[Functional bracing of fractures]

H Hackstock
Der Orthopäde 1988, 17 (1): 41-51
Fracture bracing is a nonoperative treatment of fractures using braces. This treatment is thought to have originated in the medical school of ancient China, and has been reintroduced by Dehne, Sarmiento and Latta [4, 16]. The principle is that in the closed system of the brace the dislocating forces are transformed into compression forces activated by the muscles. Fracture bracing is very successful in fractures of the humerus, the ulna and the tibia. Some degree of shortening of the fragments must be accepted, especially in the humerus. Among 84 humerus fractures, bone healing took place within 6-8 weeks in 82 and there were 2 cases of nonunion. Functional and cosmetic results were excellent. In a series of 48 ulna fractures there were 47 in which bone healing took place within 6 weeks, and only 1 case of nonunion. Complete function was restored in all cases. In tibial fractures it is essential that bracing is applied only when strictly indicated; it depends on the type and localization of the fracture. Good results have been achieved only in stable fractures with early full weight-bearing. All nonstable fractures must be fixed with a long leg cast for the first 4-6 weeks, after which further treatment may be continued with a brace for the next 4-6 weeks. Bone healing takes about 12-14 weeks in all, with the same length of time in the brace as in the long leg cast. The main advantage of fracture bracing is the early movement of joint and muscles it allows, so that no rehabilitation treatment is necessary after removal of the brace. Fractures of the femur and forearm are not reported, because the authors have not yet treated any by this method.

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