Author Affiliation: Fondren Orthopedic Group, LLP, Texas Orthopedic Hospital, Houston.
Contempo Updates Section Editor: Catherine
Meyer, MD, Fishbein Fellow.
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.
Gugenheim, Jr JJ. External Fixation in Orthopedics. JAMA. 2004;291(17):2122-2124. doi:10.1001/jama.291.17.2122