For a long time there has been a quiet battle playing out between two fabrication options in O&P; one that seems to have resulted in a stalemate.
CFab versus in-house
Throughout the history of O&P the only real fabrication option was to do it yourself, in-house. In small shops this meant that the practitioner would likely have to do all of his own fabricating, including forging the ankle and knee joints.
About a hundred years ago manufacturers began forging standardized joints for sale, making the job of being a practitioner much easier. Then, someone thought, “Wouldn’t it be nice to have a place that made the entire device for me too?”
This natural progression of thought became what we now call central fabrication, also known as CFab. Now, all that the practitioner needed to do was cast or measure the patient and let expert technicians in a remote location do the rest, freeing him up to see more patients. Great idea except for one thing. It is hard to get an end product that is as it was envisioned.
In an effort to provide patients with a device that meets their expectations, many practitioners opt to go “old school” and make all, or most, of their own devices. No, they do not make the components anymore but they do like the control they get from making everything else in-house. But there is a lot of overhead to consider: more employees, lots of equipment and more real estate. But they know what they are going to get at the end of the day.
Make CFab work
Other practitioners have discovered that their interest is in seeing patients and making the occasional adjustment. The way that successful practitioners make a CFab work for them is to remember one simple rule. Communication is key.
Let’s assume that you have made the leap of faith and have found a CFab to whom you are going to turn over your hard-won cast. As in all things, communication is the key element. It stands to reason that the only way to get what you want is to tell someone what it is. Of course you should fill out the work order with the following information: company name, patient name, brief diagnosis, type of device desired and telephone number. This is essential information.
The next most important piece of information is the return ship date. Be sure to understand that if you want it shipped on Tuesday and the package has 2,000 miles to travel, do not expect it to be there on Wednesday unless you pay for that big ticket overnight shipping. Of course the same rule applies to both directions. If you have a rush job, ground shipping is a surefire way to delay the fitting, even if it is only a couple of zip codes away. Sure, it usually only takes one day but that one time you absolutely have to have it will be the one time it takes that one extra day. Just be sure to plan in some travel time for your cast to get to where it is going.
Call ahead if you are in a hurry or you have some special considerations in design or componentry. If you need some hardware that is not an everyday item it can help to give your CFab a call so that they can order it ahead of time.
Another often over-looked but obvious detail that makes all the difference to a successful outcome is providing accurate and reliable measurements. Go beyond measurements taken by measuring tape alone. Negative and positive casts count as measurements too. In fact, they are the most important kind of measurement. No measuring tape can supply the kind of detail needed like a well-taken cast can. Conversely, nothing can ruin the chances of a good outcome like that of a poorly taken cast.
Personalization
I used to tell practitioners, “Garbage in – garbage out,” meaning if the practitioner gives me a good cast I can almost assure that they get a good device in return. Give your CFab a fighting chance by taking an accurate and sturdy cast.
Most CFabs are accustomed to dealing with a lot of different practitioners and each, it seems, wants things done in a different way. Keeping this in mind be as specific as possible when describing what you need. Asking for a “standard” device will almost certainly solicit an audible sigh on the other end of the phone. There is no such thing as “standard” in the world of CFab, not even build-up heights.
It is true that most labs will have “standard” things that they do if you are not more specific in your description but unless you have dealt with those techs before, do not assume that “standard” at this lab is the same as “standard” at another lab. More likely than not, they will be different. At the time of the writing of this article, there are no industry standards, no matter what you may have been taught. We are working on fixing that problem.
As far as I know, most technicians cannot read minds, least of all the minds of practitioners. Give your CFab technicians clear and concise instructions, accurate and stable measurements and the time needed to create the device as you have it envisioned.
Steve Hill, CO is the secretary of the Orthotic and Prosthetic Technological Association and owner/ chief executive officer of Delphi Ortho.
