Tibial Fracture Cast Shortened

Reprinted from the Journal of the American Medical Association, Volume 195, No. 6, February 7, 1966.

A new method for treating tibial fractures has arisen from a University of Miami orthopedic surgeon's experience with immediate fitting of amputee prostheses.

A specially molded plaster cast modeled after the patella-tendon-bearing prosthesis employed with some amputees has been used successfully with over 50 patients, Augusto Sarmiento, M.D., told the American Academy of Orthopaedic Surgeons.

The cast, applied only after the fracture is reduced in the conventional manner, leaves the knee relatively mobile "in a close to normal physiological environment."

Because of careful fragment immobilization, no malalignment, malrota-tion, or significant loss of leg length has resulted. The triangular cast is molded over the tibial and fibular flares, patellar tendon and popliteal space.

After the new short cast is applied, the patient walks on crutches for about two weeks with minimal weight bearing. Thereafter he is encouraged to walk without crutches.

The cast has significant advantages over the conventional long cast in terms of patient mobility. It also may reduce healing time with the beneficial use of pressure, Dr. Sarmiento believes.

The first 50 cases included 13 open fractures with an average clinical healing time of 15.1 weeks and 37 closed fractures with an average healing of 13.4 weeks. Oblique, comminuted, and transverse fractures were included at all sections of the tibia, including the middle-distal junction.

The cast holds potential dangers if used by those without a thorough knowledge of prosthetics and the time to closely supervise their patients, Dr. Sarmiento stressed.