From the Guidelines
Internal fixation is a surgical procedure that uses implants like plates, screws, rods, and wires to stabilize and repair fractured bones, with the goal of achieving fracture consolidation, restoration of the soft tissue envelope, return to function, prevention of residual chronic infection, and eradication of infection. The process begins with exposing the fracture site through an incision, followed by realigning the bone fragments into their proper anatomical position (reduction) 1. The surgeon then selects appropriate hardware—typically stainless steel or titanium implants—to secure the fragments together. Common fixation methods include compression plates that hold fragments tightly together, intramedullary nails inserted into the bone's canal, screws for smaller fractures, and wires or pins for specific fracture patterns.
Some key considerations for internal fixation include:
- The importance of preserving blood supply to bone fragments and creating a stable mechanical environment that promotes proper healing 1
- The need for careful patient selection, with moderate evidence supporting operative treatment for non-geriatric patients with certain types of fractures, such as those with post-reduction radial shortening >3mm, dorsal tilt >10 degrees, or intraarticular displacement or step off >2 mm 1
- The potential risks and complications of internal fixation, including infection, hardware failure, and the potential need for hardware removal later 1
After placement, the hardware maintains alignment while the bone heals naturally through callus formation and remodeling. This technique provides several advantages over external fixation or casting, including better anatomical alignment, earlier mobilization, and reduced risk of malunion. Recovery involves progressive weight-bearing and physical therapy based on the specific fracture pattern and fixation method used. The decision to use internal fixation should be based on the individual patient's needs and circumstances, with careful consideration of the potential benefits and risks.
From the Research
Definition of Internal Fixation
- Internal fixation refers to the surgical stabilization of bone fractures using various devices and techniques to enable fast healing and return of mobility and function to the injured extremity 2.
- The goal of internal fixation is to stabilize the fractured bone, allowing for early mobility and full function of the injured extremity 2.
Types of Internal Fixation Devices
- Internal fixation devices can be roughly divided into several categories, including:
- Wires
- Pins and screws
- Plates
- Intramedullary nails or rods
- Staples and clamps (used occasionally for osteotomy or fracture fixation) 2.
Comparison of Internal Fixation Techniques
- Studies have compared different internal fixation techniques, such as plate-screws and locked intramedullary nailing, in the treatment of adult femur shaft fractures 3.
- Another study compared replacement arthroplasty with internal fixation for the treatment of extracapsular hip fractures in adults, finding insufficient evidence to determine the superiority of one technique over the other 4.
Internal Fixation in Specific Patient Populations
- Internal fixation can be challenging in patients with osteoporosis, with a high failure rate due to decreased holding power of plate-and-screw fixation in osteoporotic bone fractures 5.
- Load-sharing fixation devices, such as sliding hip screws and intramedullary nails, may be better alternatives for osteoporotic metaphyseal locations 5.
Comparison of Internal and External Fixation
- A study compared the effects of internal fixation and external fixation for the treatment of complex tibial plateau fractures, finding similar therapeutic effects between the two techniques 6.