Discussion

Abstract

In 1913, the Belgian surgeon Lambotte 1 Lambotte A Chirurgic Operatoire Des Fractures. Masson, Paris, France1913 Google Scholar first advocated the operative treatment of orthopedic fractures to eliminate the consequences of “fracture disease.” Closed treatment with immobilization of fractures was noted to cause progressive loss of mineralized tissue, risk of nonunion, decreased muscle mass and strength, and loss of joint mobility. Immobilization of the orthopedic patient also resulted in a high incidence of infection, pneumonia, and other systemic complications. In post-World War II Europe, the operative treatment of fractures finally emerged with the development of devices to provide stable internal fixation of orthopedic injuries. These advances were a result, in part, of improvements in anesthesia, infection prophylaxis, and instrument technology. The work of Muller et al 2 Muller M Allgower M Schneider R et al. Manual of Internal Fixation. Springer, New York, NY1979 Crossref Google Scholar and Perren et al, 3 Perren S Rahn B Cordey J Mcchanil und Biologie des Frakturheilung. Fortschr. Kiefer-u. Gesichtschir. XIX. 1975 Google Scholar among others showed that fractures healing under completely stable internal fixation and full function formed no callus and did not show signs of fracture disease. 2 Muller M Allgower M Schneider R et al. Manual of Internal Fixation. Springer, New York, NY1979 Crossref Google Scholar , 3 Perren S Rahn B Cordey J Mcchanil und Biologie des Frakturheilung. Fortschr. Kiefer-u. Gesichtschir. XIX. 1975 Google Scholar Spiessl and others 4 Spiessl B Internal Fixation of the Mandible. Springer, New York, NY1989 Crossref Google Scholar brought these concepts to the treatment of maxillofacial fractures in the past 30 years. Outcome studies, medical economic analysis, new devices and materials, and refinement of technique continue to modify the concepts of operative fracture management. Of importance is that review of outcome studies on mandible fractures have not shown a lower incidence of complications, such as nonunion, in patients treated with rigid internal fixation. 5 Assael L Treatment of mandibular angle fractures: Plate and screw fixation. J Oral Maxillofac Surg. 1994; 52: 757 Abstract Full Text PDF PubMed Scopus (32) Google Scholar Thus, a century-long debate continues about the operative treatment of fractures which is further defined in this illuminating article by Villarreal et al.