Functional cast bracing for management of fracture by closaed method, By Dr.surya Prakash Sharma Resident Madras Medical college ,Chennai

1. Functional Cast
Bracing
D.Surya prakash Sharma

2. • The basis of treatment :
“Continuing function while a fracture is uniting, encourages
osteogenesis, promotes the healing of tissues & prevents the
development of joint stiffness, thus accelerating
rehabilitation.”
It’s a closed method of treating fractures

3. Theoretical Basis
• The fracture healing in FCB is mainly by External Bridging
Callus formation.
• Its has greater mechanical advantage over Medullary callus.
• The intermittent loading of the # area, by muscle activity &
weight bearing, promotes local blood flow & development of
electrical fields which are beneficial for healing.

4. • The FCB allows movement at the joint & some movement at #
site.
• This transmits a measurable load which decreases as the #
progresses to union.
• The muscle compartments acts as a fluid mass surrounded by
deep fascia.
• Fluid is not compressible & fascia cannot be stretched beyond
the confines of the cast.

5. • Thus after a certain degree of displacement, pressure & load is
transmitted without further deformation.
• This causes the bony fragments to be held more firmly.
• Rotation is resisted by components of the brace.

6. When To Apply
• Not at the time of injury.
• Asses the # clinically.
• Minor movements at the # site should be painless.

7. • Any deformity should disappear once the deforming force is
removed.
• There should be reasonable resistance to telescoping.
• Shortening should not excede ¼ inch for tibia &1/2 inch for
femur.

8. Contraindication
• Lack of patients co-operation.
• Patients with spastic disorders.
• Deficient sensibility of the limb.
• When the brace cannot be fitted closely & accurately.
• Isolated tibial fractures.

9. FCB for Tibia fractures
• Brace should be applied with in six weeks of fracture.
• Make the patient sit on a couch with legs hanging over the
edge.
• Roll cast sock or stockinette onto the limb from the toes to
above the knee.
• Apply minimal cotton padding over the heel,
tendocalcaneous, malleoli, tibial condyles & crest.

10. • With the ankle at right angle, apply POP bandages from the
toes to 2 inches above the ankle & mould it.
• Apply further POP from toes to the tibial tuberosity & mould it
over the medial proximal half of the soft tissue of the calf.
• Flex knee to 40 degrees & rest the patients heel on your lap.

11. • Apply further POP from the top of the cast to 2.5 cm above
the proxmial pole of patella.
• Firmly mould the plaster cast over the medial flare of the tibial
& patellar tendon.
• Apply pressure in the popliteal fossa & back of the calf with
flat hand ,to produce a triangular cross-section in this area to
help control rotations.

12. • Trim the upper end of the cast, keeping the ears as long as
possible on both sides of the knee.
• Posteriorly the upper edge of the cast is level with the tibial
tuberosity.
• Inferiorly the toes must be free to flex & extend fully.
• Fit a walking heel slightly anteriorly to the long axis of the
tibia.

13. FCB for Femur fractures
• Long leg cast braces are mainly used for distal half of the shaft
of the femur.
• Coz of the tendency of the proximal third of the femur to go
into varus.
• Meggitt et al designed a hip-hinge thigh-cast brace for the
management of such #.

14. • The thigh-cast extend distally to just above the knee.
• Proximally – metal uniplanar hip hinge to a rigid pelvic band
fitted to adjustable waist belt & shoulder strap.
• Axis of the hinge-tip of greater trochanter in 20 degree of
abduction at the hip.

15. • The standard long leg cast brace should be used only for the
management of # of distal half of the shaft of femur & tibial
plateau. And in obese patients.
• Other types:
1) Knee-hinge cylinder cast brace.
2) Reducesd femoral cast brace.

16. How to apply long leg cast
brace
• Full extension of the knee & sufficient callus to prevent
shortening must be present.
• Pain & marked mobility at the # site must be absent.
• Most # can be braced within 4-6 weeks of injury.

17. • Materials – plaster / thermoplastic material.
• Four stages-
1) General preparation.
2) Below knee cast.
3) Thigh cast.
4) Fitting of knee hinges.

18. 1 . General preparation;
• Make the patient sit on a couch with approximately 6 inches
of thigh exposed
• Roll the cast socks from the toes to the groin
• Apply minimal cotton padding over the heel ,
tendocalcaneous, malleoli , tibialcrest , condyles .

19. • With adhesive surface facing outwards apply a precut piece of
orthopaedic felt over the tibial condyles .
• Apply a second precut piece of orthopaedic felt over the
femoral condyles .

20. • 2 . Below knee cast
• With the ankle at right angle apply one 5 inch wide roll of
orthoflex elastic plaster bandage from the base of the toes to
within ¼ inch of the top of orthopaedic felt .
• Cover the orthoflex with one 6 inch wide roll of zoroc resin
plaster bandage .
• Carefully mold the cast around the heel and ankle .

21. • 3. Thigh cast
• Support the leg and exert slight traction on the limb
maintaining the correct rotational position .
• Heat the precut orthoplast cast in water bath at temp 72 to 77
degree C for 3 min , mop of the surface water and fit the cast
snugly around the upper thigh up to groin

22. • Trim and smooth the upper edges of the cast
• Apply a cold wet elasticized bandage over the orthoplast .
• Mold the cast into quadrilateral shape by applying pressure
with both hands .
• Allow it to set .
• The quadrilateral shape helps to control rotations .

23. • Firmly apply a 5inch roll of orthoflex elastic plaster bandage
around the thigh from ¼ inch above the lower edge of
orthopaedic felt to ½ inch below the top of cast brim .
• Cover the orthoflex with one 6 inch wide roll of zoroc resin
plaster bandage .
• Mark the cast sock , the center of patella , the line of the
joint , mid point of the limb on both medial and lateral
aspect .

24. • 4. Hinges
• Types – polyethylene or metal
• Metal hinges must be positioned accurately using a
jig .
• Temporarily lock the metal hinges in extention and
then fit them to the jig to hold them parallel .
• Hold them at a level of middle of patalla and about 2
cm behind the midpoint of the limb on each side .

25. • Shape the arms of the hinges , so that it rests snugly against
the cast .
• Check the orientation of the hinges .
• Clamp the lower end of the hinges to the below knee cast
• Wile maintaining traction on the limb , push the thigh cast
proximally and then clamp the upper end of the hinges to the
thigh cast with jubilee clips .

26. • Plaster the ends of the hinges in to the casts above and below
the clips then remove the clips and complete the attachment
of hinges
• Remove the jig and locking screws
• Check the axis of movements in knee flexion as tolerated by
the patient .
• Finish off the lower end of the brace in similar manner .

27. Thanking you