Edited by Aditya Karhade and Brian Goh - 7/1/2021
Categories
Level
Cervical
Cervicothoracic
Thoracolumbar
Lumbosacral
Rigidity
Rigid
Semirigid
Flexible
Availability
Prefabricated i.e. off-the-shelf
Custom-fitted
Cervical collars
Soft
Little to no effect on restricting motion: comfort only
Indications: whiplash injuries without unstable bony or ligamentous injury
DO NOT use for injuries with potential for instability
Rigid
Effective at reducing motion in sagittal plane
Minimal rotational stability and lateral bending
Contact
Proximal: mandile, occiput
Distal: clavicle, sternal notch, T3 spinous process
Philadelphia
Usually used as by EMTs but also a waterproof orthosis that patients can use for showering
Warning: pressures exerted on the chin, mandible, and occiput is in excess of capillary closing pressure and can lead to tissue ischemia and ulceration
Image from https://cdn3.volusion.com/mqnu5.mamc7/v/vspfiles/photos/PHP-T-2.jpg?v-cache=1530526902
Miami J
Image from https://e-medicalbroker.com/eng_pl_Ossur-Miami-J-R-Cervical-Collar-3919_1.jpg
Aspen
Image from https://www.aspenmp.com/media/catalog/product/cache/926507dc7f93631a094422215b778fe0/v/i/vista_tx_01.jpg
Halo vest
Upper cervical spine injuries (i.e. occiput-C1, C1-C2)
Rarely used at HCORP
Never used in elderly - cardiopulmonary morbidity and mortality
Injuries of lower cervical spine (C6-T7) and cervicothoracic junction (C6-T5)
Thoracic extension to rigid cervical collar required (CTO)
Image from https://sciprogress.com/wp-content/uploads/2019/10/halo-brace.jpg
Complications
Skin breakdown and ulcers to occiput, chin, mandible, ears, shoulders, and clavicles
ICU patients: obstructs central venous access, risk for sepsis, bacteremia
Concomitant head injuries: prolonged collar increases intracranial pressures
Dysphagia
Thoracolumbar Orthoses (TLSO)
TLSO used for fractures T6 to L4
Fractures L3 and below, thoracic portion unnecessary so LSO brace used
Rigid TLSO covers typically T5-S1
Maximum control of motion with custom-molded thermoplastic TLSO
Straps over shoulder increase rigidity of TLSO
Cervical extension available if multiple locations of fracture
Lumbosacral Orthosis (LSO)
LSO used for fractures L3 and below
Brace must be well-fitted to pelvis