The Rationale of Operative Fracture Care

Bridge plating osteosynthesis of 20 comminuted fractures of the femur

“…Today absolute stability is no longer the objective of internal fixation because of better understanding of bone physiology and the importance of preserved blood supply to the bone fragments (Perren 1991, Schatzker andTile 1996). Biological internal fixation is perhaps most important for comminuted diaphyseal fractures of the femur.…”

“…Biological internal fixation is perhaps most important for comminuted diaphyseal fractures of the femur. Best treatment of these fractures seems to be biological indirect reduction and splinting by an unreamed locked nail, as a first choice or a bridging plate as a second choice (Perren 1991, Schatzker andTile 1996). Unreamed nails have reduced, but have not eliminated cardiopulmonary complications (Schatzker and Tile 1996).…”

“…Best treatment of these fractures seems to be biological indirect reduction and splinting by an unreamed locked nail, as a first choice or a bridging plate as a second choice (Perren 1991, Schatzker andTile 1996). Unreamed nails have reduced, but have not eliminated cardiopulmonary complications (Schatzker and Tile 1996). Thus, there still is debate whether to nail femur fractures in multitrauma patients, who have been in shock and have concomitant chest injury.…”

“…Anatomical reduction of the fragments in comminuted diaphyseal and metaphyseal fractures of the femur are no longer the goal. Reduction aims at correct bone length and axial and torsional alignment (Perren 1991, Schatzker andTile 1996). The reduction of fragments is indirect, usually by continuous skeletal traction on the fracture table or by application of a fracture distractor.…”

“…The fragments are not directly manipulated and their soft tissue attachment is not disturbed, instead the area of comminution is bridged with a plate which is fixed to the proximal and distal fragments. The importance of preserving the viability and integrity of the soft tissue envelope of metaphyseal and diaphyseal fractures has is also supported by Schatzker and Tile ( 1996), who in comminuted fras;tures of the metaphysis and diaphysis found that a 2-3 week delay helps the soft tissue envelope to recover (Schatzker and Tile 1996). This type of indirect fixation is referred to as "bridge plating" and is part of the new concept of biological internal fixation (Perren 1991 ).…”