The effectiveness of functional brace in the treatment of tibia fracture: A review of literature


1 Department of Orthotics and Prosthetics, Rehabilitation Faculty, Shiraz University of Medical Sciences, Shiraz, Iran

2 Musculoskeletal Research Center, Rehabilitation Faculty, Isfahan University of Medical Sciences, Isfahan, Iran


Background and Objectives: Various treatment methods have been used to manage tibia fracture, including conservative and surgical treatment. Various studies investigated the effects of functional brace on fracture of tibia. This review was aimed to summarize the evidence on the effectiveness of functional brace on tibia fracture. Methods: An electronic search was carried out through internationally published scholarly articles in EBSCO, Medline, PubMed, Embase, and ISI Web of Knowledge (from 1950 to 2020) with the following keywords: tibia fracture, healing, conservative treatment, functional orthosis, brace, and patellar tendon-bearing orthosis. The quality of the papers was assessed using the Down and Black tool. Results: On the basis of the keywords, 50 articles were found, of which 11 articles were selected in accordance with the selection criteria. Most of studies support the use of orthosis for tibial fracture. The scores of reporting, external validity, internal validity (bias), and internal validity (confounding) varied between 2–7, 1–2, 1–5, and 2–4, respectively. Conclusions: One of the most important treatment methods for tibia fracture is use of functional brace. Based on the results of the available literature, use of functional brace is a good approach for stable tibia fracture. Some parameters, such as the condition of surrounding muscles, initial shortening, angulations of tibia, and intact of fibula, play significant roles in this regard.


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1.4 and 23 weeks (mean 3.7 weeks) after injury41% of fractures healed with no angulations in sagittal plane. 95% of them 
healed with angulations <6°. Posterior angulations were seen in 30% of the subjectsJafari and Nozarnejad[14]26 subjectswith mean age of 27.46±7.58 yearsFollow-up was 9.12±2.36 monthsThe classification of fractures was done using AO/OTA classification (38.5% A1, 26.9% A2, 34.6% A3.1)Most of fractures were sustained in lower third of tibia (53.85%)
All fractures eventually healed in an average of 13.7 weeks. In 12.3% of patients, shortening of bone was <1 cm. Anterior or posterior angulations were more than 10° in 2 patientsIn 4 patients varus angulations was more than 5°. Finaldeformity was observed in 8 patients (30.77%). The non-surgical treatments outcomes were not satisfactory, despite considering all principles for conservative treatmentSarmiento et al.[4]780 tibia fractures treated with prefabricated functional braces were followed. The average time before applying a brace was 3.8 weeks for closed fractures and 5.2 weeks for opened fractureClose fractures healed in an average of 17.4 weeks and opened fractures in an average of 21.7 weeks. 90% with shortening <10 mm. No association between fracture healing and age, mechanism of injury and fracture location. Degree of soft tissue damage influences the success of and speed of fracture healing. The condition of fibula and the time frominjury to bracing also appeared to affect the speed of unionMartinez et al.[2]108 closed fractures located in the proximal third of tibia were treated with functional brace88% of the subjects were treated with <6° of angular deformity and final shortening was 3.5 mm. Use of functional brace is a valuable method for tibia fracture healing at the proximal partSarmiento[13] 1000 closed tibia fractures treated with prefabricated functional below knee braceThe mean final shortening before treatment was 4.28 mm compared to initial shortening of 4.25 mm. The final shortening did not increase beyond the acceptable rangeKuzgun et al.[7]35 subjects with tibia plate fracture were recruited in this study.They were treated by surgery or by use conservative treatmentThe type of fracture was determined based on Hohl classification. Pain, walking capacity, total range of motion of knee joint and stability were the evaluated 
criteriaThere was compression of 0-5 mm in 21 cases, 5-10 mm in 12 cases, and 10 mm in 2 cases. Both methods have satisfactory results. The period of immobilization was averaged 6.6 weeks in conservative treatment and 5 weeks in surgical. The weight bearing was allowed after 2-4 weeksAO: Arbeitsgemeinschaft für Osteosynthesefragen
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