Internal fixation of fractures: evolution of concepts

The recognized goal of any fracture treatment is the restoration of normal function to the injured part(s). Historically, this was first achieved with non-operative techniques and more recently with operative fixation of fractures. Newer systems utilizing the principles of rigid internal fixation and a sophisticated armamentarium have proved useful in fractures of both bones of the forearm, major intra-articular joint fractures and the multiply injured patient. With these methods "fracture disease" (i.e. muscle atrophy, joint stiffness and bony demineralization) is decreased by early mobilization without external support. The penalties for inadequate surgery are nonrigid fixation and/or infection, emphasizing that the operative treatment of fractures is a technique to be mastered.