I Use Staples

I use staples—it's true. And I have for years. One of the first tasks I was entrusted with in my earliest days in O&P was mold modifications. Since I didn't know anything about how to modify a mold, I can't imagine that the end product fit the patient well, but that didn't seem to bother most of the practitioners for whom I worked. They would come back into the lab and yell at me if the modifications were not precise enough. From that feedback, and trial and error, I was gradually able to dial in what they wanted. Clearly that was not the most effective way to teach me how to complete what I think is one of the most critical and complex tasks undertaken in O&P fabrication. So when it was my turn to start teaching people how to modify molds, I knew there had to be a better way. After nine years in the industry, I started my own company and we specialized in pediatric lower-limb central fabrication. In this specialization particularly, modifying the molds was a significant part of the program, and precision was crucial. I never felt comfortable letting anyone else perform this task, so I made all the modifications myself. I knew if I were ever going to grow the company, I would have to teach someone to help me, but I wasn't sure if quality was really scalable. I had partially convinced myself that there was something special I was doing that could not be accurately communicated to an apprentice. As a result, I would single-handedly have to modify every mold that came in the door-forever. [caption id="" align="alignright" width="275"] Figure 1. Porter-Cable upholstery stapler. Photographs courtesy of Tony Wickman. [/caption] Of course, this was a silly notion since almost every central fabrication lab has multiple people who do modifications and most of them do a good job. The problem was figuring out a way to teach someone else how to do whatever I was doing. Before I could teach someone else how to modify molds though, I had to know exactly what I did. I had a good idea of what I did, but I really didn't have a good way to quantify it in a way that I could easily communicate. The problem was quantifying the buildups. I always thought I had a pretty good idea about how much I was adding. But when other people did it, it never looked the same. Then a friend suggested using small nails or brads to indicate the buildup heights. The idea seemed brilliant. All I had to do was tap a brad into the apex of my buildup and add enough plaster to cover it. Then when I filed the plaster down I would know exactly where to stop. It worked great, and I could even check other technicians' nail heights before they added plaster to ensure they were what I was looking for. The only problem was trying to hold onto the little nails and not hit my fingers with the hammer. That's when my friend Steve Hill, BOCO, told me about pneumatic staple guns-specifically, a Porter-Cable upholstery stapler (Figure 1, above). This tool works well for inserting staples into the cast because, unlike most power staplers, it doesn't have a built-in safety. Most power staplers have a pressure-activated safety that will only allow the stapler to fire when the tip is pressed firmly against a surface. But upholstery staplers don't have this feature, which allows you to hold it above the surface of the cast and sink the staple in to a specific depth. If you want the staple to project one-eighth inch from the cast, hold the stapler one-eighth inch off the cast and squeeze the trigger (Figure 2, below). [caption id="" align="alignright" width="340"] Figure 2. Staples project from the cast to mark the apex of the buildups. [/caption] While using a nail or staple in the cast may not sound like a huge innovation, as Gary Bedard, CO, FAAOP, says in regard to processes, "If it can't be measured, it can't be controlled." And that was exactly the problem with my process for modifying molds and doing buildups. I thought I knew exactly what I was doing, but it turns out, I didn't. I wasn't off by much in understanding my own process, but I was off by enough to make it hard to tell other people how I was achieving my results. Scalability is essential for growth in any business, so is eliminating waste, such as the time-zapping trial by fire I was subjected to in my early days modifying casts. Creating a simple, consistent way to communicate the buildups I want to an apprentice has opened a door to increasing production while still maintaining the shapes and quality I want. And all with the help of a little staple. Tony Wickman, CTPO, is the CEO of Freedom Fabrication, Havana, Florida. He can be reached at tony.wickman@freedomfabrication.com .

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