Boston and Milwaque Corset

The spine (Fig. 1) has three basic physiological curves in the sagittal plane (cervical lordosis, thoracic kyphosis and lumbar lordosis), which increase their resistance and damping to the mechanical stresses to which it is exposed. However, in the frontal plane bends are not normal, but sometimes appear on this plane deformities by lateral curvatures of the spine, resulting in pathology kind of scoliosis. This tab will describe the Milwaukee brace (Fig. 2), which is especially useful in the treatment of scoliosis in childhood, adolescence and young adulthood.

DEFINITION AND DESCRIPTION OF MILWAUKEE CORSET
Milwauee corset is a cervical brace thoracic-lumbar-sacral (CTLSO) comprising a cervical ring, a basket pelvic
superstructure and auxiliary one correction:
PELVIC BASKET
Pelvic basket (fig. 3) is constructed of thermoplastic or leather and its function is to provide a fixed support at the base of the spine. Top fits over the iliac crests, where it is anchored by means of grooves made on the mold. The front provides compression ranging from 1 cm above the symphysis pubis
up to 1 cm below Appendixand xiphoid. Lateral areas comprise the area of ​​the pelvis, from the iliac crests until
2.5 cm below the trochanters. In the back, the basket covers up to half the lower third of the buttocks.
CERVICAL RING
Cervical ring (Fig. 4) comprises two support bearings supraglottic occipital and whose function is to stabilize
head, restricting the lateral movement and keeping centered, requiring elongation of the column.
SUPERSTRUCTURE
The superstructure (fig. 5) consists of two bars later, originating at the two supports occipital and anchored in the basket, and one
previous bar joining the ring centered with shopping at its front.
AUXILIARY ELEMENTS OF CORRECTION
The correction aids consist of plates and shaped side supports and location depending on the type
and level of the curve and pads in the contact area:
• chest plate. Is L-shaped and usually made of aluminum.
Low ribs placed on the apex of the curve, achieves a passive correction thoracic curve.
• lumbar cushion. It is triangular and lined aluminum.
Is placed on the transverse processes of the lumbar curve convexity.
• axillary plate. Extends horizontally underthe armpit. Is aluminum or plastic. Placed in opposition to the dorsal pad.
• Shoulder Ring. Placed in double thoracic curves, allowing
descend shoulder maintaining higher.
• oval pad. Is placed on the previous bar to correct anterior costal deformity.

CORSET VERSIONS
There are different variants of the Milwaukee brace according to the specific case of disturbances of the curves of the spine of the patient. Therefore be placed various types of plates and / or pressure support. The most frequent scoliosis:
• Thoracic scoliosis with the apex of the curve in D7 to D9, and lumbar compensation (moderate rotation).
• Lumbar Scoliosis (D11 to L4 or L5). With the apex of the curve in L1 and L2.
• thoracolumbar scoliosis. The apex vertebra is D11 or D12.
The curve extends from D6 / 7 L2 / 3. Usually accompanied by two curves compensating cervicothoracic and lumbar level.
• double-curve scoliosis: two curves, one in the dorsal region and another in the thoracolumbar or lumbar region.
Additionally, the basket may be confected pelvic thermoplastic, which is the usual case, or in the skin in patients with
thermoplastic material sensitivity.

INDICATIONS MILWAUKEE CORSET

The Milwaukee brace tienand aimed at preventing the progression of scoliotic curves and / or kyphotic, correct magnitude of these curves, either of idiopathic, traumatic or paralytic deformity or keep curves to complete the
expected growth or surgical treatment.
Its effectiveness is highest in those unstructured scoliosis, with less than 40 ° Cobb and when the patient has not completed
growth (teenagers), ie when the radiological study reveals that are flexible.
If functional radiographs indicate a degree lateral inclination less than or equal to 20%, the expected correction will be very limited.

It is always recommended to combine the use of the corset with therapeutic exercise program indicated by the physician.
MILWAUKEE CORSET OPERATION
The Milwaukee brace operation is based on:
• Autoelongación active pelvic achieved by basket and metal superstructure attached thereto (forces F1, F2 and F5).
• Correction of the angular and rotation by thoracic plates added (forces F3 and F4).
This type of brace acts on scoliosis of the spine by applying the following forces:
• Horizontal forces balanced: curve correction by three support points.
• tensile axial forces: autoelongación correction ofrachis.
• Increased abdominal pressure: intervertebral burden reduction.
• wrap around the patient.
• Immobilization: skeletal fixation.
The Milwaukee brace has the following functions:
• Correction passive compression, elongation and derotation of the spine, and the removal of lumbar lordosis abdominal compression.
• active Correction: escape movement and ring supports, also known as "cage effect" (Fig. 6).

MANUFACTURING METHOD
The manufacturing method comprises the following phases:
1. Taking action on the patient.
Two. Taking negative mold.
Three. Obtaining positive mold and correction thereof.
April. Pelvic basket making (molding).
May. Trimming the basket.
June. Mounting the metal structure.
July. Adaptation and corset check on the patient.

TAKE ACTION
To take action, we first locate and point out the key points: xiphoid process, symphysis pubis and iliac crests.
Then take the following distances and perimeters:
• Distance between crests.
• Distance pubis-sternal handle.
• Distance pubis-chin.
• Distance glottis-occipicio.
• Neck width.
• Distance from the iliac crest to the seat.
• Perimeterwaist (pretty tight).
• hip circumference at the level of the trochanters.

NEGATIVE MOLD
For mold making places the patient negative double cotton shirt (trunk tubitón number 8). Between them is placed a strip of polypropylene which will serve to cut the cast after setting without damaging the patient's skin.
Then be marked with ink pen:
• anterior superior iliac spines.
• Top edge of pubic symphysis.
• Appendix xiphoid.
The patient should be in slight knee flexion correcting lordosis.
The trunk is covered with plaster bandages:
• Start in gluteal fold.
• Climbing to the inferior angle of the scapula.

• Molded ridges, with bandages that are applied to twisting waist and pulling down, marking the rows above them. It marked also manually locating bony landmarks.

• Opening the mold to remove the patient later.

OTHER OPERATIONS
The realization of the positive mold, rectification, making and trimming basket assembly pelvic and superstructure are operations performed in the orthopedic workshop outsourced following our instructions and given the prescription. The workshop outsourcedwe refer the Milwaukee brace for screening and testing on the patient.

ADAPTATION AND MILWAUKEE CORSET CHECKING PATIENT
Place the brace to the patient and first check:
• If there is a spot of bother, with special attention to bony areas.
• The symmetry of the corset.
• And we must remain open to 5-6 cm.
Subsequently, more specifically, it should check:
• Support in iliac crests.
• anterior and posterior superior iliac spines are free and undisturbed.
• capped peaks and symmetry in the basket.
• Ribs and sternum pressure free basket.
• Grooves sufficient support for anchoring basket.
• The trailing edge does not bother to sit.
• The leading edge free thighs and does not bother to sit.
• The side edge is 1 cm above the trochanters.
• The leading edge is above the pubic symphysis.
• lordosis is corrected.
• The previous bar is perpendicular to the ground and centered.
• subsequent bars are separated and well positioned.
• Expandable areas of the bars are parallel.
• The separation of the thorax allows inspirations.
• the head is centered over the column.
• The glottal support is well located and can swallow.
• There is a correct locationthoracic and lumbar plate.
• Revise ring placement axillary axillary pad and support on previous gibosidad.
• Check the correction on the radiograph.