450 closed fractures of the distal third of the tibia treated with a functional brace.

Four hundred fifty closed fractures of the distal third of the tibial diaphysis, treated with a functional brace, are the subject of this study. Four (0.9%) of the fractures resulted in nonunion. The average healing time was 16.6 +/- 5.6 weeks, with a range from 10-40 weeks. The average final shortening was 5.1 +/- 4.8 mm with a range from 0-25 mm. Four hundred twenty four (94.2%) fractures healed with < 12 mm shortening. Initial shortening at the time of injury essentially was unchanged, from 4.4 +/- 4.5 mm to 4.4 +/- 3.9 mm final shortening. Axially unstable closed tibial fractures do not shorten beyond the initial shortening. Four-hundred five fractures (90.0%) healed with less than 8 degrees angular deformity in either the frontal or sagittal planes, and 302 (67.1%) healed with less than 5 degrees deformity in any plane. Overall, 391 fractures (87%) healed with shortening less than 12 mm and angulation in any plane less than 8 degrees . These degrees of angular deformity and shortening seem to compare favorably with those reported by other investigators using intramedullary nails. It seems that functional bracing is an effective method of treatment of a selected group of tibial fractures.