Over the past 15 years we have developed a system of fracture management which introduces function to the injured limb early in the treatment phase. In order to accomplish this, external braces are applied as soon as the acute phase of the injury has subsided. Internal fixation has been avoided in most cases of diaphyseal fractures of long bones with resulting minimal morbidity and a high union rate. The importance of function for fracture healing seems to be related to increased vascularity and the optimum chemical, physiologic, mechanical and thermal environments provided in the limb. These functional braces have been designed to control, but not prevent, movement of the fragments by molding of the soft tissues. With proper soft tissue control, the fragments move but return to their initial positions without allowing progressive deformity to occur. Proper molding of the soft tissues in the fracture brace seem to provide adequate stiffness to the limb so that stability is maintained while allowing early weight-bearing and functional activity. The initial shortening from associated soft tissue damage at the time of injury remains essentially unchanged during functional treatment. Thus fracture bracing is most successful with fractures whose initial shortening is within acceptable limits. Such patients usually have closed fractures and since the soft tissue damage is minimal, the acute symptoms subside rapidly allowing early application of the brace and functional activity. Braces can, many times, be applied within a few days of injury and should always be introduced within the first 6 weeks for best results. Exceptions include fractures with unacceptable initial shortening or uncorrectable angulatory deformities which require traction, external fixators or internal fixation. Functional fracture bracing is not a simple technique of management because it does require close attention to details and an understanding of its basic concepts. Once initiated, functional bracing should not constitute a final commitment on the part of the surgeon and should be abandoned in the event that acceptable reduction and alignment can not be maintained.
|Number of pages||9|
|Journal||Clinical Orthopaedics and Related Research|
|State||Published - Jan 1 1980|
ASJC Scopus subject areas
- Orthopedics and Sports Medicine