Bone fragments may be fixed with screws, a metal plate held by screws, a long intramedullary rod or nail (with or without locking screws),circumferential bands or a combination of these methods.
Properly applied, internal fixation holds a fracture securely so that movement can begin at once; with early movement the ‘fracture disease’ (stiffness and oedema) is abolished. As far as speed is concerned, the patient can leave hospital as soon as the wound is healed, but he must remember that, even though the bone moves in one piece, the fracture is not united – it is merely held by a metal bridge and unprotected weightbearing is, for some time, unsafe.
The greatest danger, however, is sepsis; if infection supervenes, all themanifest advantages of internal fixation (precise reduction, immediate stability and early movement) may be lost. The risk of infection depends upon: (1) the patient – devitalized tissues, a dirty
wound and an unfit patient are all dangerous; (2) the surgeon – thorough training, a high degree of surgical dexterity and adequate assistance are all essential and (3) the facilities – a guaranteed aseptic routine, a full range of implants and staff familiar with their use are all indispensable.
Internal fixation is often the most desirable form of treatment. The chief indications are:
1. Fractures that cannot be reduced except by operation.
2. Fractures that are inherently unstable and prone to re-displace after reduction (e.g. mid-shaft fractures of the forearm and some displaced ankle fractures). Also included are those fractures liable to be pulled apart by muscle action (e.g. transverse fracture of the patella or olecranon).
3. Fractures that unite poorly and slowly, principally fractures of the femoral neck.
4. Pathological fractures in which bone disease may prevent healing.
5. Multiple fractures where early fixation (by either internal or external fixation) reduces the risk of general complications and late multisystem organ failure (Pape et al., 2005; Roberts et al., 2005).
6. Fractures in patients who present nursing difficulties (paraplegics, those with multiple injuries and the very elderly).
---from 《Apley’s System of Orthopaedics and Fractures》P700-701