Factors influencing the outcome of closed tibial fractures treated with functional bracing

Abstract

One thousand consecutive closed diaphyseal tibial fractures, treated with prefabricated functional below-knee braces, were analyzed by statistical methods to determine factors predictive of final fracture outcome. Neither the age of the patient nor the location of the fracture influenced the speed of healing. In 95% of the fractures, the final shortening was < or = 12 mm. The mean final shortening was 4.28 mm, compared with mean initial shortening of 4.25 mm. This confirmed the authors' long-held hypothesis, that, in general, for closed, diaphyseal tibial fractures treated with functional bracing and graduated weightbearing ambulation, the final shortening does not increase beyond the initial one. Final angulatory deformity in any plane was < or = 6 degrees in 90% of patients. The presence of an intact fibula was a relative contraindication for functional fracture bracing because angulatory deformity was more likely to develop. The incidence of nonunion was 1.1%. The high union rate and low morbidity associated with functional bracing of closed tibial fractures suggest that the routine use of more expensive surgical treatments is difficult to justify. A clear understanding of the rationale of functional bracing, its indications and contradictions, and its clinical application protocol are essential for the attainment of satisfactory results.