The evolution of functional bracing of fractures.

©2006 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.88B2. 16381 $2.00 J Bone Joint Surg [Br] 2006;88-B:141-8. Functional fracture bracing, described in 1967, 1 was inspired by the patellar-tendonbearing prosthesis which had recently been developed for below-knee amputees. This prosthesis had eliminated the traditional thigh corset and allowed the transfer of weight-bearing stresses from the soft tissues of the thigh to the patellar tendon and condyles of the proximal tibia. Anticipating that by a similar mechanism, a below-knee weight-bearing cast, moulded like a patellar-tendon-bearing prosthesis, would prevent shortening in axially unstable tibial fractures, the first below-knee functional cast was constructed. 1 Contrary to traditional practice, this new cast allowed full movement of the knee but immobilised the ankle. However, shortly afterwards it was realised that inclusion of the ankle and foot was unnecessary. The ankle was therefore freed and within a short time pre-fabricated plastic braces became an accepted form of treatment. 2