Scoliosis: Braces and Plaster Casts

Braces and Plaster Casts
Orthotic management of spinal disorders dates back at least to the Middle Ages. Some of the concepts underlying those primitive devices, notably three-point forces, remain valid today. Fabrication materials have progressed from metal and leather to light weight thermoplastics allowing many new designs and a new level of comfort for the patient.

Braces help control the curve as you or your child grows. These braces are sometimes prescribed post surgery, along with plaster jackets. I had a plaster cast for 7 months after my Harrington Rod surgery. They are designed to protect the back while the tiny bone ships used for grafting fuse to form a solid bone mass. Unfortunately for me my bone chips have not all formed a solid mass and I now have terrible problems with my donor site.

There are many different braces in use today, however, they all present similar problems in finding clothing that is both comfortable and trendy!

The Milwaukee Brace
Developed by Drs Al Schmidt and Walter Blount of Milwaukee. Since the 1960s back to the days of Pare in France and was carried on being used until the 1980s where the negative side set in. However this brace plays a very valuable role in the surgical and non-surgical management of spine deformities. Consists of metal uprights attached to pads at the hips, rib cage, and neck and can be very uncomfortable and in some cases is required to be worn 24/7 and of course can have physiological effects.

It is a custom made pelvic girdle from which three upright bars connect to a padded ring or collar round the neck.

The Cotrel Brace
This is similar to the Milwaukee Brace but it does not have the nexk or chin pieces

The Boston Brace
In the early seventies, the most popular of the TLSO (thoracic lumbar sacral orthosis) systems, the Boston Brace, was developed by Dr. John Hall and Mr. William Miller of The Boston Children's Hospital, it was the first brace to utilise symmetrical standardized modules eliminating the need for casting.

The Boston Brace is a moulded plastic brace and is shaped to fit the individual. It does not usually have a superstructure or neck piece it is less noticeable than the Milwaukee.

What should you wear under your brace?
All types of braces have a cotton seamless vest or t-shirt that is worn underneath and next ot the skin. Marks & Spencer, Pollards or Cotton On are all companies that provide seamless t-shirts with either long ot short sleeves, you can also get flat or seamless underwear. A body shaper or stocking are also suitable for the boys. Any departmental store offers under or leisurewear. You must make sure this fits snugly, this is to prevent it from wrinkling and annoying you when it rides up, if it is too large you will experience chafe and rubbing. You MUST buy cotton, synthetic such as nylon or polyester get hot and sticky and sore areas could develop.

Females may continue to wear a bra.

For the Milwaukee Brace the nck piece could be causing you problems so I would suggest a polo neck sweater or a scarf as a good solution. Hooded cardigans and duffel coats will also help hide the metal from the back. Or if you are like and have the "I don't give a stuff what people think about me" attitude then you don't need to worry about hiding it.

What can you wear to cover your brace?
Usually clothes 1 or 2 sizes larger are required and, for some, elastic waistlines - although some shapes will not suit elasticated wasitlines, mine doesn't! Baggy tops, like Kaftans worn with elasticated waisted jeans or lycra leggings are fashionable and comfortable, you may even find linen trousers are suitable and fit well, leaving you to explore other options for tops.

Long skirts are also comfortable and you can get many hippy style skirts that look great with various tops. Avoid silks!

Leggings and jodhpurs worn under the brace provide extra comfort.

Plaster Casts
Mine was fitted with a nice lining for comfort although I did use to find that the plaster rubbed under my arms when it was hot so what we used to do was cut out old shoulder pads and then place them over the plaster cast section where the arm pits are, that would keep me fresh and clean as these were easily washed and also stop any rubbing and chafe.

I wore mini skirts that had complete elasticated waists with t-shirts and blouses.

Another tip while wearing a plaster cast post surgery is to eat small meals more often, I used to find that if I ate a lot I would feel very uncomfortable and this is not a nice feeling when stuck inside a plaster.

We also had a wet flannel to hand as I was wearing my plaster during the summer months so I was getting very hot and as I could not shower or bath for 7 months it would get un-bearable at times. So I would lay on the floor, breathe in so my Mum could rub the wet flannel up and down my stomach to cool me.

Hope these tips have helped and if you have more then please send them in.

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