Construction and Fitting of the "Upside-Down Brace"
Robert R. Plattner, C.O. *
Jacob C. Plattner, C.O. *
Editor's Note: Information on the technical aspects of fitting the brace described in the previous article has been contributed by the Messrs. Plattner. This material was not previously included in the article by Dr. Stuttle.
Our experience with "The Upside-down Flexion Back Brace" dates back to approximately 1950, when after considerable experimental work, we arrived at a standard for measurement and fitting. We feel that it is the most effective brace to hold the patient in a flat back position.
With the patient standing, arms at sides and facing orthotist, take (1) a snug measurement of the hips at the trochanter level. Then (2) a snug waist measurement at the navel level, and (3) a snug chest measurement approximately 2" below nipple line.
Then have patient stand with back to orthotist and hands at sides. Take a vertical measurement, starting at level of coccyx up to and including approximately 1 3/4" of lower rib margin. This measurement determines the height of back brace. The length of the upper band is determined by approximately 1/3 of the chest measurement minus 1/2 to 1". This band has a slight downward curve at either end (from the mid line).
The hip band length is determined by a distance just posteriorly of one trochanter to the other trochanter. This band also has a slight upward curve at either end.
The brace has two straps that are attached at each end of pelvic band and buckle to a plastic belly pad that fits on top of rubber abdominal apron. There are also two chest straps. These are attached to the side bars and go through a D-type slide loop attached to just below the chest band and buckle on the plastic belly pad.
Upon applying the brace, the rubber apron is zipped up, centered on the body and the brace located so the bottom of the pelvic band is just above the base of the coccyx, or level with it.
When removing brace, both chest band straps are completely unbuckled and one lower hip band strap is unbuckled, leaving the other hip band strap buckled on the plastic belly pad. Upon reapplying brace, the second hip band strap is tightened only firmly with plastic belly pad at approximately the bottom of rubber apron, so that both hip band straps are located just under iliac crests or anterior superior iliac spine.
Next the chest band straps are tightened quite firmly, pulling each one out, then holding while buckling, achieving the flat back position, preferably with patient doing a pelvic roll—causing a normal flattening of the body across navel level. If brace is properly fitted, the top of the plastic belly pad will be at about the level of the umbilicus.