Closed Functional Treatment of Fractures

1 The Rationale of Closed Functional Treatment of Fractures.- 1.1 Immobilization is Unnatural.- 1.2 Function is Natural.- 1.3 Function with Rigid Fixation.- 1.4 Minimizing Interference with the Natural Process.- 1.5 Clinical Management.- 1.6 Indications and Contraindications.- 1.6.1 Shortening and Angulation.- 1.6.2 Bracing as an Adjunct to Internal Fixation.- 1.6.3 Open Fractures.- 1.6.4 Fracture Reduction and Vascular Complications.- Summary.- 2 The Scientific Basis of Closed Functional Management of Fractures.- 2.1 The Role of Vascularity in Fracture Healing.- 2.2 Biochemical Changes Related to Endochondral Ossification.- 2.3 Fracture Callus Architecture.- 2.4 The Effects of Immobilization on Fracture Healing.- 2.5 Stability of Fractures.- 2.6 Anatomic Considerations.- 2.7 Material Considerations.- 3 Fractures of the Tibia.- 3.1 Anatomy and Function.- 3.2 Shortening and Angulation.- 3.3 The Tibial Fracture with an Intact Fibula.- 3.3.1 Angulatory Deformities.- 3.4 The Tibial Fracture with an Associated Fibular Fracture.- 3.5 Management Protocol.- 3.5.1 Stage One.- 3.5.2 Stage Two.- 3.5.3 Stage Three.- 3.6 Application of Casts and Braces.- 3.6.1 The Above-the-Knee Cast.- 3.6.2 The Functional Below-the-Knee Cast.- 3.6.3 The Plaster-of-Paris Below-the-Knee Functional Brace.- 3.6.4 The Plastic Below-the-Knee Functional Brace.- 3.6.5 Prefabricated Braces.- 3.7 Mechanical Function of the Brace.- 3.8 Brace-Soft Tissue Design.- 3.9 Materials and Mechanics.- 3.10 Clinical Experience.- 3.10.1 Fractures of the Proximal Tibia.- 3.10.2 Mid-diaphyseal Tibial Fractures with an Intact Fibula.- 3.10.3 Fractures of the Distal Third of the Tibia with an Intact Fibula.- 3.10.4 Fractures of the Proximal Tibia with Associated Fibular Fracture.- 3.10.5 Diaphyseal Tibial Fractures with Associated Fibular Fractures.- 3.10.6 Short Oblique Fractures of the Tibia.- 3.10.7 Distal Metaphyseal Fractures of the Tibia.- 3.10.8 Segmental Fractures of the Tibia.- 3.10.9 Bilateral Tibial Fractures.- 3.10.10 Open Tibial Fractures.- Clinical Data.- 4 Tibial Condylar Fractures.- 4.1 The Mechanical Role of the Fibula.- 4.2 Clinical Considerations.- 4.3 Clinical Management.- 4.3.1 Application of the Brace.- 4.4 Clinical Experiences.- 4.5 Bicondylar Fractures with Associated Fibular Fracture.- 4.6 Medical Condylar Fractures.- 4.7 Bicondylar Fractures with an Intact Fibula.- 4.8 Lateral Condylar Fractures with an Intact Fibula.- 5 Fractures of the Femur.- 5.1 Femoral Fracture Bracing.- 5.2 Application of the Functional Brace.- 5.3 Clinical Experience.- Clinical Data.- 6 Fractures of the Distal Radius.- 6.1 Management.- 6.2 Application of the Brace.- 6.3 Clinical Experience.- Clinical Data.- 7 Fractures of the Forearm.- 7.1 Fractures of Both Bones of the Forearm.- 7.1.1 Management.- 7.1.2 Application of the Brace.- 7.2 Clinical Experience with Fractures of Both Bones of the Forearm.- Clinical Data.- 7.3 Isolated Radial Fractures.- 7.3.1 Application of the Brace.- 7.4 Isolated Fractures of the Radius: Clinical Material.- Clinical Data.- 7.5 Isolated Ulnar Fractures.- 7.5.1 Management.- 7.6 Application of the Ulnar Sleeve.- 7.6.1 Clinical Material.- 7.7 Bilateral Ulnar Fractures.- 7.8 Segmental Isolated Fractures of the Ulna.- Clinical Data.- 8 Fractures of the Humeral Shaft.- 8.1 Humeral Shaft Fractures.- 8.2 Management.- 8.3 Clinical Experience.- 8.4 Bilateral Humeral Fractures.- Clinical Data.- 9 Delayed Unions and Nonunions of the Tibia.- 9.1 Delayed Unions and Nonunions of the Tibia.- 9.2 Clinical Experience.- 9.3 Infected Nonunions.- Clinical Data.- 10 Fractures in Children.- 10.1 Fractures in Children.- 10.2 Management.- 10.3 Clinical Experience.- 10.3.1 Tibial Fractures.- 10.3.2 Femoral Fractures.- 10.3.3 Forearm Fractures.- Clinical Data.