Delayed Operation in the Open Reduction of Fractures of Long Bones

Murray (1941) reviewed evidence for the opinion that the best time to carry out internal fixation of a fracture is as soon after the injury as possible. The advantages claimed for immediate operation are the minimal interference with the normal healing process of a fracture, the ease of exposure and reduction, and the accurate identification of damaged tissues unaltered by oedema and fibrosis. In 1959 Smith recorded 130 fractures ofthe radius and ulna in adults treated by internal fixation. Fifty-two fractures treated by delayed internal fixation showed less delay in union than did the remaining seventy-eight fractures operated upon early. There was in fact no case of true non-union in the patients subjected to operation after a delay of one week, whereas there was an incidence of 2l8 per cent of non-union when the fractures were operated upon early. He concluded that the incidence of non-union after internal fixation can be reduced if operative treatment is delayed for one week, and preferably for two or three weeks, after the injury. Smith and Sage (1957) reported results which were at variance with the findings of Smith. In a series of 253 fractures treated by medullary nailing Smith and Sage found l97 per cent of non-union in fractures nailed within fourteen days of injury, l93 per cent of non-union in those nailed fifteen to ninety days after injury, and 30l per cent of non-union in those nailed three months or more after the injury. In view of this discrepancy it was decided to investigate again the relationship between delayed operation and non-union as illustrated by the results of intramedullary fixation of