Jewett Brace

The Jewett brace is a three-point hyperextension orthosis. It is a lightweight metal frame, rather than a full jacket, with pads at three points — over the breastbone, over the pubic area at the front, and across the mid-back behind. These three points of contact hold the thoracolumbar spine in extension and resist forward bending. It is more open and less enclosing than a moulded body jacket, which many people find more comfortable and cooler to wear.

By holding the spine extended and limiting flexion, the Jewett brace is designed to protect a healing fracture from the forward-bending forces that could cause it to collapse further, while allowing the person to get up and move about. The goals of this kind of bracing are to stabilise the injured segment, control pain, allow earlier mobilisation and help prevent a forward-flexed posture during healing. It is typically used for stable fractures in the middle and lower thoracic and upper lumbar region.

The Jewett brace is generally considered for adults with certain stable thoracolumbar fractures — commonly stable compression fractures, including osteoporotic vertebral fractures — where the spine is judged mechanically stable but would benefit from external support during healing. It is not suitable for unstable injuries, which need different management, and its three-point design is aimed at the thoracolumbar junction rather than very high or very low fractures. Whether it is appropriate is a specialist decision based on the type and stability of the fracture.

The evidence for bracing after stable thoracolumbar fractures is genuinely mixed, and it is important to be honest about that. Reviews and guidance recognise hyperextension braces such as the Jewett as one of the accepted options for conservative treatment of osteoporotic and stable thoracolumbar fractures, used to stabilise, reduce pain and allow mobilisation. However, several studies — including a systematic review of orthoses for thoracolumbar fractures — have found that for stable compression and selected burst fractures, outcomes with and without a brace are broadly similar, with comparable pain relief and healing. So while the Jewett brace is a reasonable and widely used option that many patients find helpful for comfort and confidence during healing, the evidence does not show that bracing is essential for every stable fracture. This is exactly the kind of individualised judgement that a fracture assessment is for.

Where a Jewett brace is used, it is fitted by an orthotist and usually worn during daily activity for a period of weeks to a few months while the fracture heals, with the spine monitored clinically and with imaging. It is a support during healing rather than a permanent device, and it is discontinued once the fracture is stable and settled.

• —Management of osteoporotic vertebral fracture: review update 2022. (PMC9827207)
• —Evaluating the efficacy of orthoses in the conservative treatment of thoracolumbar fractures: a systematic review. (PMC11469715)
• —Initial hospitalisation with bed rest followed by bracing and rehabilitation for osteoporotic vertebral fractures: safety and feasibility study. (PMC6267386)
• —Nonoperative treatment of burst-type thoracolumbar vertebral fractures: clinical and radiological results. (PMC3489243)