Consideration of the operative treatment of jointfractures in perspective must concern itself first with the contrast between joint-fractures and those fractures of shafts of long bones in which operation and boneplating are to-day so enthusiastically and widely, if not always wisely, practiced. This contrast seems to me rather a sharp one and depends on broad principles, or rather generalizations, which it may be well to state now.
PRINCIPLES OF OPERATION
In shaft-fractures, fixation is a factor of first importance; in fractures within, into and about the joints, the difficulty in maintaining a reduction once gained, with or without operation, is usually slight. If we operate we often need only to reduce; we do not need the massive hardware so often applied to shaft-fractures and left in (unless and until it comes out). A suture of chromic gut or wire, or rarely a pin of steel or a staple is enough;
COTTON FJ. OPERATIVE TREATMENT IN JOINTFRACTURES. JAMA. 1912;LIX(3):190–194. doi:10.1001/jama.1912.04270070191010
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