Internal fixation of bone fractures and their limitations

Description

An orthopaedic procedure known as internal fixation involves the surgical placement of implants with the aim of fixing a broken bone. Stainless steel, titanium alloy, cobalt-chrome alloy, or resins can all be used to create internal fixators. These are some examples of internal fixators: Plates and screws, kirschner wires, intramedullary nails.

Open Reduction Internal Fixation (ORIF) includes both the open reduction and setting of the bone and the use of implants to direct the bone healing process. When a fracture requires open surgery to set bones, the term "Open reduction" is used. Internal fixation is the term for the fixation of intramedullary rods, screws and/or plates in order to promote or facilitate healing. In order to promote healing and prevent infection, rigid fixation reduces micro-motion between fracture lines which occurs when implants like plates (such as the dynamic compression plate) are utilised. When a fracture such as one that is comminuted or dislocated, or when casting or splinting alone will not allow the bone to mend properly ORIF treatments are frequently used.

Bacterial colonisation of the bone, infection, stiffness and loss of range of motion, non-union, mal-union, injury to the muscles, damage to the nerves, compartment syndrome, deformity, audible popping and snapping and potential future surgeries to remove the hardware are risks and complications that may arise.

Closed Reduced Internal Fixation (CRIF) is reduced performed without doing any open surgery. In children with disturbed unstable lateral condylar fractures of the humerus it seems to be a viable choice but if fracture displacement after closed reduction reaches 2 mm, open reduction and internal fixation is advised.

For the internal fixation of bones a number of less invasive surgical procedures have been developed. With the advancement of better imaging and surgical procedures the management of distal third of tibia fractures has changed.

Adults with intracapsular hip fractures from internal fixation implants. According to the most recent research screws and fixed angle plates may not differ significantly from one another when used as internal fixation implants for geriatric persons with intracapsular hip fractures. The conclusions are based on weak evidence that makes it difficult to draw clear conclusions about significant differences in hip function, quality of life, and subsequent surgery.

Depending on where the fracture is, external fixation or joint replacements are alternatives to internal fixation for long-bone fractures. The danger of infection and the quality of the functional output are limitations that change depending on the procedure. These restrictions are based on comparative or extensive research that yields certain important findings. The following four major issues are covered: (1) the current function of locking plates; (2) the prerequisites for intramedullary nailing in Gustilo grade IIIb open fracture; (3) the restrictions on switching from external fixation to intramedullary nailing in open lower leg fracture; and (4) the restrictions on definitive anterograde femoral nailing in multiple trauma. In any anatomic site for which high-quality comparative assessments are available, locking plate fixation has not yet demonstrated therapeutic superiority.

When treated with intramedullary nailing or external fixation, the risk of infection is the same regardless of whether wound care and debridement are efficient, anti biotherapy is started quickly, and skin cover is restored within seven days. If the external fixator was fitted less than 28 days ago and the skin cover was recovered within 7 days, conversion from primary external fixation to intramedullary nailing is possible. The term "Damage Control Orthopedics" (DCO), which refers to the general effects of both the initial trauma and its treatment, is used to describe the general effects of both the initial trauma and its treatment. It is used to describe the pulmonary and systemic impact of peripheral lesions or definitive anterograde intramedullary nailing of femoral fracture in multiple traumas.