Evolución de la osteosíntesis de los huesos largos y fijación por enclavado intramedular flexible / Evolution of Long Bone Osteosynthesis and Flexible Intramedullary Nail Fixation

Introducción: Se presenta la evolución histórica y científica de la osteosíntesis de huesos largos realizada con dos tipos de implantes intramedulares: Pines o varillas flexibles y clavos rígidos. Objetivo: Publicar un artículo científico que sirva de soporte teórico y práctico al personal en formación y, como punto de referencia y consulta a los ortopédicos y traumatólogos. Métodos: Se realiza una revisión bibliográfica retrospectiva de artículos sobre fracturas de los miembros publicadas en revistas de traumatología nacionales y extranjeras indexadas en las bases de datos MEDLINE y certificadas por el organismo de Ciencia Tecnología y Medio Ambiente, así como libros de relevancia sobre este tema y experiencias de los autores. Dadas las diferencias entre los dos tipos de implantes se estudiaron por separado la osteosíntesis con pines flexibles (Rush) y la realizada con clavos rígidos (Küntscher). Se seleccionaron las siguientes variables para el estudio: reducción, vía de acceso, penetración del implante, estabilidad, bloqueo, metal usado y consolidación. La fecha de incorporación de las innovaciones tecnológicas a la práctica quirúrgica fue enmarcada en tres momentos generacionales en el período de tiempo comprendido desde 1939 hasta la actualidad. Conclusiones: Esta revisión permitió identificar dos tipos de implantes intramedulares: los pines flexibles y los clavos rígidos. El estudio de sus características permitió organizarlos en generaciones para poder ubicar en el tiempo su contribución a los conocimientos que permiten devolver al paciente su vida activa(AU)

Introduction: This article discuses the historical and scientific evolution of long bone osteosynthesis performed with two types of intramedullary implants, flexible pins or rods and rigid nails. Objective: To publish a scientific article that serves as theoretical and practical support for staff in training and, as a point of reference and consultation for orthopedists and traumatologists. Methods: A retrospective bibliographic review of articles is carried out on limb fractures published in local and foreign trauma journals indexed in the MEDLINE databases and certified by CITMA, as well as relevant books on this topic and experiences of the authors. Given the differences between the two types of implants, we separately studied the osteosynthesis with flexible pins (Rush) from that performed with rigid pins (Küntscher). The variables selected for the study were reduction, access route, implant penetration, stability, locking, metal used, and consolidation. The inclusion of technological innovations to surgical practice was framed in three generational moments from 1939 to the present. Conclusions: Thow types of intramedullary implants were identifies from this revision: flexible pins and rigid nails. The study of their characteristics allowed to organize them into generations in order to locate their contribution to the knowledge allowing the patient to return to an active life over time(AU)

Albin Lambotte: Pioneer of Osteosynthesis (Bone Fixation).

Stamp Vignettes focus on biographical details and accomplishments related to science and medicine, and not individual views and prejudices except when they had a major impact on the subject's life. The authors of Stamp Vignettes do not intend to imply any endorsement of such views when discussing a Stamp Vignette on Medical Science.

Maintaining mobility after fracture: A biomechanical analysis of fracture consequences at the Roman Sites of Ancaster (UK) and Vagnari (Italy).

OBJECTIVE: This study uses biomechanical data from tibiae to investigate the functional consequences of lower limb fractures. Adults with malunited fractures are hypothesized to have experienced altered mobility, indicated by asymmetric tibial cross-sectional geometries (CSG). MATERIALS: Ninety-three adults from Roman (1st to 4th centuries CE) Ancaster, UK and Vagnari, Italy (Ancaster n = 16 adults with lower limb fracture:53 without fracture; Vagnari n = 5:19) METHODS: Biplanar radiographs were used to quantify and compare tibial CSG properties and asymmetries between individuals with and without fractures to femora, tibiae, and/or fibulae. The amount of angulation, rotation, and overlap, indicative of linear deformity, were measured for each fracture. Individuals who loaded their fractured leg differently than their opposite, uninjured leg were identified using outlying amounts of CSG asymmetry. RESULTS: Two Ancaster individuals had poorly aligned fractures. None of the Ancaster or Vagnari individuals with lower limb fractures had CSG properties or asymmetries outside the calculated normal ranges. CONCLUSIONS: Regardless of how a fracture healed, individuals at Ancaster and Vagnari generally resumed mobility after trauma whenever possible. SIGNIFICANCE: This research contributes information about injury recovery and suggests that resilient behaviors and persistent mobility may have been valued or required responses to fracture in the study communities. This work advises that impairment should not be inferred based solely on the appearance of lesions. LIMITATIONS: Site, sex, and age patterns in injury recovery are not evaluated due to sample size limitations. SUGGESTIONS FOR FURTHER RESEARCH: Biomechanical assessments of post-traumatic function in varied cultural contexts are advised in order to further characterize the impact that physical and social factors have on injury recovery.

A historical perspective with current opinion on the management of atrophic mandibular fractures.

The management of atrophic mandibular fractures has been a challenge for maxillofacial surgeons for decades. During the past 70 years, various techniques for treating edentulous mandibular fractures have been advocated. These techniques have been praised, criticized, abandoned, improved, and used in combination with other methods. Although some of the principles of management outlined before the end of World War II are still valid in today's technological era, other concepts did not survive the test of time. The aim of this paper is to examine the evolution of treatment modalities for the management of atrophic mandibular fractures that have been employed over the years. Debates and discussions generated by this topic are included. Current techniques and treatment philosophies with thoughts for future therapies are provided.

Dorsal Plating of Distal Radius Fractures Historical Context and Appropriate Use.

The management of distal radius fractures has evolved over time from a largely nonoperative paradigm to a more commonly performed operative procedures today. Surgical trends have similarly developed, with dorsal plating falling out of favor due to complications involving extensor tendon pathology as well as due to the ubiquity of the volar plate along with the advent of locking plate technology. However, with the improvement in design of newer generation dorsal plates, this technique should be used in the appropriate clinical situation, including dorsal comminution and angulation with concomitant carpal pathology. Outcome data supports dorsal plating and has been shown to be comparable to that of volar plating, with some unique advantages. As such, the technique of dorsal plating should have a role in surgical management of these injuries.

History of internal fixation (part 1): early developments with wires and plates before World War II.

Though the date at which an orthopaedic implant was first used cannot be ascertained with any certainty, the fixation of bone fracture using an iron wire was reported for the first time in a French manuscript in 1775. The first techniques of operative fracture treatment were developed at the end of the 18th and in the beginning of the 19th centuries. The use of cerclage wires to fix fractures was the most frequent fixation at this time. The French Berenger-Feraud (1832-1900) had written the first book on internal fixation. However internal fixation of fractures could not become a practical method before Lister had ensured the safety of open reduction and internal fixation in the treatment of fractures. Lister is not only the father of asepsis; he also used metal wires to fix even closed fractures. The first internal fixation by means of a plate and screws was described by Carl Hansmann in 1858 in Hamburg. Nevertheless, Arbuthnot Lane (1892) and Albin Lambotte (1905) are considered to be the founders of this method, which was further developed by Sherman in the first part of the 20th century.

History of internal fixation with plates (part 2): new developments after World War II; compressing plates and locked plates.

The first techniques of operative fracture with plates were developed in the 19th century. In fact, at the beginning these methods consisted of an open reduction of the fracture usually followed by a very unstable fixation. As a consequence, the fracture had to be opened with a real risk of (sometimes lethal) infection, and due to unstable fixation, protection with a cast was often necessary. During the period between World Wars I and II, plates for fracture fixation developed with great variety. It became increasingly recognised that, because a fracture of a long bone normally heals with minimal resorption at the bone ends, this may result in slight shortening and collapse, so a very rigid plate might prevent such collapse. However, as a consequence, delayed healing was observed unless the patient was lucky enough to have the plate break. One way of dealing with this was to use a slotted plate in which the screws could move axially, but the really important advance was recognition of the role of compression. After the first description of compression by Danis with a "coapteur", Bagby and Müller with the AO improved the technique of compression. The classic dynamic compression plates from the 1970s were the key to a very rigid fixation, leading to primary bone healing. Nevertheless, the use of strong plates resulted in delayed union and the osteoporosis, cancellous bone, comminution, and/or pathological bone resulted in some failures due to insufficient stability. Finally, new devices represented by locking plates increased the stability, contributing to the principles of a more biological osteosynthesis while giving enough stability to allow immediate full weight bearing in some patients.

The art of trochanteric fracture reduction.

The name of Ender is primarily associated with the Ender nails, which were popular for trochanteric fracture fixation more than thirty years ago. However, Ender's concepts were not limited to the implant. Ender developed a unique classification system for trochanteric and subtrochanteric fractures, which provided the theory for closed reduction maneuvers that made the method so successful in his hands. While Ender's nails have become history in the meantime, his principles of fracture reduction can be readily applied on surgery with modern implants such as proximal femoral nails. This article reflects the classification and the principles published by Hans Georg Ender in some print work hardly available nowadays.

Osteosynthesis techniques used for mandibular sagittal split osteotomy ­ history of orthognathic procedures and modern practice.

Choosing an appropriate fixation technique after maxillary or mandibular osteotomy is one of the key factors affecting the success of orthognathic surgery. In line with the development of new surgical methods and techniques, the surgeons' approach to the fixation of bone fragments has evolved accordingly, varying from non-fusion to different osteosynthesis techniques. Advances in medical sciences and medical technologies, have changed our attitudes to bone fragment reduction in orthopaedics and traumatology, and also in maxillofacial surgery. The pivotal underlying principle which determines bone healing ­ that is proper positioning so as to ensure appropriate contact area and immobilisation so as to ensure osteosynthesis ­ has remained unchanged for centuries. However, over the years, patient comfort and the predictability of treatment outcomes have vastly improved. The paper provides an overview of the techniques and methods used for the fixation of osteotomized fragments after bilateral sagittal split osteotomy since its introduction by Hugo Obwegeser up to the present day.

Early history of scapular fractures.

The first to use the term Scapula was Vesalius (1514-1564) and thus it has remained ever since. Probably the oldest injured scapula, from 250 million years ago, was described by Chinese authors of a skeletal examination of a fossilised remains of a dinosaur Yangchuanosaurus hepingensis. In humans, the oldest known scapular fractures date back to the prehistoric and early historic times. In ancient times, a fracture of acromion was described in the treatises of Hippocrates. Early modern history of the treatment of scapular fractures is closely interlinked with the history of the French surgery. The first to point out the existence of these fractures were Petit, Du Verney and Desault in the 18th century. The first study devoted solely to scapular fractures was published by Traugott Karl August Vogt in 1799. Thomas Callaway published in 1849 an extensive dissertation on injuries to the shoulder girdle, in which he discussed a number of cases known at that time. The first radiograph of a scapular fracture was published by Petty in 1907. Mayo Robson (1884), Lambotte (1913) and Lane (1914) were pioneers in the surgical treatment of these fractures, followed in 1923 by the French surgeons Lenormat, Dujarrier and Basset. The first internal fixation of the glenoid fossa, including a radiograph, was published by Fischer in 1939.

[History of internal fixators. The subsequent importance for spinal surgery]. / Geschichte des Fixateur interne. Seine spätere Bedeutung für die Wirbelsäulenchirurgie.

BACKGROUND: This article presents a retrospective look at spinal implants of the 1970s and 1980s. OBJECTIVE: The historical development of internal fixators as the successor to external fixators. MECHANICAL PRINCIPLE: Pedicled screws are stably anchored in vertebral bodies of the thoracic or lumbar spine or the sacrum using a dorsal approach. They are joined by a rod as a longitudinal support, separated by freely selectable distances and in any desirable and initially modifiable angle. After locking this results in an angular and rotationally stable completely sunken bilateral construction for fixing two or more vertebrae together and the position can be manually adjusted using long lever arms on the pedicled screws. RESULTS: The first in vivo application in humans was on 22 December 1982 in Basel. The initial indications were unstable spinal fractures. The expectations placed on the new working principle of internal fixation and its realization were confirmed and short stretch fixation exclusively of the neighboring vertebra and immediate mobilization of patients could be routinely achieved. The indications were extended to include instability of the spine for conditions outside the field of traumatology. Further developments of implants and other technical solutions in the coupling system using the same basic principle in the direction of multisegmental applications, ease of operation and titanium-based materials became internationally established and were developed into universal spinal stabilization systems for spinal degeneration, deformities, tumors and olisthesis. CONCLUSION: The basic principle of spinal fixators (internal and external) is contained in the complete product range of dorsal stabilizing implants from practically all manufacturers worldwide and has become taken for granted.

Early history of operative treatment of patellar fractures.

The presented overview shows that the first efforts to address patellar fractures by operative treatment, although sporadic, emerged in the pre-antiseptic era. Introduction of Lister's antiseptic method in Great Britain, Germany and the USA in 1877-1882 contributed to a new, progressive trend in the treatment of fractures of the patella as well as of other bones. The authors, using Lister's antiseptic method, evaluated three basic aspects in their operations, namely healing of the surgical wound without infective complications, achievement of bony union and a good functional outcome, i.e. restoring the range of motion in the knee, even if limited in most cases. The majority of them used a longitudinal incision and fixation by a silver wire.

Eponyms in elbow fracture surgery.

Eponyms are common in medicine and in orthopaedic surgery. For future reference and historical considerations, we present common eponyms in elbow fracture surgery. We describe in short the biography of the name giver and give, where possible, the original description on which the eponym was based. Whether eponyms should continue to be used is a question that remains unanswered, but if we use them, knowledge of the original description can prevent confusion and knowledge of the historical background sheds light on the interesting roots of our profession.

[A brief history of internal fixation of femoral neck fracture].

In 1858, a German surgeon named Von Langenbeck did the first internal fixation of femoral neck fracture (FNF) with metal silver screw. In 1875, a German doctor Franz K?nig did the same operation successfully with metal screws under antiseptic condition. In 1883, an American surgeon, Nicholass Senn suggested that all of the FNF should be treated by operation, but the proposition was not accepted extensively. In 1931, Smith-Petersen from the USA and his colleagues first published the report on the result of open reduction and internal fixation of FNF by the use of trifin nail. Due to the help of auxiliary appliance designed separately by the Swedish Sven Johansson (1932) and American H. Heyward Wescott (1934). In 1941, the American Academy of Orthopaedic Surgeons (AAOS) advocated the technique of trifin nail for its internal fixation. However, in 1976, the British Medical Research Council pointed out that the trifin nail was not suitable for the displaced FNF. The Asnis cannulated screws appeared in 1980, that is still in use today. In the 1940s, Chi-mao Meng and Yan-qing Ye started to treat FNF with trifin nail. In 1989, Jie Wei cured the FNF with cannulated screws produced by AO company first, which was extensively applied nationwide soon.

The history of internal fixation of proximal femur fractures Ernst Pohl-the genius behind.

The most frequently used implants for internal fixation of proximal femoral fractures are currently the dynamic hip screw and the intramedullary hip nail. However, little has been written about one of the pioneers in this field, a German genius, the designer Ernst Pohl (1876-1962). Without his involvement the concepts of intramedullary nailing coined by Gerhard Küntscher, Richard Maatz and other surgeons could hardly have been implemented. Through his achievements Pohl has rightly merited his pre-eminent position in the history of bone surgery. This article outlines the extraordinary contribution of Ernst Pohl to the development of skeletal surgery and radiology, as well as other medical disciplines.

Evolución histórica de las ideas en el tratamiento de fracturas trocantéricas / Historical development of trochanteric fracture treatment ideas

Se realiza una revisión de los distintos conceptos, estrategias de tratamiento y dispositivos de osteosíntesis, desde que se comienza a conocer en los primeros tratados las fracturas del fémur en el siglo XVI hasta nuestros días. Mal conocida al principio, es confundida con luxaciones de cadera hasta incluso avanzado el siglo XVIII. En el siguiente siglo los cirujanos ponen su empeño en tipifi car los distintos trazos de fractura y relacionarlas con su pronóstico. Los tratamientos ortopédicos que defi enden las diversas escuelas, a veces incluso encontrados, y que abarcan hasta principios del siglo XX, provocan una alta incidencia de secuelas y un porcentaje muy preocupante de mortalidad sobre todo ligado al prolongado encamamiento. En el siglo XX y fruto de la mejora en técnicas asépticas y anestésicas se comienza a propugnar la cirugía, pero no es hasta la década de los 60 cuando nace la propuesta de que el tratamiento quirúrgico y de urgencia de estas fracturas, debe ser la regla. Se desarrollan diversos tipos de osteosíntesis pudiéndose establecer cuatro diferentes etapas: Sus inicios, el clavo-placa monobloque, las osteosíntesis dinámicas y por último los clavos trocantéricos. Todo progreso en el desarrollo de nuevas osteosíntesis, aunque sea mínimo es de gran utilidad y de importancia considerable, dada la gran repercusión de las fracturas de cadera en nuestro medio (AU)

A review was performed of the various concepts, treatment strategies and osteosynthesis devices, since the fi rst treaties about femoral fractures were published in the 16th Century, until today. Initially, it was poorly known and often confused with hip dislocations even until well into the 18th Century. In the following century surgeons strove into typifying the different fracture lines, thus relating these with their prognoses. The orthopedic treatment that the various schools defend, sometimes contradictory, and that was carried out until the onset of the 20th Century, caused a high incidence of secondary effects, and a very worrying percentage of mortality due to prolonged bed rest. In the 20th Century and thanks to improved aseptic and anesthetic techniques, surgical intervention was more widespread; nevertheless, it was not until the 1960s when surgical and emergency treatment of such fractures became the gold standard. Diverse types of osteosynthesis were developed, with four different stages being established: its beginnings, the monoblock nail-panel, dynamic osteosynthesis and lastly trochanteric nails. Progress in the development of new osteosynthesis—even minimum—is of great use and considerable importance, given the important repercussion of hip fractures (AU)