Bones are made up of different connective tissues, which have the ability to heal themselves during a fracture. In the case of children and young adults or mild cases fracture, splints and casts are used for the treatment.
However, in all other cases, open reduction and internal fixation are required for which orthopedic nails, wires, pins, and staples are used to give the bone anchorage points so that it can heal properly. The internal fixation depends on the type of the fracture and which bone and parts of the bone are fractured.
Nails are usually used for the fracture of long bones like the femur, humerus, tibia etc. The purpose of nails is to immobilize the bone in the correct alignment so that the bone ends do not overlap. There is no fascia or muscle interspersed between the fractured bone ends and both ends meet each other accurately to promote the callus formation. These are metal rods which are fixed in the medullary canal of the long bones to hold the fractured ends together. These are of different varieties and sizes according to the size of the bone and type of bone. Their varieties include:
Enders nail: They may be used for distal femoral, proximal humeral, subtrochanteric region of the femur and tibial shaft fractures as it provides three point fixation.
TENS nail: These are used for diaphyseal fractures of long bones, metacarpal, metatarsal fractures and complex fractures of the clavicle.
Other nail types include kuntscher nail, square nail, and rush nail.
Wires are famous among children, for example, k-wires are used in sub-trochanteric fracture of humerus common in children. The wires are flexible and easy to bend and are usually used in the fractures of those bones where weight loading is minimal.
Internal fixation using wires is mostly done for the fractures of the small bones like phalanges, metacarpals, and metatarsal. It is also used for fracture of subparts like condyles of the proximal and distal humerus.
Its types include:
Suture wire: It is used for internal fixation and tendon repair.
K- wire: It is used for both temporary, permanent fixation, and skeletal traction.
Pins are used to correct soft tissue damage and minimal bone fractures. The purpose of pins is that it provides provisional internal fixation so that it can be manipulated by further hardware use and inaccurate permanent fixation is avoided. It comes in different diameters and according to that, it can aid in screw fixation.
Various varieties include:
- Steinmann pin
- Austin Moore pin
- Knowles pin
When there is vast damage and bone is broken into fragments then staples can be used between these fragments for internal fixation and bone reconstruction. They are more useful than inter-fragmental screws in these types of cases. Staples are usually used around the joints as in ankle and foot surgeries. These staples are also used in cases of soft tissue damage.
U-type stainless steel: These are used for internal fixation and bone reconstruction.
Coventry: It is also used for bone reconstruction and also for repair of soft tissue damage.