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We extend the discussion to a more general theme. General principles of bracing On every curve, brace should press on three points: The first pressure point, on apex, covers one third of the hump surface. The peripheral two thirds of the convex side have to be maintained far from the brace parts. That reduces the hump Figure 1, dodging 1and allows some movements around the apex dodging 2 and 3.
All dodges have an active correcting action. Two other pressure parts of the brace act on both extremities of the concave side, on apexes of neighbouring curves. Their pressed surface is tiny, some one fifth of the whole concave surface for each pressure part. No brace part should hinder dodging 1, 2 or 3. Their body areas have to remain free or far from the brace walls. Actually, nearly no one respects those rules, for several reasons, and we see all over the world nearly all braces embedded in concave pressures, in pressures on dodging areas.
Here follow examples of rules and of good and bad pressure parts. The normalization of the shape of bones is a goal of orthotic effect. The orthesis brace increases pressure on the convex side and releases the load on the concave one. That causes a quicker growth on the concave side and a growth slackening on the convex one.
There are Delpech laws, well known for more than two centuries the beginning of 19th. Why should the Delpech laws not be true for vertebral apophyses? But there are good braces necessary without iatrogenic action and without pressures on concave parts of the deformed body concave pressures.
Only with braces without concave pressures, as we show in this paper, the congenital deformations can be changed. They are the apexes of the neighbouring curves. Dodging 2 and 3 allow movements straightening the curve an active way.
In those cases, wedging is a main symptom. Concerning congenital scoliosis We only saw a single publication of two cases of congenital wedged vertebrae which had been made more symmetric by bracing http: The brace maker had been an attendant at the lectures of one of us.
This paper proves that this assertion is false, like many others. The mother is a physiotherapist and was concerned that her son boy had a mild scoliosis. They attended the scoFig. The vertebral index according to Cheneau 1, 2 was 36, which means very great wedging. This index is quite independent on the size of the picture. Weaning of bracing was started on April when the boy was cm tall and the body weight was 50 Kg and finished at the end of the next year when the boy was almost 17 years of age.
It means that the boy was treated 6 years by Boston brace 3, Fig. The radiograph showing definitive result Fig. Boy, 11 years old, The third lumbar vertebra has two pedicles at its right side. Modified boston brace radiographic follow up was on 26 April when the patient was 20 years of age, showing no change since Status of patient in is shown in figure 5. Case 2 Six years old German girl was examined for the 1st time in Her mother has noticed a scoliosis of her daughter at the age of six.
The spine deformations are clearly visible although the girl stands without any overhang scoliosis is not decompensated. The vertebral index was The lower part of the upper vertebra on its right side was strongly notched, the upper part of the lower vertebra was less notched.
NMR views showed a kind of horizontal bi-lobulation of this atypical block Th Fig. Two, then two more years later, in region Th, the smaller side has grown much more than the right one.
The vertebral index is now In the lumbar region, symmetry is nearly complete, and can hardly be calculated. We are now waiting for the end of adolescence before we can judge if corrective remodelling is achieved. Charging one side of a growing joint and discharging the other one brings on a greater growth on the discharged and a slower growth, even a growth stop, on the overcharged side.
What seemed to be unknown up to our times is that the laws of Delpech concern wedged vertebrae, too, and that an abnormal bone piece reacts according to Fig.
As a result, the congenital wedged vertebrae became nearly symmetric. Other cases are being treated by brace at present time and we expect a longer delay before publishing them. This strategy therefore can reduce the rate of surgical cases. We think that a brace should be given in selected congenital scoliosis patients, too. Both presented cases are congenital, with incarcerated wedges. In the 2nd case Fig. L5 is wedged a reverse side, greater side left.
At level of L5, it is not possible to measure an angle, near 0. Block Th5—6 atypical and bi-lobulated.
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Details of the block T5—6, the smaller side of which having grown almost to symmetry. Left,Wedge coefficient One team Cheneau, Engels and Bennani is now treating similar 2 cases. There is necessary to wait a certain time before these cases will be possible to publish. The team intends to publish these cases without respect whatever the result can be, good or bad. We think that a brace should be given in selected congenital scoliosis patients.
Concerning idiopathic scoliosis In idiopathic scoliosis 1, 2we have studied and measured the wedging of short time results in a small series.
No case of this series had carried braces with concave pressures. Measuring a wedge before and after treatment is a little untrue because wedging is often accompanied with rotation, and un-wedging with derotation. A true measurement should compare apexes with the same views, independent of the rotation. We did not make such an essay in order not to submit the patients to X-ray irradiation. But Kotwicki 4, Fig. They are a little different, but wedging can be seen even in Fig. Wedged vertebra, derotated with hand - manually Dr.
Wedging can be seen also in the derotated spine, and its size is just a little different from the previous view. Both radiographs have been made a couple of seconds from one to another. We never have found a single publication which took wedging in account. The problem of rotation is not present in one of two cases we showed here the girl because the apex of vertebrae was not rotated, as it generally is in congenital scoliosis 1.