exos medical: new waterproof cast/brace technology
By ccrossen | May 11, 2009
This past February, I launched into a large Jeffrey Pine and broke my arm/wrist. Luckily, it was a clean, break, no displacement, and looked like it would heal easily with standard treatment - a fiberglass cast for six weeks. Not only was this during the start of an incredible three week powder run, I was also scheduled to head out on a surf trip in four weeks, and a normal cast, with padding and wrap underneath, wouldn’t really allow me to keep playing. I needed help, namely a low-profile cast solution that would fit under a glove or mitten, as well as hold up in water for six hours per day. Not an easy list. After a little searching, I discovered Exos Medical, a new company based out of Aspen and Minnesota that makes a heat-moldable, waterproof cast. Exos braces, splints, and casts are thermoformable and are prepared for application using a waterless, dry-heat preparation system. Fortunately, my wife is a physician, so we called up Exos to see if we could try out some of their products. They were very receptive (my wife helps a lot of patients at Squaw and Northstar medical clinics) and sent us a Short Arm Cast, as well as a wrist brace. Exos also makes short thumb spica and long thumb spica casts.
It actually took a little while to arrange all of the shipping/details, etc. so I ended up being casted with a normal short arm fiberglass cast, after being splinted for four days. The normal cast, the classic 3M fiberglass tape cast, worked well, had a very easy application, sturdy design (actually survived one of the hardest falls of the season), was inexpensive, and could be worn beneath an enormous red fleece mitten I found at the local thrift store. The cast was tolerably comfortable, and I could sort of hold a pole as well. Not bad, but the cast was bulky, relatively heavy, smelly, itchy, uncomfortable, and was definitely not waterproof as the arm was wrapped in padding and gauze before the fiberglass was applied.
At first glance, the Exos short arm cast looks like a forearm protector, some sort of padded brace that you’d use for downhill mt. biking or moto. The cast is cut to fit the forearm, fitting snugly over the palm and between the thumb and the index finger. The cast has an overlapping closure that encloses the forearm, tightened via the Boa lacing system.
Once the Exos materials arrived, we cut off the fiberglass cast, and followed the instructions for the Exos cast. Simply put into the oven for five minutes, take out, insert arm into the softened material, tighten the Boa system, and wrap with hands where needed to ensure a tight, comfy fit. Within a few minutes after application, the cast hardens and is ready to go.In a word: amazing. The ability to have a custom, heat-moldable cast that’s light, adjustable, removable, waterproof, low-profile, and for the most part durable, is incredible. Once heat molded and formed to the shape of the arm, the cast can be snugged, loosened, or removed and then placed on the arm again using the Boa system to tighten the cast again. The cast can also be remolded numerous times if the first fit isn’t as comfy as liked.
After application and fitting, I proceeded to ski, surf, and generally do most of my normal stuff pretty normally, all with great results. I missed about 10 days or so of skiing, and then was able to ski at 25%, 50%, 75%, etc. as the healing improved. The really big benefit of the Exos cast was it’s low-profile, which allowed me to wear a larger glove and have much better dexterity, pole plants, and poling (touring). Stability was excellent, comfort was great, though the cast did cause a lot of sweat, especially while touring. But the removeable/retightening Boa system allowed me to take the cast off, shower, and then put it on again.For the most part, this cast was perfect. The arm healed great, no problems at all. So from a clinical perspective, the cast did its job. Granted, I had a very straightforward, non-displaced distal radius fracture that did not require surgery or any other special treatment. Occasionally, I needed to wash my cast as it did begin to smell - I guess the touring and sweating caught up with me. But I was always able to remove any odor by simply washing the cast with soap and water. From a comfort perspective, the cast is fine. It is niot super-comfy, the material used on the inside of the cast is not soft, not hard either, does cause some rubbing/friction at the edges, especially when engaged in activities where the arm/wrist is moving a lot. The external fabric between the thumb and index finger did peel away from the main cast material. This did not affect performance or structural integrity, but I ended up with a flap of fabric blowing in the breeze.
The most trying aspect of the cast was the Boa lacing system. While this system is designed to help facilitate easy loosening and tightening, which it did to a degree, overall, the design needs some work. In general, while ideally the Boa system is a one-person job, it ended up being a two-person job, as it was impossible to tighten the wrist area and the middle, and end easily and well by myself. The Boa system could easily be shortened to close the bottom of the cast, while using some sort of velcro closure for the top half of the cast. Also, while I tried a medium cast, I found it a bit long and a bit overkill. Sizing is very important for comfort, performance, and healing. When I bent my arm to 90 degrees, the cast dug into my elbow joint.
After wearing the cast, I transitioned to the Exos wrist brace after about five weeks. The wrist brace is much smaller, lighter, and lower-profile. The wrist brace, also heat-moldable, uses a nylon cord and velcro closure system, which you simply pull with your fingers to tighten. Overall, the wrist guard worked great as well, for a period. I primarily used the wrist guard for the last two weeks of my healing, namely for a surf trip and the end of the ski season. While the basic design of the wrsit guard was excellent, I had significant break down of the material between the index finger and thumb, and the velcro broke down and did not work, causing the nylon cord to loosen often. Granted, I was surfing six hours a day, duck diving, paddling, etc. and skiing as well, so I expected some wear and tear, but after two weeks, the guard was pretty thrashed. The brace served its purpose though, provided great protection and stability in the waves and water.
Bottom-line, I would use the cast and brace again, no question at all. They make such a huge difference in dexterity and performance, and make it possible to get out there and continue your activities, it’s worth paying the extra money for these products. Anyone who’s active and needs a cast that can also get wet, should look into Exos.
Speaking of money, it’s not exactly clear at this point how much your local doctor will charge, nor whether insuance wioll cover the cost. it all depends on your physician. I was a unique case, applying the cast at home; a doctor will typically form the cast.
Another key point is compliance: these casts are not for everyone. Because of the removability, the patient needs to be responsible and dedicated to wearing the cast for the primary purpose of healing the broken bone.
From Exos:
Exos braces, splints, and casts are thermoformable and are prepared for application using a waterless, dry-heat preparation system.
- Clean, waterless preparation provides less opportunity for baterial growth
- Improved technician handling
- Improved patient comfort
- No mess, clean up or waste
Application of an Exos product is a simple three step process that lasts approximately 7-10 minutes depending on the type of product. Some products take as little as 5 minutes. Exos products were the brainchild of Mark Joseph, a product designer, in Aspen, Colorado. Building on his experience with moldable thermoplastics and foam materials used in the ski boot technology, Mark developed a laminate system of splinting, bracing, and casting products that has innovative applications in the medical field. While the surgical technologies in the treatment of fractures have evolved significantly over the past 25 years, the non-operative methods of stabilizing extremity injuries externally using plaster and fiberglass have not changed appreciably during this time. Exos technology offers a creative and innovative advancement to these systems that is durable, light weight, radiolucent, anti-microbial, waterproof, washable, remoldable, adjustable, and removable (in appropriate situations).Short Arm Fracture Brace This fracture brace offers superb support and protection for major injuries to the wrist. It is used primarily for fractures to the distal radius or distal ulna, and can be employed for acute injuries as well as post-operatively. The SAFB provides superb stability for all types of Colles fractures, Salter-Harris pediatric wrist and forearm injuries, and complex carpal injuries. It’s signature feature is the Boa Technology ® adjustable closure system which provides for minute adjustments in circumferential compression of the cast. It can be tightened or loosened instantly as indicated, making the need to split or bivalve casts, to avoid compartment syndromes or the dread Volkman’s ischemia, a thing of the past. Post-operatively the ability to loosen and examine a patient’s wound, without needing to cut off or replace a cast, can be a major advantage. As with all Exos products, the ability to heat form and custom fit the fracture brace to the patient’s extremity ensures a uniformly comfortable fit.
Features
Custom fit
Easy to apply
Adjustable tension
Radiolucent
Waterproof
Reformable
Lightweight
Durable
Benefits
Superior comfort
Saves Time
Greater stabilization and comfort
Eliminates removal for x-ray
Improved hygiene/Increased water activities
Limits waste
Improved Comfort
Topics: Gear Reviews |
July 15th, 2009 at 3:33 pm
Hi Chris I just read about your experience with the Exos Wrist Splint and It would be ideal for my athletic activities. I am having difficulty with my fiberglass cast. I live in New York and hope I can get it sent to me so I can adapt it myself as you did. Does the company sell it directly to the public? Any help or advice you can give me would be greatly appreciated. Thankyou.
July 22nd, 2009 at 1:22 pm
I also would love to know if I could get the Exos cast for my wrist fracture. I swim and now I am unable to train for 6 weeks. Any ideas on how to get one?
November 23rd, 2009 at 4:59 am
Chris:
I couldn’t agree with your more about how well Exos casts work. Last Winter I broke a thumb and tore a ligament, and my Exos cast allowed me to successfully complete the American Birkebeiner 54 cross-country ski marathon without any problems. I had some fun and created a short animated slideshow titled “A Skier Cooks His Cast” which tells my story. Click upon my name to link to my blog post with the video. Glad everything worked out for you!
Rich (aka … the Northstar Nerd)
June 16th, 2010 at 6:20 pm
I have a scapholunate dissocation. Wondering how this splint worked for surfing? Do you have flexibility in your wrists to push yourself off the deck of your board to stand up? Currently, I’m using plastic molded splints. The fit isn’t right yet.
I’m from the Northeast (Cape Cod) and spend most of the time in the water wearing a wetsuit. Would I wear this outside or inside the wetsuit?
Appreciate any info.