The Fundamental Principles of Fracture Treatment

Although the methods of reduction and fixation of fractures Have been constantly changing since the days of Hippocrates the method of healing has never changed, and never will. It takes a very considerable force to fracture a normal bone: If the bone breaks after a trivial accident the fracture is said to be Pathological. Bone shows an exception from the normal healing of other structures which heal by fibrous tissue. A bone repairs itself by bone. The natural stimuli to union after a fracture in a normal "?ne is thought to be one or both of : 1. Blood set free at the site of fracture. 2. The two fractured bone ends in contact. Any conditions which interferes with these natural stimuli WlU delay healing, e.g. : 1-Factors affecting the hcematoma. {a) Small crack and small liaematoma. (6) Transverse fracture and little stripping of periosteum, and consequent small hcematoma. (c) Open operation and loss of haematoma. (d) Compound fracture and loss of haematoma. (e) Sepsis and loss of haematoma. 2-Factors affecting the contact of bone ends. {a) Separation of bone ends by excessive traction. (6) Muscle interposition. On the other hand good apposition of bone ends, where only a small crack has occurred or where reduction is perfect, promotes rapid union.