Early history of operative treatment of fractures

Abstract

Surgery in the first half of the nineteenth century was primarily dominated by pain and fear of lethal infections. Therefore, the absolute majority of fractures and dislocations were treated non-operatively. Development of operative treatment of fractures was influenced by three major inventions: anaesthesia (1846), antisepsis (1865) and X-rays (1895). The first to use external fixation is traditionally considered to be Malgaigne (1843). However, his devices cannot be considered as external fixation. Von der Höhe, in 1843, fixed a non-union of the femur by inserting into both fragments a couple of screws transversely connected outside the wound. Von Langenbeck in 1855 treated a non-union of the humerus with screws connected by a devise designed for this purpose. A predecessor of nailing of acute diaphyseal fractures may be considered to be fixation of diaphyseal non-unions of the femur, humerus and tibia with ivory intramedullary pegs, performed by Dieffenbach in 1846. Nevertheless, until 1885, osteosynthesis was still a Cinderella having at its disposal mainly wires, ivory pegs and very primitive types of external fixation. During the following 35 years (1886-1921), operative treatment of fractures witnessed an unprecedented revolution. Radiology became an integral part of bone and joint surgery. All types of osteosynthesis, i.e. plates (Hansmann 1886), external fixation (Parkhill 1897) and intramedullary nails (Schöne 1913) were introduced into clinical practice. Basic experiments were undertaken, surgical approaches described and the first textbooks on osteosynthesis published.

A historical perspective: Bernhard von Langenbeck German surgeon (1810–1887)

“…In 1852, von Langenbeck introduced the first osteosynthesis device in a patient suffering from pseudoarthrosis, thereby establishing the principle of "fixateurexterne" (Beger and Gansauge, 2010). He further contributed to the field of orthopedics, in 1855, when he treated a non-union of the humerus with "screws connected by a devise designed for this purpose," (Bartonicek, 2010). Moreover, von Langenbeck and Theodor Kocher developed the well-known and commonly utilized posterior approach for the stabilization of posterior wall fractures of the proximal femur and acetabulum (Mehlman et al, 2000).…”

Internal fixation: An evolutionary appraisal of methods used for long bone fractures

“…Ivory and bone were found to have lower infection rates and non-unions and they were found to be reabsorable into the body 23 . Thus Nicholas Senn is considered to be the father of biodegradable implants because he prepared a hollow perforated intra-osseous splint using these materials 7 . Silver was also involved in fixation as wires and pins, its first use being reported in 1827 23 .…”

Materials in Fracture Fixation

“…Its originator is believed to be Joseph-François Malgaigne, a French surgeon who in 1843 used a percutaneous clamp to treat fractures of the patella. 85 In fact, his use of the device predated the development of plaster casts for fracture immobilization. 86 Since the time of Malgaigne, many developments in the design and composition of external fixators have been made and the use of this technique has become widespread within orthopedic surgery.…”