The first step is to figure out the appropriate size of the brace. Using the X-OS measuring tape, place the measuring tape just above the knuckles and wrap it around the relaxed hand. Whichever color the black line lands closest to is the appropriate measurement to fit the brace. If you do not have the X-OS tape measure, you may use a standard tape measure and reference the product catalog to identify the appropriate X-OS wrist brace. Once we've determined the appropriate size, remove the brace from the packaging and locate the BOA tensioning reel. Lift up on the reel till you hear a click. This will allow you to pull the tensioning wire out. Turn the brace sideways. Tent the brace by pulling the under part of the brace on top of the other. This will create space for equal air flow, so the brace will heat evenly. Place the brace in the X-OS oven. Set the timer to 5 minutes and the temperature to medium, and the brace will heat to the desired temperature in 3 to 5 minutes. After 3 to 5 minutes, remove the X-OS brace from the oven. The brace will be malleable to form fit appropriately to the patient. Slide the patient's hand in, paying attention to the position of the thumb. Make sure the top of the brace is placed evenly over the bottom. Push down on the BOA tensioning reel till we hear the audible click to confirm it is locked. Start tensioning the brace. To ensure more even circumferential pressure, grab the wires on the proximal and distal ends, and pull gently and then continue to tension the BOA tensioning reel while guiding the clip up to the tensioning reel. Once we have achieved a comfortable tension, turn the patient's hand as shown, and apply a gentle pressure as shown to mold the brace to the patient. This should take approximately 3 to 4 minutes to cool. Apply pressure along the palmar crease on the inside of the hand to push the hand in a slight palmar extension. 15 to 30 degrees is considered optimal anatomical position for comfort for the patient. Hold the position 3 to 4 minutes till the brace is cool. Once the brace is cooled and firm, place the hand on the table and recheck the tensioning. If the brace is a little bit loose, retighten the reel to comfort. We want to always be sure the brace is not too tight to disallow airflow or apply too much pressure on the skin, which can lead to skin maceration. If the brace is too tight, loosen the reel and re-tension and check to make sure the brace is fitted appropriately.

Exos wrist brace

measuring tape

BOA tensioning reel

Exos oven

tensioning and adjusting

X-OS wrist brace

BOA reel

heating brace

palmar crease