SH17 FRACTURE FIXATION THROUGH THE AGES

Throughout the ages, immobilisation has been flagged as a key ingredient for successful fracture management. The means by which this is achieved, however, and the duration of immobilisation have changed greatly, and are examined in this article. The first man to describe the reduction and immobilisation of fractures was the Ancient Egyptian Imhotep around the time of 3000 BC. He wrote about fixation using wooden splints and bandages for at least two to three months, which undoubtedly successfully treated the fracture, but at the expense of sacrificing soft tissue integrity. The same mistake continued for centuries, with casts being made of widely varying materials including stone, cardboard and linen dipped in egg white, resins and even blood to achieve rigidity. It was not until the early 19th century when the famous military surgeon Seutin popularised the belief that prolonged immobilisation and bed rest was actually detrimental to fracture healing, and he advocated early mobilisation in starch bandages. This was soon followed, in 1852, by the development of the Plaster of Paris cast as we know it, by Matthysen. He described strips of coarse meshed cotton, rolled in plaster and wet, to allow rapid moulding around a fracture site – a property of great importance on the battlefield. Whilst operative techniques of fixation have developed and progressed from these times, little has changed in terms of casts. It seems that Paré may have been right after all, when he wrote ‘I dress it, but God cures it’.