Fractures, treatments and devices

Fractures, or broken bones, have always occurred. Prompt treatment is important if a patient is to regain full use of an injured arm or leg. In treating a fracture, the bone ends must first be brought back into alignment. After that, the bones must be held together until their ends grow back together. Closed or simple fractures, in which the bone ends do not penetrate the skin, have always been relatively easy to treat. Open or compound fractures were serious accidents prior to the advent of antiseptics in the 1860s, because infection would set in.

Immobilizing the Bones

The earliest method of holding the bones in place was to use a splint. Splints are strips of stiff material laid parallel to each other alongside the bone. Ancient Egyptians used wood splints made of bark and cushioned with linen. Ancient Hindus treated fractures with bamboo splints. But the splint alone cannot do the job—there must be something to hold the splint in place (a bandage, tape or other wrap).

Casts Replace Splints

Around 1852 Dutch army surgeon Antonius Mathijsen revived the ancient Arabian system and introduced roller bandages. The bandages were filled and covered with quick-drying plaster of paris (gypsum) and combined the features of a splint and bandage. Broken bones were held in place while the wet bandages were applied. When the bandages dried, they became rigid. They held the bones perfectly in place during healing. Plaster of paris casts remained standard treatment for fractures until the early 1980s. At that time, casts made of fiberglass plaster came into use. Fiberglass casts are favored for their light weight and water resistance.

Traction

Fractures have been treated with extension and traction to align the ends of the broken bones from ancient times. The ancient Greeks used traction (pulling on a broken limb with weights and pulleys), but that practice died out until after the Middle Ages. Traction was revived by French surgeon Guy de Chauliac (1300-1368) during the fourteenth century. The English orthopedist Hugh Owen Thomas (1833-1891) devised improved methods of traction.

Screws and Plates

Hugh Arbuthnot Lane (1856-1943) of Great Britain devised a way to hold broken bone ends together mechanically when they would not heal naturally. In 1893 he introduced the use of steel screws to rejoin bones, then improved the technique around 1905 by using steel plates screwed into the bone ends. These techniques are still in use today but with improved materials for the plates and screws.

Antiseptics and Compound Fractures

Lane's method of repairing severe fractures could only succeed after the English surgeon Joseph Lister (1827-1912) introduced antiseptics to surgery. Compound fractures meant heavy contamination of the wound, which almost always led to severe infection. Because the infection could not be controlled, it usually led to death. Since infection could not be avoided in pre-antiseptic days, the usual method of treating compound fractures was amputation. The era of antiseptic surgery began in 1865. It was only then that infection in compound fractures could be controlled.

[See also Antisepsis ; Bandages and dressings ]