International Journal of Biomedical And Advance Research ISSN: 2229-3809 (Online) Journal DOI:10.7439/ijbar CODEN:IJBABN IJBAR (2014) 05 (03) www.ssjournals.com Review Article Internal fixation: An evolutionary appraisal of methods used for long bone fractures Seemab Mehmood, Umar Ansari * , Murtaza Najabat Ali, Nosheen Fatima Rana Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Pakistan *Correspondence Info: Umar Ansari Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Pakistan E-mail: ansari@smme.nust.edu.pk 1. Introduction 1.1 Bone fracture Bone fracture may occur due to diseased conditions like cancer, osteoporosis or external forces causing the bone to lose its integrity by imparting greater impact. The AO system of classification of fractures enlists all the metaphyseal/diaphyseal and articular fractures and their types. Types of fracture include; Simple fracture, open fractures (hard to treat). Comminuted fracture requires insertion of fixation device whereas compound fractures can be healed with fixation plates 40. 1.2 Fracture Management There is an uprising increase in the instance of trauma and injury. Therefore to accurately ensure the fracture management; fixation or reduction of fracture to reinstate anatomical associations while maintaining the stability of the fixation device or the splintage and to preserve the blood supply of soft tissues and bone alongside by efficient reduction techniques is advantageous. Fracture management is of important concern and has been going on since centuries with the concept of fracture healing via plating systems evolving since 1800s. ―AO manual of Internal Fixation‖ proposed in 1965 describes the major goals of fracture management which facilitated to standardize the set of rules for ―osteosynthesis‖. This manual was proposed by the Swiss group of surgeons who formulated an assembly in 1958 known as the ―Association for the study of Internal Fixation‖ (AO/ASIF). The principles stated in the manual were:  Anatomic Reduction  Absolute stability with inter-fragmentary compression  Preservation of blood supply, callus formation through minimal plate to bone contact  Early mobilisation There are many treatment modalities as explained below: 1.2.1 External Fixation Fracture management using a device which is positioned outside the skin to stabilise the bone fragments through wires or pins associated to one or more longitudinal bars / tubes is known as external fixation. 1.2.2 Internal Fixation Internal fixation devices work on the standard of load sharing either static or cyclic which is either applied through compression or torsion 37 . Internal fixation devices offer sustenance 'til bone is entirely rehabilitated. These can also be kept throughout the life time of a recipient. Many types of internal fixation devices are accessible a) Wires and Pins: They are used for the fracture of the small bones e.g. of the foot or hand where large fixation devices are difficult to insert. b) Plates: They are used for metaphyseal/diaphyseal fractures or too long bone fracture. It works as the splint as external fixation device. It is inserted through the screws and fixation is achieved with the resistance force between the screw and plate. c) Screws: Screws can be implanted without plate to cure fracture. In any joint fracture or uneven surfaces like knee joint hip joint, pelvis etc., and screws are easy option. Biodegradable screws are also available so that second orthopedic surgery can be avoided. d) Rods: When bone weakens or loses its strength to sustain load, rods are inserted in to the long bones to provide functional support. Abstract Internal fixation has been playing a pivotal role in orthopedic surgical procedures, yet the evolution of these devices has been relatively short. There is an uprising increase in the instance of trauma and injury. Therefore to accurately ensure the fracture management; fixation or reduction of fracture to reinstate anatomical associations while maintaining the stability of the fixation device and to preserve the blood supply of soft tissues and bone is advantageous. Internal fixation devices offer sustenance until the bone is entirely rehabilitated. These can also be kept throughout the life time of a recipient. This review focuses on an evolutionary perspective of different devices used surgically for the repair of long bone fractures. Keywords: Internal fixation, metaphyseal, diaphyseal, osteosynthesis