Contempo Updates
Clinician's Corner
May 5, 2004

External Fixation in Orthopedics

Author Affiliations

Author Affiliation: Fondren Orthopedic Group, LLP, Texas Orthopedic Hospital, Houston.


Contempo Updates Section Editor: Catherine Meyer, MD, Fishbein Fellow.

JAMA. 2004;291(17):2122-2124. doi:10.1001/jama.291.17.2122

In the presence of adequate stability and vascularity, bone fractures heal with histologically normal tissue, unlike injuries to most tissues, which typically develop fibrous scar tissue. Historically, physicians have sought methods to treat extremity fractures to achieve stability, including casts and internal fixation. Rigid casts made from plaster of Paris or synthetic plastics are noninvasive and inexpensive and can be used for the treatment of most stable fractures. However, casts do not provide adequate immobilization for grossly unstable fractures, and inadequate immobilization may result in nonunion, delayed union, or displacement of fracture segments. Also, casts immobilize muscles and joints adjacent to the fracture, which can result in weakness and fibrosis of muscles, stiffness of joints, and contractures. Because of these potential problems, surgical treatment with internal and external fixation is often indicated for unstable fractures.

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