| Internal fixation | |
|---|---|
 | |
| ICD-9-CM | 78.5 |
| MeSH | D005593 |
Internal fixation is anoperation inorthopedics that involves the surgical implementation ofimplants for the purpose of repairing abone, a concept that dates to the mid-nineteenth century and was made applicable for routine treatment in the mid-twentieth century.[1][page needed] An internal fixator may be made ofstainless steel,titanium alloy,[2] orcobalt-chrome alloy.[3]
Types of internal fixators include:
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Open reduction internal fixation (ORIF) involves the implementation of implants to guide the healing process of a bone, as well as the open reduction, or setting, of the bone.Openreduction refers toopen surgery to setbones, as is necessary for somefractures.Internal fixation refers to fixation of screws and/or plates,intramedullary rods and other devices to enable or facilitatehealing. Rigid fixation prevents micro-motion across lines of fracture to enable healing and prevent infection, which happens when implants such as plates (e.g.dynamic compression plate) are used. ORIF techniques often are used in cases involving serious fractures such ascomminuted or displaced fractures or, in cases where the bone otherwise would not heal correctly with casting or splinting alone.
Risks and complications may include bacterial colonization of the bone,infection,stiffness and loss of range of motion, non-union, mal-union, damage to the muscles, nerve damage and palsy,arthritis,tendonitis, chronicpain associated with plates, screws, and pins,compartment syndrome,deformity, audible popping and snapping, and possible future surgeries to remove the hardware.
Closed reduction internal fixation (CRIF) isreduction without any open surgery, followed by internal fixation. It appears to be an acceptable alternative in unstable distressed lateralcondylar fractures of thehumerus in children, but if fracture displacement after closed reduction exceeds 2 mm, open reduction and internal fixation is recommended.[4]
Various techniques of minimally invasive surgery for internal fixation of bones have been reported. The treatment of fractures of the distal third of the tibia has evolved with the development of improved imaging and surgical techniques.[5]
The latest evidence suggests that there may be little or no difference between screws and fixed angle plates as internal fixation implants for intracapsular hip fractures in older adults.[6] The findings are based on low quality evidence that cannot firmly conclude major difference in hip function, quality of life, and additional surgery.[citation needed]
