USA(Miami): Dr. Augusto SARMIENTO: FUNCTIONAL FRACTURE BRACING (FFB)

Dr.Sarmiento: FFB is a system of nonsurgical care for certain long- bone fractures based on the proposition that immobilization of joints above and below a fracture is not essential for healing, and that the resulting physiologically induced motion at the fracture site is conducive to the formation of a stronger callus. Body Cast Editor: How has functional fracture bracing evolved from its inception? Dr. Sarmiento: Experiences with the PTB prosthesis for the below-the-knee amputee developed in the early 1960s, which successfully eliminated the traditional thigh corset, prompted me to suspect that a below-the-knee cast molded like the prosthesis could be successfully used in the treatment of tibial diaphyseal fractures, where the proximal fragment would be the equivalent of the stump and shortening would be prevented. The initial results were encouraging, but soon I realized that neither the indented patellar tendon nor the molded tibial condyles were major weight-bearing contributors. The soft tissues surrounding the fractured bones were the structures that prevented shortening above the one present at the initial injury. A degree of shortening that does not increase with the introduction of graduated weight-bearing ambulation. Therefore, the name PTB commonly used to describe the cast is wrong. Further experiences with the short-leg functional cast led to the construction of a brace that gave freedom of motion of the ankle joint, as well. Following subsequent clinical and laboratory investigations, the concept was extended to other bones, such as the humerus, forearm, isolated fractures of the ulna, the femoral shaft, tibial nonunions, and Colles' fractures. The results were mixed, so much that the use of the system was discontinued for fractures of both bones of the forearm, open tibial fractures and the femur. Advances in the surgical treatment of these fractures fully justified their dismissal. Similarly, the intramedullary nailing of fractures has made this approach a successful one in the management of many tibial fractures, particularly in those with unacceptable initial shortening or uncorrectable angulation.