RECENT ADVANCES IN THE TREATMENT OF

FRACTURES
• AO method of fracture treatment
• Functional bracing
• Ilizarov's technique
The AO advocated the internal fixation of fractures based on principles laid down
by them.
The basic guiding principle is that by achieving stable fixation of fractures, a limb
can be mobilised early, thereby avoiding the disadvantages of immobilisation i.e.,
stiffness of joints, muscle wasting etc. ( ‘FRACTURE DISEASE’ )
FRACTURE DISEASE :
Fracture disease, which is a complication of fracture treatment and immobilization, is
defined as atrophy of bone, soft tissues, nail, skin, and cartilage.
Seen in fractures treated by conservative method .
Principles of treatment
Anatomical reduction
Stable internal fixation
Preservation of blood supply
Early mobilization
Implants types
Pin and wire fixation
Screw fixation
Plate and screw fixation
Intramedullarynail fixation
External fixation
FUNCTIONAL BRACING
In principle, the technique consists of applying an
external splint (called a brace) to a fractured limb.

The brace provides adequate support to the fracture

while permitting function of that limb, until the union is
complete.

Bracing is done if the reduction of the fracture is

satisfactory, and the swelling has subsided usually 2-
3weeks after the injury.
Brace works by supporting the soft tissues in a tight
compartment
In long series of cases treated this way, it was found that
shortening and angulation was not a significant problem.
Bracing may not reduce the time taken by the fracture to
unite, but it markedly reduces the stiffness and wasting
of muscles caused by immobilisation in traction or
plaster.
It also drastically reduces the length of rehabilitation.
Functional bracing is used for simple fractures where the
reduction is stable.
It is also useful for a fracture fixed internally where
internal fixation is inadequate.
In such cases, a guarded mobilisation may be done using
a brace, and thus strain on the implant is avoided.
In severely compound fractures, after initial treatment with external fixator or
traction, brace can be used to allow functional use of the limb.
Overall, bracing is most popular for fractures of the shaft of the tibia, humerus, and
femur.
 ILIZAROV'S TECHNIQUE (RING FIXATOR)
Gavril A. Ilizarov, a Russian surgeon revolutionized external
fixation in the management of difficult non-unions and limb
lengthening.
The basic premise of Ilizarov’s technique is that osteogenesis
requires dynamic state.
The dynamic state means that the site of osteogenesis (e.g., a
fracture) requires either a controlled distraction or a controlled
compression.
 ,
• This dynamic force,when properly applied, causes the dormant mesenchymal cells at the non-union site to differentiate
into functioning osteoblasts.

• This results in bone synthesis and fracture healing.

The concept that compression enhances bone healing (DCP ), was known even prior to
Ilizarov, but the concept of distraction osteogenesis was put forward by Ilizarov.
According to his theory in wider perspective, any living tissue when subjected to
constant stretch under biological conditions, can grow to any extent.
The biological conditions are provided by:
(i) aligning the fracture with minimal damage to its vascularity, and
(ii) performing an ‘osteotomy’(CORTICOTOMY) of the bone (e.g.,in limb lengthening
surgeries),without damaging its periosteal and endosteal blood supply.
PROCEDURE :
The whole segment of the limb is stabilised ring fixator.
This protects the growing tissues from bending or shearing forces, but permits loading
in the long axis of the limb.
Distraction or compression can be applied at the fracture or corticotomy site by
twisting nuts on the fixation system
Distraction or compression is carried out at the rate of 1 mm per day OR This is
done in four sittings —¼ mm, four times a day.
 Uses :
1)Limb lengthening
2)Non-union
3)Deformity correction
4)Osteomyelitis
5)Arthrodesis
6)Communitted intra articular fractures
USES :
1) Limb lengthening, when shortening is associated with deformity.
In this situation the fixator assembly is so designed that it corrects the deformity and
produces lengthening at the same time.
Massive limb lengthening (even up to 18 inches) have been performed by using this
technique.
The fixator provides a stable biological environment to the new bone at the site of
lengthening.
LIMB LENTHENING
2) Non-union ,those associated with deformity or shortening.
one-stage fixator application.
Non-unions requiring skin cover and bone grafting operations can be managed by
using Ilizarov technique without subjecting the patient to staged surgeries.
NONUNION
3) Deformity correction, which may be congenital or acquired can be corrected by
Ilizarov's technique.
DEFORMITY CORRECTION
4) Osteomyelitis
offers the possibility of liberal excision of necrotic bone. The gap thus created can
subsequently be made up by transporting a segment of bone from either end.
OSTEOMYELITIS
5) Arthrodesis can be performed by “crushing” the articular surfaces against each
other, and thus stimulating union between opposite bones.
ARTHRODESIS
6) Communitted intra articular fractures e.g., proximal tibia and distal tibia
ADVANTAGES OF ILIZAROV'S TECHNIQUE
•Immediate load bearing
•A healthy viable bone in place of devascularized bone
•Correction of more than one problems by one stage operation.
DISADVANTAGES OF ILIZAROV'S TECHNIQUE
• Inconvenience, as the external fixator hampers normal activity
• Long duration of treatment
• Pin tract infection
• Nerve palsy by pin insertion or traction
• Joint stiffness caused by transfixation of the soft tissues by the external fixator.