If orthopedic surgery is to contribute anything to the present treatment of fractures, it will be in the direction of greater conservatism in the use of open operations, and in the advance of the use of more perfect methods for the external or closed (mechanical) reduction and fixation of fractures. Accurate manipulative reduction, splinting and extension is a fine art which is not to be replaced by the scalpel, bone plate or bone clamp.
Operative intervention in closed fractures is at all times a hazardous and difficult undertaking; volumes have been written, and endless surgical debates are still going on, as to whether it is indicated or justifiable except in unusual cases; but for the purpose of this paper this subject must be left in statu quo.
In compound fractures, three additional factors are introduced of such vital import as absolutely to contraindicate, to my mind, all immediate operative intervention
STERN WG. THE CONSERVATIVE TREATMENT OF THE BONE INJURY IN COMPOUND FRACTURES. JAMA. 1924;83(24):1908-1913. doi:10.1001/jama.1924.02660240022006