The document discusses principles of bone healing and fracture fixation. It describes two types of bone healing: primary healing which occurs with rigid fixation and no callus formation, and secondary healing which involves callus formation with more flexible fixation methods. It also outlines the four principles of fracture fixation established by the AO foundation: restoring anatomy, providing stability, preserving blood supply, and early mobilization. The document further provides examples of common upper and lower limb fractures and how they are typically fixed surgically with plates, screws and other hardware to reunite bone fragments and enable healing.

1. Jarrad Stevens
Orthopaedic Surgeon
Why did you fix it like that?
David Slattery
Orthopaedic Surgeon

2. 1300 BONEJOINT
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3. Understanding Bone healing
Principles of Fixation
Upper Limb
Lower Limb
Pelvis
Paediatrics

4. Jarrad Stevens
Orthopaedic Surgeon
Hip|Knee|Trauma
Understanding
Bone Healing

5. When bone is fracture and then anatomically
realigned and held compressed. The normal
remodeling of bone occurs (Haversian
remodeling) and no callus is formed. Strain less
than 2% and absolute stability is required
Primary Bone Healing

6. Secondary bone healing (strain is between 2%-
10%)involves responses in the periosteum and
external soft tissues – callus formation occurs.
With non-rigid fixation, as braces, casts, external
fixation, bridge plating, intramedullary nailing.
Secondary Bone Healing

7. Arbeitsgemeinschaft für Osteosynthesefragen
The four AO principles of fracture fixation:
• Fracture reduction to restore anatomical
relationships.
• Fracture fixation providing absolute or relative
stability as the “personality” of fracture, patient
and injury requires.
• Preservation of blood supply to soft tissues and
bone.
• Early and safe mobilisation
Principles of Fixation

8. Jarrad Stevens
Orthopaedic Surgeon
Hip|Knee|Trauma
Upper Limb
Warning: Graphic Surgical Images

9. Midshaft Clavicle Fracture
Clavicle Plate: Can return to activities fairly
quickly after operation, normally sling for
comfort for 2 weeks then active ROM

10. Lateral Clavicle Fracture
Hook plate: Limited over head activities for 3
months and then plate removed.

11. Humeral Head
Proximal Humerus Locking plate: The screws
lock into the plate strengthening the construct.
Pendular ROM for 3-6 weeks before active ROM

12. Syndey Harbour Bridge

13. GT Fracture
Insertion of the Rotator cuff
may alter rehabilitation

14. Humeral Shaft
Bridging Fracture fragments to
allow for secondary bone healing
‘Relative stability’

15. Distal Humerus
Hook plate: Limited over head
activities for 3 months and then
plate removed.

16. Distal third Humerus
Fracture Specific
Plate – radial
nerve at risk –
absolute stability
interfrag screws

17. Olecranon Fracture
Olecranon Fractures – Tension Band Wire,
designed for early ROM, often needs to be
removed once healing has been achieved.

18. Proximal Ulna Fracture
Proximal Ulna Fractures
aim to start ROM early,
Sometimes need the
plate out

19. Where does Ortho fit?
Both Bone Forearm fracture: plates
are used to compress the fracture,
early ROM is normally achievable

20. Warning: Graphic Surgical Images

21. Distal Radius Fractures
Bridging for secondary bone healing

22. Wrist Fractures
Restoration of the anatomy for return to
function and early mobilisation

23. Jarrad Stevens
Orthopaedic Surgeon
Hip|Knee|Trauma
Lower Limb

24. Femoral Shaft

25. Pathological Fracture
Tumour has eroded
the bone causing it to
fracture. The bone is
not expected to heal
in this situation

26. Patella Fracture
Patella Fracture: ‘Figure of 8’ tension band wiring
– can mobilise early, but metalware often has to
be removed

27. Warning: Graphic Surgical Images

28. Osteochondral fracture
OCD is fixed with small
‘headless screws’

29. Tibial Plateau Fracture
Typically patients are advised not to weight bear
while this fracture heals

30. Midshaft Tibial Fracture
Patients can
normally walk
on this
construct
within a
couple of
weeks

31. Distal Third Tibia
Open Fracture fixed with bridging plate

32. Warning: Graphic Surgical Images

33. Clean open fractures first

34. Warning: Very Graphic Surgical Images

35. Ankle Fracture Dislocation

36. Ankle Fracture Dislocation
When

37. Open Fractures

38. Surgical Approach

39. Surgical Approach

40. Surgical Approach