A personal essay by Augusto Sarmiento, MD — pioneer of functional fracture bracing. Reflects on two family members with severe physical disabilities whose resilience shaped his treatment philosophy. Not a clinical study; a philosophical commentary on what clinicians owe patients in terms of expectation and respect.
Sarmiento built his career on the idea that patients can participate actively in their own fracture recovery — that a humerus in a brace, with a patient who is engaged and capable, can do as well as one treated operatively.
This essay is the philosophical underpinning of that view. When you are deciding between operative and conservative management, especially for elderly or disabled patients, the question is not just biomechanical. It is: what is this patient capable of?
The clinical application is direct. Do not let a patient's disability, age, or circumstance compress your estimate of their functional potential. Sarmiento's bracing philosophy works precisely because it asks patients to do something, and they rise to it. The authors' own caveat is implicit: this is a two-person anecdote, not a clinical trial. Use it to sharpen your instincts, not to replace data.
A personal essay by Augusto Sarmiento, MD — pioneer of functional fracture bracing. Reflects on two family members with severe physical disabilities whose resilience shaped his treatment philosophy. Not a clinical study; a philosophical commentary on what clinicians owe patients in terms of expectation and respect.
Sarmiento built his career on the idea that patients can participate actively in their own fracture recovery — that a humerus in a brace, with a patient who is engaged and capable, can do as well as one treated operatively.
This essay is the philosophical underpinning of that view. When you are deciding between operative and conservative management, especially for elderly or disabled patients, the question is not just biomechanical. It is: what is this patient capable of?
The clinical application is direct. Do not let a patient's disability, age, or circumstance compress your estimate of their functional potential. Sarmiento's bracing philosophy works precisely because it asks patients to do something, and they rise to it. The authors' own caveat is implicit: this is a two-person anecdote, not a clinical trial. Use it to sharpen your instincts, not to replace data.