Evolution of Technology

Plate and Screw Fixation

Plates and screws are commonly utilized for fracture fixation in long bones and some short tubular bones of the hands and feet. Some of the basic principles of fracture fixation are as follows:

  • fractures should be reduced to restore anatomic alignments
  • fractures should be treated with a fixation method that provides stability
  • there must be enough blood supply to allow for the body to heal the injury
  • treatment should allow for early and safe mobilization of the injured area

Every fracture is different and should be managed with methodology that best suits the patient and injury pattern. The aforementioned principles are utilized by orthopaedic surgeons to ensure optimal outcomes post operatively.

Evolution of Procedure

Open Reduction Internal Fixation

Open reduction internal fixation is performed in the operating room through an incision with dissection to expose the fractured bone. The surgeon will utilize clamps and wires in order to obtain a reduction of the bone by putting the broken pieces back together.

Once this reduction is obtained and temporarily held, the surgeon will place a plate and screws to hold the broken bone in the correct position so that the body can heal the fracture. The surgeon will then close the incision and place some form of dressing over the surgical site. In the vast majority of cases the plates and screws are intended to remain in place permanently without a need to return to the operating room.

Evolution of Diagnosis

Hand Fractures

Fractures of the hand and fingers are among the most commonly reported injuries experienced among the general population. Broken hands, dislocated fingers, tendon lacerations, and nailbed injuries are some of the most commonly reported upper extremity injuries presenting to emergency departments within the United States. Sporting injuries, machinery, and falls are often the root causes for these injuries.

Fractures to the phalanges (fingers) or metacarpals (long bones within the palm) are often able to be managed without surgical intervention. Most patients are able to be treated with soft tissue rest, splints to ensure immobilization for healing, or possibly a bedside procedure. Some indications for surgery include unstable fracture patterns, concern for subsequent rotational deformity of the finger(s) involved, open fracture with exposed bone, or if the fracture involves a significant portion of the joint surface.

Patients should discuss their injuries with their doctor to discuss the most appropriate treatment options available for both operative and non-operative management.