The Milwaukee Brace

Bracing HistoryDeveloped by Drs Al Schmidt and Walter Blount of Milwaukee. Since the 1960s back to the days of Pare in France and was carried on being used until the 1980s where the negative side set in. However this brace plays a very valuable role in the surgical and non-surgical management of spine deformities. consists of metal uprights attached to pads at the hips, rib cage, and neck and can be very uncomfortable and in some cases is required to be worn 24/7 and of course can have physiological effectsMany different braces were designed by different centers, culminating in the very sophisticated German designs of the late 19th century.The development of spine fusion for Scoliosis and Kyphosis by Hibbs and Albee, both in 1911, gave surgeons a new method of treating these deformities and led to a decline in the use of bracing.By 1940, however, the results of surgery were so unreliable and the risks so high, that there was a very negative attitude about surgery. At the same time there were an increasing number of post-poliomyelitis scoliosis cases coming to the orthopaedic surgeon. This led to an environment conducive to a good spine brace and a good management program.The traditional surgical treatment of poliomyelitis scoliosis had been by the performance of a posterior spine fusion followed by the application of a corrective turnbuckle cast. Although this cast was highly effective for curve connection, this correction was achieved by placing large pressures on the chest and rib cage. The patient was then kept in bed for 6-9 months. This method of management produced nice-looking spine radiographs but at a very high price-a very significant reduction of lung space which was often permanent.It was this same problem which led Harrington to develop his rods.Drs. Blount and Schmidt realized this problem and began cutting larger and larger windows in these casts. Soon the cast became a plaster pelvic section, a plaster head and neckpiece, and thick columns of plaster connecting the two. The doctors realized they could better accomplish their goal by a brace rather than by plaster.The patient needing surgery would then be admitted to the hospital and a brace fitted. It would gradually be lengthened as the pads were tightened, correcting the curve. Surgery was then done and in a few days the brace would be reapplied, some further correcting done until maximum possible correction had been achieved, and then the child was sent home for six months of bed rest in the brace.Although appearing crude compared to today's standards, the bracing system gave good correction, kept the patient always in a balanced, compensated alignment, and dramatically reduced the respiratory compromises of the turnbuckle cast. By using various pads, any area or direction of Scoliosis or Kyphosis could be treated. The major problem of cast sores was dramatically reduced.It was only after success with the surgical treatment of spine deformity that the Milwaukee brace began to be used in the non-operative management of spinal deformities. The 1950's were the years of refinement of design, transforming the brace from the ugly, boxy "frame" of its origin into a more sleek design that could be worn day and night.One very major complication of the Milwaukee brace was the bad effect of the distractive chin pad on the teeth as well as maxillary and mandibular development. Early in the 1970's, this was solved by using the "throat mold" and by decreasing the passive elongation force. By 1975, thermoplastics had replaced the leather girdle and the brace had reached a form, which is essentially the same as today.Finally, it is important to realize that Drs. Blount and Schmidt did not only develop a brace, they also developed a system of management, or in modern terms, a "patient care program." A brace by itself is useless unless it is applied for the right indications, is worn the proper number of hours each day, is removed at the proper time, and is accompanied by the necessary physiologic and psychologic support systems.