Fracture fixation and bracing are common external fixation techniques used in clinical practice, primarily for initial stabilization of fractures, joint dislocations, or soft tissue injuries. The main goal is to support the injured area externally to limit movement, promote natural tissue healing, reduce pain, and prevent secondary damage.
This treatment is usually employed as an emergency measure or short-term therapy, often combined with imaging examinations. Compared to surgical internal fixation, it offers advantages such as being non-invasive and adjustable, but requires follow-up assessments to determine the final treatment plan.
Depending on the location and severity of the injury, common types include short-arm braces (forearm), long-arm braces (entire arm), and tubular plaster casts. The materials are typically made of plastic fiber boards or adjustable elastic fabrics, wrapped layer by layer to form a three-dimensional support structure.
The mechanism involves restricting fracture end displacement, allowing the fractured trabeculae to heal along the correct trajectory. The elastic design of the brace can absorb some impact forces while permitting slight bending to maintain local blood circulation, preventing complete rigidity that could lead to tissue necrosis.
Suitable for patients who are not fit for immediate surgery or require observation of healing progress in moderate trauma cases. However, absolute contraindications include open fractures, severe nerve or vascular injuries, etc.
The procedure involves four steps: 1) imaging to locate the fracture, 2) measuring and cutting the brace material, 3) layered wrapping for fixation, 4) checking blood circulation and peripheral nerve function. Usually, it needs to be maintained for more than 12-14 hours daily.
“Dosage” adjustments depend on the type of injury: long bone fractures require covering adjacent joints, while wrist injuries need to preserve some mobility. Pediatric patients should use adjustable braces to accommodate growth needs.
The treatment cycle typically lasts 2-6 weeks, during which the brace can be adjusted based on healing progress. This method provides immediate pain relief and allows patients to maintain basic daily functions during early healing.
The most common complication is peripheral circulatory disturbance, which may cause coldness, pallor, or cyanosis of the limb. About 5-10% of patients may develop contact dermatitis, presenting as redness, swelling, and itching at the wrapping site.
Before application, spinal injuries and nerve or vascular compression must be ruled out. Strictly contraindicated in: 1) open fractures 2) patients with bleeding disorders 3) local skin ulcers or infections
Patients should check limb color and pulse daily, and return for adjustment of the bandage tightness every 3-5 days. If “5P syndrome” (Pain, Pallor, Pulselessness, Poikilothermia, Paresthesia) occurs, seek medical attention immediately.
When used with analgesics, attention should be paid to possible dizziness that may affect activity control.
If subsequent surgery is needed, the brace must be removed only after confirming initial fracture stability. When combined with physical therapy, joint mobility should be gradually increased under medical supervision.
Most simple fractures (such as Colles’ fracture) achieve over 85% anatomical alignment after proper fixation. Systematic evaluations show that correctly used external fixation reduces the risk of secondary displacement to below 5%.
Compared to traditional plaster, adjustable braces significantly reduce skin complications in pediatric patients by about 30% and avoid the inconvenience of repeated plaster changes. However, complex fractures still require imaging follow-up assessments.
1. Plaster fixation: provides higher stability but lacks adjustability 2. Surgical internal fixation: suitable for severely displaced or open fractures 3. Non-fixed braces: only suitable for minor sprains or protective support
When choosing alternatives, factors such as fracture type, patient age, and overall health should be considered. For example, elderly patients with osteoporosis may prioritize internal fixation to prevent secondary fractures.
During the fixation period, avoid putting excessive pressure or twisting on the affected area, such as lifting heavy objects or sudden turns. It is recommended to use assistive devices for daily movements and regularly report to the doctor if the fixation device becomes loose or skin redness occurs to reduce the risk of complications.
What should I do if swelling or pain worsens after fixation?Mild swelling can be alleviated with ice packs (15 minutes each, several times daily) and elevating the limb. However, if pain persists or worsens, or if skin turns purple, seek medical attention immediately. The doctor may need to adjust the fixation or perform imaging to confirm bone healing.
What factors influence the duration of fixation?The duration depends on the fracture type, age, and overall health. Complex fractures or diabetic patients may require longer fixation periods. The doctor will decide when to remove the fixation device based on X-ray follow-up results indicating stable healing.
How to start rehabilitation exercises after removal of fixation?Follow the physical therapist’s instructions, starting with gentle joint movements and gradually increasing range of motion and muscle strength training. Early excessive activity may cause secondary injury. Regular follow-up visits are recommended to assess progress and avoid rushing rehabilitation steps.
What are the advantages and disadvantages of bone pins or braces compared to traditional plaster?Braces (such as adjustable supports) facilitate skin observation and cleaning but may not be suitable for unstable fractures; plaster provides more stability but has poor breathability, requiring skin care. The doctor will choose the most appropriate fixation method based on fracture location and severity.
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