Manoranjan Mallik1, Ramesh Chandra Maharaj2, Pravat Kumar Rout3, Debi Prasad Nanda4, Prajnadipta Rout5
BACKGROUND
Tibial shaft fracture is one of the commonest fractures encountered in orthopaedic
clinics today. With recent trend being surgical management, it has increased the
economic burden in developing countries like India. Thus, interest in functional
cast bracing can manage many of the fractures safely with less cost and shorter
hospital stay with equally good results.
METHODS
This prospective study included 30 patients with closed tibial shaft fracture with
minimal displacements who were treated with 3 weeks of initial long leg cast
followed by functional cast bracing as described by Sarmiento in 1967 with a below
knee patellar tendon bearing (PTB) cast with encouraged progressive weight
bearing for 6 to 9 weeks. Our goal was to achieve shortening of < 10 mm,
angulations of less than 5 degrees in any plane with full range of motion at knee
as per Sarmiento.
RESULTS
Union was seen in 25 (83 %) cases. Angulations of < 5 degrees was noted in any
plane in 79 % cases. Varus and apex posterior angulations were the most common
deformity. Shortening 10 mm was noted in 72 % cases with almost complete ROM
of knee joint in all patients. Non-union was noticed in 2 (7 %) cases.
CONCLUSIONS
Functional cast bracing can still be an ideal method of management for many of
the tibial shaft fractures and with better understanding of the technique and
proper application, it can safely be used on other long bones as well.
