The history of fracture fixation of the hand and wrist.
The treatment of fractures of the hand and wrist has evolved over the centuries from one of rest and immobilization to internal fixation and early motion. Although today's technology (anesthesia, antibiotics, metal implants) has allowed us more freedom in treating these injuries, a number of our patients continue to experience stiffness, nonunion, malunion, and chronic pain. We explore the techniques used to treat hand and wrist fractures throughout the centuries and determine what beneficial aspects of fracture care have been maintained and those that have changed as a result of new technology. We are now realizing that rigid immobilization of fractures at the expense of the soft tissues can be just as damaging as the ancient physician's techniques of prolonged immobilization with frequent dressing changes. New implants and lighter cast materials have allowed improved digital motion and early functional use of the extremity. This has become especially important in the treatment of the aging population, which demands improved function and a quicker return to activities. The optimal treatment of these fractures for each patient remains elusive, however, and there remains a tendency to rely on technology at the expense of sound clinical care. We must not loose sight of the goals of fracture treatment and should heed the lessons learned throughout centuries of treating these injuries.


METHODS
Level V (expert opinion).
Harness
Neil G
NG
Hand Surgery Service, UCLA David Geffen School of Medicine, Los Angeles, California, USA. Neil.G.Harness@kp.org
Meals
Roy A
RA
D002370:Casts, Surgical / Q000266:history; D005593:Fracture Fixation, Internal / Q000266:history*; D006230:Hand Injuries / Q000266:history / Q000601:surgery; D049671:History, 18th Century; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D049690:History, Ancient; D006801:Humans; D007103:Immobilization; D009426:Netherlands; D011885:Radius Fractures / Q000266:history / Q000601:surgery; D014954:Wrist Injuries / Q000266:history / Q000601:surgery