280 Canine Sports Medicine and Rehabilitation
general rule, molded external coaptation
devices (custom) are more efficient stabilizers
of bones and joints than are premade devices
(Piermattei et al., 2006) due to patient‐specific
design and applied biomechanics. In closely
approximating the patient’s individual topog
raphy, custom devices disperse corrective
forces over a larger surface area resulting in
fewer soft tissue problems and better tolerance
(Piermattei et al., 2006).
An orthosis is any medical device attached to
the body to support, align, position, prevent or
correct deformity, assist weak muscles, or
improve function (Deshales, 2002). These
dynamic devices provide protected motion
within a controlled range, prevent or reduce
severity of injury, prevent or relieve contrac
ture, allow lax ligaments and joint capsules to
shorten and approach normal distensibilty, and
provide functional stability for an unstable
limb segment (American Academy of
Orthopaedic Surgeons, 1987; Prokop, 2006)
(Figure 11.12).
Surgical management of many orthopedic
conditions in veterinary practice remains the
standard of care and the preferred therapeutic
choice. At the same time and for a variety rea
sons including financial, personal preference,
advanced patient age, perceived increased
anesthetic risk, comorbidities, or circumstances
requiring a delay of surgery, a number of
patients are not surgical candidates. Until
recently, veterinarians had no viable option for
these patients. V‐OP provides choices using
customized, articulated (as needed), external
coaptation in the pre‐ or postoperative periods,
as well as in lieu of surgical intervention
(Box 11.1). Rehabilitation for these nonsurgicalFigure 11.12 Bilateral, double‐articulating, carpus/foot
orthoses stabilize biplanar carpal instability
(hyperextension of the radiocarpal joint and valgus due
to medial collateral ligament injury). With proper
rehabilitation, a normal trot can be achieved.
Box 11.1 Orthopedic conditions amenable
to veterinary orthotic devicesCommon problems amenable to thoracic limb
orthoses● Elbow: instability and osteoarthritis
● Carpus: hyperextension
● Carpus: bi‐ or triplanar instability
● Carpus: collateral ligament injury
● Carpus: arthrodesis postsurgical support
● Carpus: arthrodesis failure
● Carpus: prophylactic support for contralateral
limb amputation
● Foot injuries including tendon laceration and
digit amputation (e.g., adactyly, ectrodactyly,
severe syndactyly, hypodactyly, or other limb
reduction defects)
● Peripheral neuropathy
● Brachial plexus distal neuropathyCommon problems amenable to pelvic limb
orthoses● Stifle: cranial cruciate ligament rupture
● Stifle: patellar luxation (grades 1 and 2)
● Stifle: collateral ligament injury
● Tarsus: hyperextension
● Tarsus: collateral ligament injury
● Tarsus: failed Achilles tendon repair
● Tarsus: Achilles tendon rupture or avulsion
postoperative support
● Tarsus: Achilles tendon sprain nonsurgical with
out complete disruption or avulsion
● Tarsus: Achilles tendon chronic plantigrade
stance
● Tarsus: sciatic neuropathy (tarsal collapse)
● Foot injuries including tendon laceration and
digit amputation
● Foot deformities (e.g., adactyly, ectrodactyly,
severe syndactyly, hypodactyly, or other limb
reduction defects)
● Degenerative myelopathy
● Peripheral neuropathy: sciatic nerve trauma
(e.g., pelvic fracture, surgical collateral injury)
● Intervertebral disc disease, spinal canal stenosis,
cervical spinal instability
● Fibrocartilagenous embolus