Functional bracing of fractures of long bones was first introduced in the late 1960s. This method was quite popular during that period following Sarmiento’s work on this. This technique was based on the proposition that freedom of motion of the knee joint and early weight-bearing ambulation could be introduced during treatment of tibial fractures without increasing shortening of the limb or interfering with fracture healing.
Early success led to the development of an orthosis similar in design that permitted freedom of motion of the ankle and knee joint. The system was expanded to include some diaphyseal fractures of the femoral shaft and fractures of the upper limbs following the success in tibial fractures.
The principle of the treatment by fracture bracing is to allow early mobilization with help of a brace that does not hamper function after the fracture has started glueing. The initial cast is removed within two weeks and the limb is put in functional brace.
Trqaditional casting method had been to immobilize the limb one joint above and one below the fracture whereas functional bracing method devised the braces that would allow motion on on either side. This allowed early mobilization of the patient and early use of limb which aided into union of fracture.
Bracing is a philosophy of fracture care based on the idea that function and motion at the fracture site are conducive to osteogenesis.
The acceptibility range of fracture fragment was quite wide and higher degree of angulation and malposition was acceptable as long aas fracture united and it did not hamper the function or increased risk for late degenrative changes.
Here is what Sarmiento said on this
The use of fracture bracing often calls for the acceptance of a deviation from the normal anatomy of the fractured bone, but with the realization that minor changes in length, rotation, and alignment of long bones are easily compensated for and do not represent functional or cosmetic disturbances.
Functional bracing is best applied tosimple, low-energy fractures. Other methods of treatment such as external fixation and closed intramedullary nailing have become the preferred treatment for many complicated fractures.
In the case of the tibial fracture, functional bracing continues to provide good results for closed low-energy fractures, particularly those with associated fibular fractures, though there is increased trend towards surgery due to increased patient demand for early activity.
The most common reason for complications with functional bracing is the lack of awareness of the ba¬sic physiologic foundations of the treatment and the belief that bracing is only a technique.
With time and more undrestanding of the subject, functional bracing indications have been defined better. It has been found that braces are helpful only in controlling angular deformities and do not prevent the shortening.
For example a comminuted fracture of tibia would not be served any good by brace as it would result in unaccpetable shortening.
Functional fracture bracing should not be used at the time of the initial treatment of acute fractures and should be introduced only after the acute symptoms have subsided. A brace should be discontinued and other therapeutic modalities introduced if the brace fails to provide or maintain the desirable stabilization and alignment of the fracture fragments.
Its success seems to be determined by an understanding of its philosophy and principles and by rigid adherence to the technical details, Srmiento observed