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Early history of operative treatment of fractures

  • Trauma Surgery
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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.

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Acknowledgments

This article could not have appeared without the extraordinary help in collecting original sources, offered by Ms. Ludmila Frajerová from the Klementinum (Czech National Library) and Ms. Mirka Plecitá from the 3rd Faculty of Medicine, Charles University, Prague and Arsen Pankovich, MD. I also wish to thank Ms. Ludmila Bébarová and Chris Colton, MD for editing the English version of the manuscript.

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  1. Department of Surgery, 1st Faculty of Medicine of Charles University and Thomayer University Hospital, Videnska 800, 140 59, Prague 4, Czech Republic

    Jan Bartoníček

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Bartoníček, J. Early history of operative treatment of fractures. Arch Orthop Trauma Surg 130, 1385–1396 (2010). https://doi.org/10.1007/s00402-010-1082-7

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