One of my favorite movies, Jerry Maguire, reminds me a lot of the current state of central fabrication. Tom Cruise plays a run down sports agent tired of the impersonal high pressure field. He desires a business world where service is centered around personal contact and less pressure for numbers. We at O&P¹ found out years ago that personal service is a definite key to success. While many are saying, “Show me the money.” O&P¹ likes to refer to another line in the movie, “Help me help you.” If you don’t remember, it’s a turning point in the movie where Jerry convinces his client that he is as much a part of the overall success as Jerry. Simply put, if both parties communicate, success is a two way street.

What Differentiates Us?

Service. Service in central fabrication entails speed, accuracy and quality. We have reached a point in the orthotics and prosthetics field where product differentiation is minimal. Repeat business only occurs when the client sees value in the relationship, has trust in the business partner and the business partner shares the same vision with the client. Service benefits therefore weigh heavier than product features.

Price vs. Cost

Remember price isn’t that same as cost. You may save a few dollars somewhere else but does that savings cost you in other areas? John Ruskin a famous author once said:

“It’s unwise to pay too much…but it’s worse to pay too little. When you pay too much you lose a little money that is all. When you pay too little, you sometimes lose everything, because the thing you bought was incapable of doing the thing it was bought to do.
The common law of business balance prohibits paying a little and getting a lot. It can’t be done. If you deal with the lowest bidder, it is well to add something for the risk you run. And if you do that, you will have enough to pay for something better.”

Help Us Help You

Give us a try and you will find a fun, friendly atmosphere where people listen to each other. There are only a few things we ask: accurate measurements, a good cast and a complete work order. Those three simple things are a big part of the success or failure of utilizing central fabrication.

How often have you been able to say this?

O&P¹ has two CPO’s on staff that can understand and differentiate the needs of both the practitioner and the patient. They know the true variable nature of our business.

Andy Steele, CPO and Dennis Clark, CPO has teamed up with a combined total of 35 years experience. They know that every now and then a practitioner needs to make a tough commitment to a family, hospital, physician, or patient and that the practitioner needs his/her fabrication partner to stand beside them in that commitment.

Acting as emulsifiers, Andy and Dennis are available to help both practitioners and technicians understand each others needs through the flow of information to create a quality outcome on time. O&P¹‘s business success depends on your business success. As long as we can meet or exceed your expectations, you can continue to meet and exceed your clients’ needs. And that is what is most important to all of us.

“It’s great to call and talk to someone who knows what I want.”

At O&P¹, it is our goal to hear you say this often!

“The Double Wall Socket protects my sleeves from holes that could occur with other systems. I also like the ease of switching from my work leg to my biking leg and not missing a beat.”

–Don Moore, BK amputee, Bicyclist

The Double Wall Socket design is patented. O&P¹ is a licensed TEC Double Wall Facility. For more information regarding the double wall socket, please contact Andy Steele at 800-408-3598

CAD/CAM using your cast

One of the easiest ways to use CAD/CAM without the investment is to send a cast of your patient to O&P¹for modification and fabrication. Take the cast of your patient in much of the same manner you normally would, fill out the O&P¹ work order and measurement sheet and we’ll do the rest. Please refer to our FAQ’s section for standard turnaround times.

CAD/CAM to measurement

Trans-femoral to measurement

Tired of spending hours modifying trans-femoral casts only to end up with something that doesn’t fit your patient? If so, then CAD/CAM to measurement is for you. A set of measurements takes only a few minutes to complete, eliminating the need for a cast. Follow the instructions below and we will be able to create a socket that gets you to a quick starting point. The socket is only as good as your measurements so please follow the instructions step by step.

Measurements need:

• Ischium to distal end.
• Perineum to distal end.
• Starting with your zero level at perineum, take circumferences every 2 inches. (Every 1 inch is the limb is very short.)

Other information needed:

• Left or right side.
• Brim style.
• Other length and circumferential measurements if setting up and/or finishing the prosthesis.

AFO to measurement

Orthotics and Prosthetics One now offers AFO to measurement. With a series of measurements we can generate a model using TracerCAD. Please call for more information or go to the work orders section for details on measurements required.

CAD/CAM – your CAD, our CAM

If you have a front-end system using TracerCAD or Shapemaker we can be your fabrication support. Create the model your way, include fabrication specifications in your email or fax us a work order and we’ll take it from there. Most new CAD/CAM users prefer this method because it frees them from the financial commitment of a carver (usually $40,000 to $100,000) and eliminates hiring new staff to maintain and run the equipment.

The C.R.O.W. is a combination of an ankle foot orthosis and a custom boot. The C.R.O.W. was developed for patients with severe charcot changes of the foot and ankle where a more traditional means of treatment was not satisfactory. The device is in essence a bivalved copolymer full foot enclosure ankle foot orthosis with a rocker bottom sole built on the device.

The orthosis is fully lined with a custom foot insert and custom formed to a plastic impression of the patient’s affected limb. Appropriate modifications are performed to the impression, which permits for equal weight distribution through the limb and foot. The C.R.O.W. can be modified within limits to accommodate changes by flaring, adding padding and trimming where and when appropriate. It is very useful in protecting the patient from further breaks but not 100% as patients can and do fracture in plastic and fiberglass casts.

The C.R.O.W. is easy to don and doff. Patients can bathe daily and maintain proper hygiene. Many patients learn to drive with the C.R.O.W. Over all the acceptance is good due to availability of colors in the copolymers. The ability to bathe and sleep with freedom from a cast makes the C.R.O.W. a great asset.

Casting for the C.R.O.W

Casting

Casting a patient’s foot at an angle of 90 degrees or as close to that position as possible is imperative for proper modification in the construction of the C.R.O.W. boot, as importantly, is the casting of the knee to the relationship of the foot.

Casting Preparation

Before casting place stockinette from the proximal section of the knee to the distal end of the toes.
A cutting strip of appropriate material at least 1″ wide should also be applied. Place “T” foam covered with a plastic sheet in position under patients foot.

Positioning

Toes need to be slightly hypextended causing a natural rocker of the forefoot. The placement of “T” foam under the patient’s foot will cause this when pressure is applied on the foot.

Weight Reduction

When the foot is casted in a rocker position, less material will be needed to create a walking sole on the C.R.O.W. boot itself, therefore a significant reduction in weight.

Casting Procedures

Place plaster strips over the distal end of the toes.
A clear reference by means of plaster strips will give you the exact starting point for the toe build up and modifications.
Mark bony prominences and potential problem areas with indelible pencil.
Wrap leg using standard procedure of casting.

Cost of capital is another issue to consider. Many of the companies we service have front-end CAD systems. They use us for fabrication support to defray the cost of a carver or CNC milling machine. Unless you can keep the milling machine busy 8 hours a day, I argue there is no need for it (the only exception being when same day service is required). To put some numbers to it – a milling machine is roughly $70,000 while a BK foam carving costs only $50. It would take approximately 1400 carvings to equal the cost of the milling machine. If an average office does 50 carvings a month, then it would take about 28 months to equal the cost of the milling machine. While that doesn’t appear to be a long time, consider that during that time you also pay for repairs, upgrades, and staff to run the machine. But more importantly, what happens if technology improves and renders this machine useless? By using a central fabrication center you eliminate the startup and maintenance costs and risk of technological obsolescence.

Companies that are “Thinking Lean” into the future are the ones that will survive the test of time and prove to be the most profitable. Their goal will be to lower overhead costs, eliminate material waste and free up cash flow. Using central fabrication will help orthotic and prosthetic companies meet these goals.

Andy Steele, CPO MBA

Clark & Associates Prosthetics & Orthotics