2007 General Principles of Internal Fixation eMedicine Orthopedics

Description: Fractures have been treated with immobilization, traction, amputation, and internal fixation throughout history. Immobilization by casting, bracing, or splinting a joint above and below the fracture was used for most long bone fractures, with the exception of the femur, for which traction was the mainstay of treatment. In the past, open fractures and ballistic wounds with long bone fractures were not amenable to standard fracture care because of the associated soft tissue injury and the difficulty in preventing sepsis; thus, they usually resulted in amputation, especially during the US Civil War.
Although the concept of internal fixation dates back to the mid 1800s, Lister introduced open reduction, internal fixation (ORIF) of patella fractures in the 1860s. Use of plates, screws, and wires was first documented in the 1880s and 1890s. Early surgical fixation initially was complicated by many obstacles, such as infection, poorly conceived implants and techniques, metal allergy, and a limited understanding of the biology and mechanics of fracture healing. During the 1950s, Danis and Muller began to define the principles and techniques of internal fixation. Over the past 40 years, advancements in biological and mechanical science have led to contemporary fixation theories and techniques.
Synonyms and related keywords: broken bone, fracture, open fracture, open reduction and internal fixation, ORIF, bone screws, pretapped screws, self-tapped screws, pull-out strength, plate fixation, Kirschner wires, K-wires, Steinmann pins, dynamic compression plates, DCP, dynamic compression screw, limited-contact dynamic compression plates, LC-DCP, intramedullary nails, IM nails, biodegradable fixation, biodegradable implants
Lakatos & Herbenick 2007 Updated: Nov 6, 2009