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Technical Note: Two in One KAFO

Robert A. Bangham, C.O.

The purpose of this design is to provide a solution to a problem that most of today's orthotists have dealt with. We have all seen people with either a "closed head" injury or Cerebral Vascular Accident (CVA) and provided them with an ankle-foot orthosis (AFO). Most orthotists have returned another day and seen that someone had added a "knee immobilizer" to control knee instability in either the frontal or the sagittal planes, or some combination of the two. The purpose of this design, developed with the help of the Central Fabrication Department of Hittenbergers, Inc., is to provide a custom made knee-ankle-foot orthosis (KAFO) (Figure 1) that can be converted from a KAFO to an AFO (Figure 2) and back again, with lockable or free motion knee joints, all in a physical therapy department using only a screwdriver or allen wrench.

Fabrication Technique

An AFO is fabricated with holes drilled and tapped (8-32) in the uprights distal to the calf band. The proximal KAFO section is then fabricated with appropriate clearance holes in the knee joint uprights so that it can be removed as a complete unit (Figure 3) or reinstalled if the AFO proves to be insufficient to provide knee stability. Use of a bail lock for ease of locking and unlocking is preferred. An elastic driven bail featuring an inverted "V" design (Figure 3) with the ends of the "V" bound in leather and attached with 8/32 screws at each end to the knee uprights is used. By including this feature in the design, the bail lock can be readily removed separately from the knee joint (Figure 1) to provide the patient medial/lateral stability with a free knee, or it can be locked again by reinstalling the bail lock. The same effect can be achieved with drop lock clips.

Acceptance

1. Patients like the feel of stability the orthosis gives them.
2. Insurance companies will pay for this as an initial prescription, but would pay no more for an extensive revision to a recently provided, but inadequate AFO.
3. The author likes the ease of making modifications at remote sites.
4. Several orthotists have further modified this design to suit their practices.

Resistance

1. Some individuals have demonstrated a lack of "gadget tolerance" when it comes to the convertibility of the orthosis.
2. Some individuals have expressed concern about "over-bracing," yet were among the first to go for the "knee immobilizer" as previously mentioned.

Robert A. Bangham, C.P., 67 West Lake Drive, Antioch, California 94509.

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