedtothecontextsinwhichtheorganizationworks.ThecostofthematerialsusedinICRCprostheticandorthoticdevicesislowerthanthatofthematerialsusedinappliancesassembledfromcommercialready-madecomponents.

WhentheICRClauncheditsphysicalrehabilitationprogrammesbackin1979,locallyavailablematerialssuchaswood,leatherandmetalwereused,andorthopaediccomponentsweremanufacturedlocally.Intheearly1990stheICRCstartedtheprocessofstandardizingthetechniquesusedinitsvariousprojectsaroundtheworld,forthesakeofharmonizationbetweentheprojects,butmoreimportantlytoimprovethequalityofservicestopatients.

Polypropylene(PP)wasintroducedintoICRCprojectsin1988forthemanufactureofprostheticsockets.Thefirstpolypropyleneknee-jointwasproducedinCambodiain1991;othercomponentssuchasvariousalignmentsystemswerefirstdevelopedinColombiaandgraduallyimproved.Inparallel,adurablefoot,madeinitiallyofpolypropyleneandEthylVinylAcetate(EVA),andnowofpolypropyleneandpolyurethane,replacedthetraditionalwooden/rubberfoot.

In1998,aftercarefulconsideration,itwasdecidedtoscaledownlocalcomponentproductioninordertofocusonpatientcareandtrainingofpersonnelatcountrylevel.


Objective of the manuals

TheICRC’s“ManufacturingGuidelines”aredesignedtoprovidetheinformationnecessaryforproductionofhigh-qualityassistivedevices.

Themainaimsoftheseinformativemanualsareasfollows:

• TopromoteandenhancestandardizationofICRCpolypropylenetechnology;• Toprovidesupportfortrainingintheuseofthistechnology;• Topromotegoodpractice.

Thisisanotherstepforwardintheefforttoensurethatpatientshaveaccesstohigh-qualityservices.

ICRCAssistanceDivision/HealthUnitPhysicalRehabilitationProgramme


Choosing between two methods

Thefollowingindicationsmighthelpinmakingachoicebetweenthetwopossiblemethods.

Weight relief: partial or complete?

Accordingtotheprescriptionand/orthepathology,theorthosismustpartiallyorcompletelyrelievetheweightappliedontheleg.

Tothisend,alayerofEVAisaddedunderthefootpriortothedrapingofthepolypropylene.

Thefollowingfiguresgivearoughestimateofthedegreeofweightrelief:• NoEVA:70%oftheweightonthelegand30%ontheorthosis.• 3mmEVA:50%onthelegand50%ontheorthosis.• 6mmEVA:30%onthelegand70%ontheorthosis.• 12mmEVA:0%onthelegand100%ontheorthosis.

Introduction

Theaimofthisdocumentistodescribetwomethodsforproducingpatellar tendon-bearing (PTB) orthoses,workingwiththeICRCpolypropylenetechnologyandorthopaediccomponentsusedattheICRC’sphysicalrehabilitationcentres.

Anterior-closing shell Posterior-closing shellWeak at ankle level, especially for heavy patients or patients walking with ankle dorsiflexion.

Strong at ankle level, thus suitable for overweight patients or patients walking with ankle dorsiflexion.

Easy to fit into normal shoes.Sometime difficult to fit into normal shoes because of the volume of the orthosis at mid-foot.


Patientassessment,castingandrectificationofpositivecastimpressionsareperformedinaccordancewithprostheticandorthotic(P&O)standards,takingintoaccountthefollowingpoints:• Theproximalpartismanufacturedlikeatrans-tibialprosthesisandensurestheweight-bearing

function.• Thedistalpartismanufacturedlikeanankle-footorthosis.• Theremustbelittleornoweightborneonthelegwhilethecastisbeingtaken.• Inthemethodinvolvingaposterior-closingshell,theEVAusedtoincreaseweightreliefisplaced

onlyundertheheel,soitaffects the position of the cast(seesection3.1,page19).

CasTIng and ReCTIFICaTIOn1


2.1 eVa preparation for increased weight relief

Followtheproceduredescribedbelow,orgoontothenextsectionifthepatientdoesnotrequireadditionalweightrelief.

PTBO WITh anTeRIOR-ClOsIng shell2

4PlacetheplastermodelontheEVAsheetanddrawalinearoundit1cmwiderthanthefoot.

4Holdtheplastermodelinavice.

HeattheEVAat120°for3to5minutes,dependingonitsthicknessandontheefficiencyoftheoven.

PuttheEVAunderthefootandholditfirmlyinplacewithanelasticbandageforoneminute.

GrindtheedgeoftheEVAuntilitisperfectlyalignedwiththeshapeoftheplastermodel.


6GluetheEVAundertheplastermodel.

2.2 Moulding of eVa

EVA(6mm)canbemouldedpriortodrapingofthepolypropylene:• toimprovecomfort;• topreventskinbreakageinpatientswithsensationloss.

Followtheproceduredescribedbelow,orgoontothenextsectionifEVAisnotrequired.

4Positiontheplastermodelwiththeforefootpointingdownwards.

CutapieceofEVA:• width,kneecircumference;• length,thelengthoftheplaster

model(leg+foot);• thickness,6mm.

HeattheEVAat120°for3to5minutes,dependingontheefficiencyoftheoven.

DrapetheEVAovertheplastermodelmanuallyandholditinplaceuntilithascompletelycooled.


2.3 Orthosis trim line

4Cutofftheexcesswithacutterorapairofscissors.

StapletheEVAontothefrontoftheplastermodel.

4Marktheorthosistrimlineasfollows:

A Thetopmustbehorizontal,6cmabovethepatellatendongroove.

B Thepatellaandthehamstringtendonsareleftfree.

C Theshelloverlapstheantero-posteriormid-lineby1.5cm.

D Attheankle,keeptheline1cmanteriortothetopofthemalleoli.

E Theusualdistallimitoftheanteriorshellishorizontal,at1/3ofthelengthoftheleg,butmaybelongertoprovidegreaterprotection.

F Attheforefoot,clearthesidesofthetoesandtheheadofthemetatarsuscompletely,passingbeneaththem.This will allow the polypropylene to follow the movement of the metatarso-phalangeal joints.


2.4 Plastic reinforcement

Theorthosismayneedreinforcement,especiallyatanklelevel.Ifthisisthecase,followoneoftheproceduresdescribedbelow;otherwisegoontothenextsection.

2.4.1 double layer of polypropylene

4Asecondlayerofpolypropylenecoveringtheankleandthefootismouldedatthesametimeasthemainlayer.

Cutapieceofpolypropylene:• thickness,3mm;• width,instepcircumference;• length,lengthoffoot+10cm.

Grindthelast3cmattheproximalendtograduallyreducethethicknessofthepolypropylene.

4Thetwolayersareheatedatthesametime.

Thereinforcementisplacedontheplastermodel,thenthesecondlayerisvacuum-mouldedimmediatelyafterwardstoobtainaperfectsealbetweenthetwolayers.

The double layer of polypropylene has the disadvantage of reducing flexibility of the forefoot in relation to the metatarso-phalangeal joint.

�0 ICRC Physical Rehabi l i tat ion Programme

2.4.2 lateral reinforcements (channels)

4CuttwobandsofEVA:• thickness,6mm;• width,7mm;• length,15cm.

Pullastockingovertheplastermodel.

Gluethebandlightlyontothestocking.

The more anterior the position of the channel, the more the device will resist dorsiflexion of the ankle.

Reinforcements prolonged along the side of the mid-foot increase the volume of the orthosis so that it may no longer fit into the patient’s shoe.

2.5 Posterior shell

2.5.1 Vacuum moulding of polypropylene

Ifthishasnotalreadybeendone,pullastockingovertheplastermodel.For maximum efficiency, the EVA used to channel the polypropylene must not be covered with a stocking.

Dustthestockingwithtalcumpowder.

Measurementofthepolypropylenesheet:

� Kneecircumference+10cm.� Instepcircumference+10cm.� Legandfootlength+10cm.

Thickness,4mmor5mm,dependingonthepatient’sweight.

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��Manufac tur ing Guidel ines Patel lar Tendon-B ear ing O r thosis

Heatthepolypropyleneat180°for20to25minutes,dependingonthethicknessofthepolypropyleneandtheefficiencyoftheoven.

Drapethepolypropyleneovertheplastermodelandstickittogetheralongtheanteriorside.

Tightenthepolypropylenearoundthesuctionconewitharopeorsomethingsimilar.

Openthevacuumvalve.

4Cutofftheexcesswithapairofscissorswhilethepolypropyleneisstillhot.

2.5.2 Preparation of the posterior shell

Drawthetrimlineonthepolypropyleneasexplainedinsection2.3(page8).

Cuttheorthosiswithanoscillatingsaw,followingtheoutline.

Removetheshellgentlytoavoiddamagingtheproximalpartoftheplastermodel,asitwillbeusedtomouldthesecondshell.

Removethestockingfrominsidetheorthosis.

Grindthetrimlineandsmoothit.

IfanEVAhasbeenmoulded,transferthetrimlinetotheEVAandcutofftheexcesswithapairofscissors.

Before moulding the second shell, keep an angle of 90° at the corner of the anterior/proximal trim line because a rounded shape would create a notch in the polypropylene of the posterior shell which might prevent proper functioning of the hinged joint.

Keepthevacuumonuntilthepolypropylenecoolsdown.

�� ICRC Physical Rehabi l i tat ion Programme

2.6 anterior shell

Repairtheproximalpartoftheplastermodelifnecessary.

2.6.1 Moulding eVa

Toimprovecomfort,6mmEVAcanbemouldedpriortodrapingofthepolypropylene,whetherornotthesamehasbeendonefortheothershell.


4CutapieceofEVA6mmthickandlargeenoughtocovertheproximalhalfoftheplastermodel.


PuttheEVAovertheplastermodelandholdittightlyinplacewithanelasticbandageforoneminute.

4RemovetheEVAandcutit,followingthetrimline.

Takethepolypropyleneshell(withitsEVA)andfixthenewlymouldedEVAwithtwostaplesclosetotheproximal/medialtrimline.


2.6.2 Vacuum moulding of polypropylene on the anterior shell

4GlueastripofEVA6mmthickand3cmwidearoundthemiddleoftheplastermodel.The polypropylene draping will stop at this level, where the rope tightened around the EVA will ensure a sufficient vacuum.

GlueanotherstripofEVA6mmthickand3cmwideonthemiddleofthefirstpolypropyleneshellatrightanglestothefirststrip.This will allow the polypropylene to be cut after draping without damaging the shell beneath.

Coverwithastockingtheareareceivingthepolypropylene.Do not cover the strip of EVA where the rope will be tightened because the vacuum may leak through the stocking mesh.

Placetheplastermodelwiththeforefootpointingupwards.


Cutapieceofpolypropylene:• width,kneecircumference+5cm;• length,halftheleglength+10cm;• thickness,4mmor5mm,dependingonthepatient’sweight.


4DrapethepolypropyleneovertheplastermodelandstickittogetheralongthelongitudinalstripofEVA.

Tightenthepolypropylenearoundthesuctioncone.

Openthevacuumvalve.

Cutofftheexcesswithapairofscissorswhilethepolypropyleneisstillhot.



2.6.3 Preparation of the anterior shell


CutcarefullyalongtheEVAstripinthemiddleoftheposteriorshellwithanoscillatingsaw.

Removetheposteriorshellfromtheplastermodel.

Removethestockingfrominsidetheorthosisandcutofftheexcesswithajigsaw.


IfanEVAsheethasbeenmoulded,transferthetrimlinetotheEVAandcutofftheexcesswithapairofscissors.

2.7 Preparation for initial fitting

2.7.1 Preparation of the hinged joint

4SecurethetwoshellsontheplastermouldwithScotchtape.

Markthepositionofthehingedjointonthelateralandmedialsides:• 4.5cmabovethepatellartendon

groove;• inthemiddleoftheantero-

posteriordiameter.

Makesurethatthehingedjointsonbothsidesareatthesamelevel.


4Drillahole3mmindiameterthroughbothshells.

4Assembletheanteriorandposteriorshellswith2slottedscrewsandnuts3mmindiameter(headinside).

Cutandgrindtheboltprotrudingfromthenut.

2.7.2 Proximal strap

Useaready-madeVelcrostrap25mmwide,ormakeastrapwithnylonwebbingorsomeotherstrongmaterial.

4Withatubularrivet,fixthebeltholdingthelooponthemedialsideoftheposteriorshell,atthedistallimitoftheanteriorshell.

Theloopshouldbelocated5mmfromtheanteriorshell.


4Insertthebeltthroughthelooptomeasurethelength.

Fixthestrapwithatubularrivetonthelateralside.

Makesurethestrapisperfectlyhorizontalbeforefixingit.

2.7.3 distal strap

Thisstrapisnotalwaysneeded.Thedecisiontoinstallitorotherwisewilldependonthecapacityofthepatient’sshoetoholdthefootinsidetheorthosis.

Usea25mmVelcrostrap.

4Withalargetubularrivet,fixthebeltholdingthelooponthemedialside,4cmabovethemalleoli.

Theloopshouldbeplacedonthepolypropyleneandnotbeincontactwiththepatient’sleg.

4Fixthestrapwithalargetubularrivetonthelateralside.Makesurethestrapisperfectlyhorizontalbeforefixingit.

Coverthesurfaceofthestrapincontactwiththepatient’slegwith3mmEVA.

2.7.4 Preparation of the eVa

IfEVAisused,glueittemporarilyinsidetheorthosis.


2.8 Initial fitting and finishing

4Thepatientputsontheorthosisbyopeningtheanteriorshellandslidinghis/herfootthroughtheproximalend.

TheinitialfittingisperformedinaccordancewithP&Ostandards,takingthefollowingpointsintoaccount.

• Shouldthepatient’slegslipthroughthebrim,theproximalpartcanbepaddedwithEVAtodecreaseitswidth.

• Whilethepatientisstanding,checkthedegreeofweightrelief.• Aheelliftonthecontrolateralsidemightbeneededtoaccommodatetheincreaseinlengthofthe

legwiththeorthosis.

2.8.1 Finishing of the polypropylene

4Roundoffthecornersofbothanteriorandposteriorshells.

Carryoutanymodificationsrequiredonthepolypropyleneandsmooththetrimline.

GluetheEVAcompletelyinsidethepolypropylene,cutofftheexcessandsmooththetrimline.


2.8.2 Finishing of the hinged joint

Usetwocopperrivets3mmindiameterwithtwobrassorstainlesssteelwashers.

Removethe3mmboltononesideofeachrivet.

Heatthecopperrivetwithaweldinggunand“stamp”itsheadintothepolypropyleneoftheanteriorshellinordertocreatedepressionstocountersinktherivethead.

4Placetherivetheadonananvilandhammergentlyonthepartoftherivetprotrudingfromthewasherinordertocreateasmooth,roundedshapeasshownonthepicture.Usearivetsettorounditoff.

Inserttherivet,headinside,andinstallthewasheroutside.

Cuttherivetwithdouble-actioncuttingpliersorside-cuttingplierssothatonly2mmprotrudesfromthewasher.

Dothesamefortheotherside.


PTBO WITh POsTeRIOR-ClOsIng shell3

3.1 eVa preparation for increased weight relief

The EVA is placed only under the posterior part of the foot, in order to avoid an increase in volume at the mid-foot which may prevent the patient from wearing normal shoes.

Followtheproceduredescribedbelow,orgoontothenextsectionifthepatientdoesnotrequireadditionalweightrelief.

4PlacethemetatarsalheadoftheplastermodelattheedgeoftheEVAsheetanddrawalinearoundit1cmwiderthanthefoot.

4Holdtheplastermodelinavice.

HeattheEVAat120°for3to5minutes,dependingonthethicknessoftheEVAandtheefficiencyoftheoven.

PuttheEVAundertheposteriorpartofthefootandholditfirmlyinplaceforoneminutewithanelasticbandage.

�0 ICRC Physical Rehabi l i tat ion Programme

GrindtheedgeoftheEVAuntilitisperfectlyaligned,aroundandbelow,withtheshapeoftheplastermodel.

6GluetheEVAundertheplastermodel.

3.2 Moulding of eVa

EVA(6mm)canbemouldedpriortodrapingofthepolypropylenetoimprovecomfort.

Do not cover the foot, as this would create an increase of volume which might prevent the patient from wearing normal shoes.


Placetheplastermodelwiththeforefootpointingupwards.

4CutapieceofEVA:• width,kneecircumference;• length,leglength;• thickness,6mm.


DrapetheEVAovertheplastermodelmanuallyandholditinplaceuntilithascooledcompletely.


4Cutofftheexcesswithacutterorapairofscissors.

Grindthedistaltrimlinetograduallyreduceitsthickness.

StapletheEVAontothebackoftheplastermodel.

3.3 Orthosis trim line

4Markthetrimlineasfollows:

A Thetopmustbehorizontal,6cmabovethepatellatendongroove.

B Thepatellaandthehamstringtendonsareleftfree.

C Theshelloverlapstheantero-posteriormid-lineby1.5cm.

D Attheankle,thelinemustremainabovethemalleolitofacilitatedonning.

E Theusualdistallimitoftheposteriorshellishorizontal,at1/3ofthelengthoftheleg,butitmaybelongertoprovidegreaterprotection.

F Attheforefoot,clearthesideandthetopofthetoesandtheheadofthemetatarsuscompletely,passingbeneaththem.This will allow the polypropylene to follow the movement of the metatarso-phalangeal joints.


3.4 Plastic reinforcement

Lateralreinforcements(channels)significantlyimprovethestrengthoftheorthosis.Thereareseveralwaysofmakingthesereinforcements.

4CuttwostripsofEVA:• width10mm;• length20cm;• thickness,6mm.

Grindbothdistalandproximalendstograduallyreducetheirthickness.

Gluethestripsontotheplastermodel,1cmanteriortothelateralandmediallongitudinalaxis.

Reinforcements prolonged along the side of the mid-foot increase the volume of the orthosis so that it may no longer fit into the patient’s shoe.

3. 5 anterior shell

3.5.1 Vacuum moulding of polypropylene

The procedure described below ensures uniform thickness of the polypropylene all over the orthosis. Do not try to make a single seam on the anterior side, because the creases gathering at ankle level will make it necessary to stretch the polypropylene too thinly.

Ifthishasnotyetbeendone,pullastockingovertheplastermodel.For maximum efficiency the EVA used to channel the polypropylene must not be covered with a stocking.


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Manufac tur ing Guidel ines Patel lar Tendon-B ear ing O r thosis

Measurementofthepolypropylenesheet:

� Kneecircumference+10cm.� Instepcircumference+10cm.� Legandfootlength+10cm.

Thickness,4mmor5mm,dependingonthepatient’sweight.


Drapethepolypropyleneovertheplastermodelandstickittogetheralongtheposteriorsideandunderthefoot.

Tightenthepolypropylenearoundthesuctioncone.

Openthevacuumvalve.

4Cutofftheexcesswithapairofscissorswhilethepolypropyleneisstillhot.



3.5.2 Preparation of the anterior shell


Cuttheorthosiswithanoscillatingsaw,followingtheoutline.Toremovetheshell,itmightbenecessarytobreakthedistalpartoftheplastermodelbelowtheankle.However,caremustbetakennottodamagetheproximalpart,whichisneededtomouldthesecondshell.

Removethestockingfrominsidetheorthosis.

Grindtheorthosistrimlineandsmoothit.

IfanEVAhasbeenmoulded,transferthetrimlinetotheEVAandcutofftheexcesswithapairofscissors.

Before moulding the second shell, keep an angle of 90° at the corner of the posterior/proximal trim line because a rounded shape would create a notch in the polypropylene of the posterior shell which might prevent proper functioning of the hinged joint.


3.6 Posterior shell

Repairtheupperhalfoftheplastermodelifnecessary.

3.6.1 Moulding eVa

Followtheproceduredescribedinsection2.6.1(page12).

3.6.2 Vacuum moulding of polypropylene on the posterior shell


3.6.3 Preparation of the posterior shell


CutcarefullyalongtheEVAstripinthemiddleoftheanteriorshellwithanoscillatingsaw.

Removetheposteriorshellfromtheplastermodel.

Removethestockingfrominsidetheorthosisandcutofftheexcesswithajigsaw.


IfEVAhasbeenmoulded,transferthetrimlinetotheEVAandcutofftheexcesswithapairofscissors.


3.7 Preparation for initial fitting

3.7.1 Preparation of the hinged joint


3.7.2 Preparation of the straps

Followtheproceduredescribedinsection2.7.2(page15)fortheproximalstrap,andsection2.7.3(page16)forthedistalstrap.

3.7.3 Preparation of eVa

IfEVAisused,glueittemporarilyinsidetheorthosis.


3.8 Initial fitting and finishing

Seesection2.8(page17).

4Itisoftennecessarytoflarethepolypropyleneattheposteriorpartoftheheelinordertofacilitatedonningandtoavoidpainfulcontactwiththeedgeoftheplastic.


ICRC Code Description Unit of measure Quantity

For negative and positive cast :ODROSTOCOT60 Tubular stockinet, 60 cm Cm 70According to size:• MDREBANDP10• MDREBANDP12• MDREBANDP15

Plaster of Paris bandages10, 12 or 15 cm x 3 m

Piece 3

OTOOPLASPW40 Plaster of Paris powder Each As requiredFor EVA and plastic moulding :If required, according to colour:• OPLAEVAFERA06• OPLAEVAFLIV06• OPLAEVAFKIN06

EVA 6 mmTerra, olive or beige colour

Each As required

None Nylon stockinet Piece 1According to colour and thickness:• OPLAPOLYCHOC04• OPLAPOLYCHOC05• OPLAPOLYLIV04• OPLAPOLYLIV05• OPLAPOLYSKIN04• OPLAPOLYSKIN05

HomopolymerTerra, olive or beige colour,4 or 5 mm thick

Each As required

For the strap:OSBOSTRVP325 Strap, Velcro, PVC, with loop, brown, 300 mm x 25 mm Piece 1OHDWRIVET131 Rivet, tubular, 13 mm x 12 mm Piece 2

orOSBOVSBO24 Strap, Perlon webbing, 25 mm Cm 25None Strap, Velcro, 25 mm Cm 20OSBOVSBO35 Loop, 25 mm x 100 pieces Piece 1OHDWRIVET131 Rivet, tubular, 13 mm x 12 mm Piece 2For the hinged joint:OHDWRIVEC032 Rivet, copper, 3 mm x 20 mm Piece 2OHDWWASHB133 Washer, brass, 13 mm dia. x 3.1 mm thick Piece 2

list of manufacturing materials

MISSION

The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of war and internal violence and to provide them with assistance. It directs and coordinates the international relief activities conducted by the Movement in situations of conflict. It also endeavours to prevent suffering by promoting and strengthening humanitarian law and universal humanitarian principles. Established in 1863, the ICRC is at the origin of the International Red Cross and Red Crescent Movement.

Acknowledgements:

Jean François GallayLeo GasserPierre GauthierFrank JoumierJacques LepetitBernard MatagneJoel NiningerGuy NuryPeter PoetsmaHmayak Tarakhchyan

and all prosthetists-orthotists who have worked in ICRC-assisted physical rehabilitation centres.

International Committee of the Red Cross19 Avenue de la Paix1202 Geneva, SwitzerlandT + 41 22 734 60 01 F + 41 22 733 20 57E-mail: [email protected]© ICRC, September 2006All photographs: ICRC/PRP

Physical Rehabilitation Programmeankle-Foot orthosis

Manufacturing guidelines

0868

/002

0

9/20

06

200

Prosthetics and Orthotics Manufacturing Guidelines - 3 ... · The aim of this document is to...

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Transcript of Prosthetics and Orthotics Manufacturing Guidelines - 3 ... · The aim of this document is to...