2. INTRODUCTIONINTRODUCTION
A closed method of treating fractures
based on the belief that continuing
function while a fracture is uniting ,
encourages osteogenesis, promotes the
healing of tissues and prevents the
development of joint stiffness, thus
accelerating rehabilitation
Not merely a technique but constitute a
positive attitude towards fracture healing.
3. CONCEPTCONCEPT
The end to end bone contact is not
required for bony union and that rigid
immobilization of the fracture fragment
and immobilization of the joints above and
below a fracture as well as prolonged rest
are detrimental to healing.
4. It accepts that the loss of the anatomical
reduction of a fracture is a small price to
pay for rapid healing and the restoration
of function, without compromising the
appearance of the limb by operative scars.
It complements rather than replaces other
forms of treatment.
5. HISTORYHISTORY
1855 – H.H.Smith designed appliance for
nonunion proximal femoral fractures.
1910 – Lucas Championniere “ LIFE IS
MOTION”.
1926 – Gurd [ # of foot and ankle].
1950s – Dehne [# tibia].
1963 – Sarmiento began his systemic
study,
6. THEORETICAL BASISTHEORETICAL BASIS
Elimination of movt at a fracture site is
not mandatory for a fracture to unite,
STABILITY – needed
1. Reduce the pain
2. Maintain alignment
3. Prevent deformity.
7. External bridging callus: situated at
distance from the axis of potential movt, it
has a greater mechanical advantage than
medullary callus, stronger early repair.
8. Optimal physiologicalOptimal physiological
environmentenvironment
Function in brace provides a milieu
wherein metabolic, mechanical, chemical,
thermal and electrical factors favorably
enhance tissue healing.
Intermittent loading strain in the
tissues electrical potentials for bone
formation.
Muscle activity increase in circulation
supply of nutrient & clearance of waste
maintains chemical milieu.
9. Irritating effect of motion at the # site &
deviatoric stains in the surrounding &
interposing tissue prolongs the
inflammatory response of s.s
hyperemia increase in temperature.
M.E streaming potentials through
capillary gradients & strain related
potentials through tissue deformation
enhancement of E.E.
10. E.E affects chemical reaction in the S.S
and has an effect on the rate, quantity
and orientation of tissues formation in
callus.
12. Role of soft tissuesRole of soft tissues
Early stages soft tissues transmit most of
the load.
Muscle compartment act as fluid mass
surrounded by an elastic container – deep
fascia.
Fluids are not compressible and fascia
can’t be stretched beyond confines of the
cast – HYDRAULIC FORCES.
After initial displacement, pressure and
load are transmitted without further
deformation.
13. Muscle contract bulge normally.
In FCB muscles are forced inwards
away from the rigid walls and against the
central fragments thus causing the
fragments to held more firmly.
14. Hydraulic forces of the soft tissues resist
the overlap and angulation until callus
forms.
Rotation is resisted by components of the
brace and or by tendency of muscle
contraction and Jt movt to align the
fragments.
15. SHORTENINGSHORTENING
Braces do not prevent shortening.
It is determined at the time of injury by
degree of soft tissue damage.
Shortening in closed # does not increase
beyond that that which develops immediately
following initial injury.
Movts are elastic no progressive deformity.
Control related to fit of brace and extent of
damage
16.
17. LOAD BEARINGLOAD BEARING
S.T. two major mechanisms for load
bearing and provision of stiffness to the
limb when encompassed in FCB.
I related to their incompressibility.
[ displace under load only until they have
filed all the gaps with in the container]
important in early post injury period.
II intrinsic strength S.T in tension as
they support the bony fragments at their
natural attachments.
19. CONTRA-INDICATIONCONTRA-INDICATION
Lack of co-operation by the pt.
Bed-ridden & mentally incompetent pts.
Deficient sensibility of the limb [D.M with
P.N]
When the brace cannot fitted closely and
accurately.
Fractures of both bones forearm when
reduction is difficult.
Intraarticular fractures.
20. Galeazzi fractures
Monteggia fractures
Proximal half of shaft of femur [tends to
angulate in to varus only used by expert]
Isolated # of tibia, fibula tends to cause
varus angulation and to delay in
consolidation of #. [ Proximal 1/3]
21. Time to applyTime to apply
Not at the time of injury.
Regular casts, time to correct any
angular or rotational deformity.
Compound # es , application to be
delayed.
Assess the # , when pain and swelling
subsided
1. Minor movts at # site should be pain
free
2. Any deformity should disappear once
D.F removed
22. 3. Reasonable resistance to telescoping.
4. Shortening should not exceed 6.0 mm
for tibia, 1.25 cm for femur.
23. For # tibia following low energy injury,
bracing can be done with in first 2 wks.
High energy injuries with more pain &
swelling needs an additional period of 1 or
2 more wks.
For humerus # es , most conditions
bracing can be done by 7-10 days time.
Median time of brace removal tibia 18.7
wks, humerus 10 wks.
24. OPEN FRACTURESOPEN FRACTURES
Does not preclude FCB.
Greater degree of soft tissue damage
increased instability of limb needs delay
in using FCB.
High degree of soft tissue damage &
shortening may require external fixation
for sometime before FCB.
25. RESULTSRESULTS
Shortening encountered in closed tibia
fracture rarely exceeds 1 cm. [won’t
cause limp].
Angular deformities usually < 5*.
Cosmetically and functionally acceptable
for most pts. OA changes doesn’t occur
from deformities of such magnititude.
26. Types of limb segmentsTypes of limb segments
Limb segments with two bones and
interosseous membrane surrounded by
muscular tissues with lesser amount of fat
in sub-cut region.
One limb segment with bulky muscle layer
with relatively large sub-cut fat.
First type is inherently stable ,well
controlled with FCB.
One bone seg, relatively unstable because
of sub cut fat provides lubrication.
