Functional Bracing: A Closer Look

The philosophy of functional bracing is based upon principles which are different from the goals of the AO technique. Sarmiento and other advocates of functional bracing maintain that rigid immobilization of fractures is unphysiological and that movement at the site of a fracture during functional activities encourages osteogenesis.

Functional bracing and ankle fractures

In their prospective case series, "Weightbearing Radiographs Reliably Predict Normal Ankle Congruence in Weber B/SER2 and 4a Fractures," Martin G. Gregersen et al. evaluated for the first-time ankle congruence following the non-operative treatment of SER4a (partially unstable) ankle fractures with functional orthoses.

Stable vs. partial unstable study design

A prospective study was designed to evaluate if weightbearing radiographs predict whether stable/SER2 and partially unstable/SER4a Weber B ankle fractures reach union with preserved normal tibiotalar congruence. 149 patients with Weber B fractures were recruited into the trial. Non-operative treatment with a weight bearing functional orthosis was prescribed for all patients.

It's all about the medial clear space

Assessment of stability of Weber B SER2/4a ankle fractures, with weightbearing radiographs, predicts preservation of normal ankle congruence in those deemed stable, with no difference between SER2 and SER4a fracture types. When the non-weightbearing medial clearance measurements are >4mm but <7mm, and reduce to normal on weightbearing images non-operative functional treatment is a viable option. Will this convert the AO disciples...? Not likely, but time will tell.