1887

History of fracture treatment

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Abstract

There is evidence that attempts have been made to treat fractures since 4000 years BC. Early medical practitioners appreciated that, if left unsupported, fractures either would not heal or would develop significant malunions, compromising future use of the limb. This chapter review history of fracture treatment; treatment of fractures in animals; external skeletal fixation; internal fixation; changes in philosophy.

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Figures

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1.1 Application of an extension device to a fractured arm by Gersdoff in 1517. (Reproduced from with permission from the publisher)
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1.2 Malgaigne’s clamp (1849) used for fractures of the patella and olecranon. The prongs projected through the skin. (Reproduced from with permission from the publisher)
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1.3 An early external fixation apparatus. (Reproduced from with permission from the )
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1.4 An acrylic pin external fixator used to treat a mandibular fracture in a cat. Following reduction of the fracture, transfixation pins are driven into the mandible. Acrylic is then moulded around the pin ends; the acrylic sets to create a hard bond between the pins.
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1.5 A hybrid external skeletal fixator used to stabilize a comminuted distal humeral fracture in a cat. The ring is secured to the bone distally using tensioned wires; the hybrid post extends proximally allowing the use of linear components on the proximal humerus. (Courtesy of D Clements)
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1.6 An interlocking nail (left) and a transfixation bolt (right). The nail is placed in the medullary canal; holes are then drilled through the bone, aligning with the holes in the nail, and bolts are placed to interlock with the nail.
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1.7 Lane bone plates broken at their weakest point. (Reproduced from with permission from )
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1.8 Cyclic fatigue of a plate. A mildly comminuted fracture in a 5-year-old Labrador Retriever was treated by open reduction, anatomical reconstruction and application of a compression plate. Individual fragments were repositioned prior to application of the plate, compromising their vascularity. Despite good limb function following the initial surgery, the bone did not heal and the construct failed 3 months postoperatively.
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1.9 Pin–plate fixation. (a) A severely comminuted tibial fracture in a 6-year-old terrier was reduced in a minimally invasive fashion and (b) stabilized using an intramedullary pin and a medial plate. The fracture healed uneventfully.

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