For most of human history, a broken bone was treated from the outside. Splints, wraps, traction, prolonged bedrest—those were the tools available. Healing happened, but often imperfectly. Malunion, nonunion, deformity, stiffness, and disability were common. Internal fixation changed that. In this episode, we discuss the development of modern implants, how they are made, what they are made of, how they are used, and developments on the horizon.
Understanding internal fixation is critical to our later discussions on surgical techniques for a variety of conditions. We started in Episode 1 of Season 2 discussing bunion surgery. This was meant to be an introduction to how we approach realignment and repair of bone segments. Everything we have learned about fracture fixation in emergent conditions, we have refined and honed to use in our reconstructive efforts. Bunion surgery involves just about every surgical principle we will cover in this season - soft tissue envelopes, anatomically safe corridors, biomechanical tension and compression, deformity realignment, and bone fixation.
Throughout human history we have suffered broken bones. Only until recently were broken bones stabilized with devices more complicated than a tree branch and leather straps. Once we had a grasp on aseptic techniques, metallurgy, and the biologic processes involved in bone healing, modern internal fixation of bone injury was achievable.
The current methods and devices are essentially derivatives from the Swiss AO group, a collection of surgeons who outlined the important principles for the use of these devices: anatomic reduction, stable fixation, preservation of blood supply, and early mobilization of joints.
Manufacturing has come a long way, with forging and machining of basic screws and plates being replaced with 3D printing and patient-specific prostheses generated from complex weight bearing CT scans.