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The following article was published in our article directory on March 28, 2012.
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How Broken and Fractured Bones are Treated and How these Healing Techniques were Developed

Article Category: Medicines and Remedies

Author Name: Lawrence Reaves

One of the first problems that brought about the emergence of the surgical treatment of fractures, was the total lack of any appropriate implants and instruments. Therefore, anyone who wanted to deal with the surgical treatment of fractures, had to develop their own implants. So there was a time of testing suitable materials, of conducting the first experiments, and of searching for appropriate surgical approaches.

One of the biggest challenges was to find a suitable material or materials for making the implants. The oldest implants that were used for fracture fixation were made from various materials, mainly ivory, bone, and of course, purified metals (such as bronze, gold, copper, silver, brass and steel, or aluminum). Pins made of bone and ivory were used for intramedullary fixation. Silver cerclage suture wire was used for thin plates and intramedullary nails. But the first plates were made of nickel-plated steel sheet, and others of silver, carbon steel, vanadium steel, aluminum and brass. All of these metals used proved to be very problematic in terms of both mechanical properties and corrosion. The situation was resolved by implanting stainless steel. Although this was invented before the First World War, it only began to be used for implants at a much later time.

Many authors have experimentally verified their thoughts in the field. One of the first to do so was Ferdinand Riedinger (lived 1844 to 1918), a German surgeon of Würzburg. Part of his article published in 1881 was dedicated to pseudoarthrosis of the forearm, with a description of a number of experiments that were conducted on rabbits and dogs. While the implanted intramedullary pins of ivory and bone pads functioned without a problem, with implants made of wood and rubber, suppuration occurred.

A significant experimenter in improving technques in this regard was Nicholas Senn (lived 1844 to 1908), who even in the year 1889 published the book "Experimental Surgery". He studied, among others, the healing of intracapsular femoral neck fractures. The largest and most comprehensive experiments were conducted beginning in the year 1914 by Ernest William Hey Groves (lived 1872 -1944). He studied the tibia and femur in cats and rabbits, fixing the healing of fractures with fixed plates, intramedullar ivory or steel pins, and outer soles. He devoted a large chapter to the results of his experiments in both editions of his "Bone Traumatology", illustrated by X-ray photographs of macroscopic and microscopic preparations. His conclusions are still valid today.

Cerclage wire is one of the oldest methods of osteosynthesis. Its technical improvements were published almost at the same time, by three authors. The American surgeon Robert Milne in 1912 introduced a method with a flexible cerclage helix. The Italian orthopedist Vittorio Putti (lived 1880 - 1940) in 1914 described a narrow metal cerclage strip. A similar method was published two years later, by an American surgeon from New Orleans, Frederick William Parham (lived 1856 to 1927). In the world of implants, they expanded under the name Putti-Parham, and various modifications are still used today.

Keywords: medicine, health, surgery, history, advice, lifetsyle, fitness, adventure

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