1. The document discusses the principles of fracture treatment established by the AO study group in the 1950s, including anatomical reduction, stable internal fixation, preservation of blood supply, and early pain-free mobilization. 2. It explains the two modes of fracture healing - direct and indirect - and how the type of stability provided by fixation determines which type of healing occurs. 3. Minimally invasive techniques like MIPO and LISS aim to provide stability while minimizing soft tissue disruption, allowing for indirect reduction and a biological response of callus formation.

1. Indian Pre-Basic Course:
PRINCIPLES OF
FRACTURE TREATMENT
( CONCEPTS )
PROF.M.Sudhakar Shetty
M.S(Orth) D.Orth., F.I.C.S.,
M.Ch Orth(Liverpool)
MSS

2. MSS

3. INTRODUCTION
 AO STUDY GROUP 1950 ‘S.
 Maurice E. Müller, Hans
Willenegger, Martin Allgöwer,,
Robert Schneider and Walter
Bandi.
 Arbeitsgemeinschaft fur
Osteosynthesefragen
 KNOW THE REASON FOR FAILURE
AND METHODS TO PREVENT IT .
MSS

4. Ideal management of fracture
 The revolution continues -
methods are evolving,
principles remains the same.
 Proper understanding of the
personalities of the fracture and
the injury is the prerequisite.
MSS

5. FRACTURE DISEASE.
 PAIN AND LACK OF
PHYSIOLOGICAL
CHALLENGE TO BONE &
MUSCLE COMPLEX.
 EDEMA.
 SOFT TISSUE ATROPHY
 OSTEOPOROSIS.
MSS

6. DISABILITY
FRACUTR
E
DISEASE .
> MALUNION
OR NONUNION
MSS

7. LIFE IS MOVEMENT ,
MOVEMENT IS LIFE.
 GUIDING PRINCIPLE
FOR ALL FRACTURE CARE..
MSS

8. TO ACHIVE FREEDOM FROM
PAIN.
STABLE INTERNAL FIXATION
DURING BONE HEALING AND
ADEQUATE SOFT TISSUE CARE
MSS

9. EARLY PAIN FREE
MOBILIZATION
INCREASE BLOOD SUPPLY
ARTICULAR NUTRITION.
PREVENT OSTEOPOROSIS
PREVENTS FRACTURE
DISEASE
MSS

10. Modes of Fracture
Healing
Based on mechanical environment,
2 ways of bone healing
Direct Indirect
(primary) (secondary)
bone healing bone healing
MSS

11. MSS

12. ABSOLUTE STABILITY
Complete absence of displacement
between bony fragments
Direct bone healing
MSS

13. DIRECT BONE HEALING
MSS

14. MSS

15. INDIRECT BONE
HEALING
MSS

16. MSS

17. MSS

18. FOUR FOUNDING
PRINCIPLES
1. Anatomical reduction.
2. Stable internal fixation.
3. Preservation of the
blood supply.
4. Early active pain free
mobilization.
MSS

19. For affective application of the concepts
clear understanding that
 Articular and diaphysis fractures have very
different biological requirements.
 Type and timing of surgical intervention must be
guided by injury to soft tissue envelope.
 Physiological demand of the patient.
MSS

20. ANATOMICAL
REDUCTION
 JOINT FRACTURES
– Articular cartilage does not remodel .
Incongruity becomes permanent and can
lead to post traumatic arthritis.
– Perfect anatomical restoration and
freedom of joint motion can only be
obtained by internal fixation –
Sir John Charnley
MSS

21. ARTICULAR FRACTURE
ANATOMICAL REDUCTION AND STABLE INTERNAL FIXATION
- AO
MSS

22. ANATOMICAL REDUCTION
 LENGTH,ROTATION, AXIAL ALIGNMENT.
 CORTICAL CIRCUMFRENCE
RECONSTRUCTED TO ACHIVE MECHANICAL
STRENGTH.
MSS

23. ANATOMICAL
REDUCTION
LENGTH,
ROTATION,
AXIAL
ALIGNMEN
T
MSS

24. STABLE INTERNAL
FIXATION
 ADEQUATE STABILITY
TO MAINTAIN LENGTH,
ROTATION.
 ABSOLUTE STABILITY
‘LAG SCREW, PLATING”
DIRECT HEALING.
 CALLUS FREE HEALING
IS NOT THE MAIN AIM.
MSS

25. STABLE INTERNAL
FIXATION
MECHNICAL ERA
(ABSOULTE STABILITY AND
PRIMARY BONE HEALING )
BIOLOGICAL ERA
(RELATIVE STABILITY AND INDIRECT
BONE HEALING)
MSS

26. ATRAUMATIC SURGICAL
TECHNIQUE
 INDIRECT
REDUCTION.
 MINIMAL
EXPOSURE.
 PERCUTANEOUS
SCREW FIXATION
MSS

27. ATRAUMATIC SURGICAL
TECHNIQUE (INTERNAL
FIXATOR)
 REDUCE
CONTACT
BETWEEN THE
“PLATE BODY”
CONTACT TO
ISOLATED
POINTS.
MSS

28. MINIMALLY INVASIVE PLATE
OSTEOSYNTHESIS (MIPO)
 MIMICK ALL ADVANTAGES OF
NAIL
1. MINIMAL EXPOSURE.
2. CLOSED SURGICAL TECHNIQUE.
3. INDIRECT REDUCTION.
4. SPLINTING OF FRACTURE
5. RAPID CALLUS FORMATION
MSS

29. ATRAUMATIC SURGICAL
TECHNIQUE(INTERNAL
FIXATOR)
 SUBMUSCULAR
APPROACH--LISS
 COMBINATION
PLATE HOLE-LCP
MSS

30. EARLY PAIN FREE
MOBILIZATION
“functional
after
treatment.”
Early mobilization prevents :
FRACTURE DISEASE, pressure sores,
pulmonary problems and blood clots

31. INDICATION FOR
INTERNAL FIXATION
 LONG LASTING IMMOBILISATION OF
SOFT TISSUE.
 LOAD BEARING ARTICULAR
SURFACES.
 EXACT AND
STABLERECONSTRUCITON
( FOREARM# , SUPRACONDYLAR FEMUR#).
MSS

32. Summary
“3 Surgeons with 4 Principles”
1. Anatomical reduction.
2. Stable internal fixation.
3. Preservation of the blood supply.
4. Early active pain free mobilization .
MSS

33. THANKS FOR
LISTENING
ANY QUESTIONS?........
MSS