The Milwaukee brace is a CTLSO that was originally designed by Blount and Schmidt to help maintain postoperative correction in patients with scoliosis secondary to polio. The brace is designed to stimulate corrective forces in the patient. When the patient has been fitted properly with a brace, the trunk muscles are in constant use; therefore, disuse atrophy does not occur. The brace has an open design, with constant force provided by the plastic pelvic mold. The pelvic portion helps reduce lordosis, derotates the spine, and corrects frontal deformity.
The uprights have localized pads that apply transverse force, which is effective for small curves. The main corrective force is the thoracic pad, which attaches to the 2 posterior uprights and to 1 anterior upright. Discomfort from the thoracic pad creates a righting response to an upright posture. In contrast to the thoracic pads, the lumbar pads play a passive role.
The uprights are perpendicular to the pelvic section, so any leg-length discrepancy should be corrected to level the pelvis. The neck ring is another corrective force and is designed to give longitudinal traction. Jaw deformity is a potential complication of the use of the neck ring. The throat mold, instead of a mandibular mold, allows the use of distractive force without the development of jaw deformity.
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