As the top orthopedic implant manufacturing company in India, we have conducted various researches that showed that functional bracing is significant in the management of most closed diaphyseal tibial fractures that are caused by a low-energy injury.
Extreme shortening or angulation must be avoided in all kinds of fractures, regardless of the nature and cause of the injury. The idea of functional bracing cannot be accepted unless its basic grounds are properly understood. The early phase of the shortening of the fragments experienced just after an injury is found by the amount of soft tissue pathology.
The greater the impact and displacement of the fractured bone, the greater are the chances of the initial shortening. Many renowned trauma implants and spine Implants specialist quote that this shortening, if corrected and made fundamentally stable by adequate positioning between fragments, should not recur after the introduction of any kind of functional movement. However, if such stability is not possible as in the case of oblique, spiral, or multiple fragment fractures, then there are chances of recurrence of initial shortening after the introduction of any kind of weight-bearing activities.
As a Spine Implants Exporter, we are aware that functional braces are not designed to prevent shortening and therefore cannot be expected to do so. If the initial shortening is unacceptable by the patient then the braces are not recommended.
However, in the major cases of low-energy fractures, initial degrees of shortening are functionally and superficially acceptable. It is observed that the shortening of magnitude 1 or maybe 1.5 cm does not result in a limp. Somehow, if such shortening produces a limp, this problem could be easily solved by the addition of a lift to the shoe which is a common method of cure in ortho surgical implants science.
Working in the business of orthopedic surgical instruments for more than a decade now, we believe that it is the duty of the surgeon to validate and understand the needs of the patients in order to determine whether or not under a given circumstance a surgical procedure should be carried out solely for preventing shortening or it can be corrected by a shoe lift.
The greater the impact of the fracture, the greater the dislocation is likely to be, and the greater the dislocation, the greater is the amount of soft tissue harm. Such high impact fractures are more likely to incur higher shortening initially with a longer span of healing.
Open fractures caused generally due to high impact injuries, are more likely to experience more shortening and unsteadiness. If the initial displacement and shortening were negligible, a steady reduction would ensure that no further shortening will take place. Low-impact gunshot damage with fractures usually have only restricted soft tissue trauma and are intrinsically more stable than injuries with a high blow. They open themselves well to the functional bracing technique implemented by many Elastic Nailing System specialists and trauma implants experts.
Initial shortening can also recur in the absence of such acquired intrinsic stability, quotes a top orthopedic implants doctor. Further, he says that since it is often difficult to truly acknowledge the amount of soft tissue pathology in the case of open fractures due to the rupture of fascia, muscle, and skin, greater shortening than that initially observed on the X-ray film might take place. This is one of the many reasons why intramedullary fixation is still the choice of treatment for types I and II open fractures.
We believe that it is very important to find other methods of treatment that can be used in order to correct the existing shortening and/or deformities. Functional bracing is a preferred method that permits such departures from the initial plain departure which otherwise would not be possible after the fracture has been internally stabilized.
Many orthopedic implants experts believe that the majority of closed tibial fractures – particularly oblique and minute one have less shortening (less than 1 cm) at the time of the initial insult. Since that shortening does not augment further with the gradual use of the extremity, the bulk of such tibial fractures heal with less than 1 cm of shortening.
This is acceptable in ortho surgical implants science and does not produce difficulty in walking or create any stage for late defender changes. We would like to conclude on the node that in instances where the initial shortening is unacceptable and closed manipulations do not produce stable reductions, other methods of treatment are needed.