Orthopaedic
Hand Service
Massachusetts
General Hospital
Internal fixation of the hand and wrist has changed
tremendously over the past four decades. Essential to this change has been the
acceptance of internal fixation as a safe, effective and viable alternative in
the treatment of many fractures of the hand and wrist. More importantly, as
technology has advanced, there has been the acceptance of the definitive place
of internal fixation with plates and screws as a primary method of management
of many fractures of the hand and wrist. Advances in material science and a
better understanding of the biology of the musculoskeletal system has lead to
an aggressive approach to many fractures of the hand and wrist, especially
those associated with soft tissue injury. It is now well recognized that early
stable skeletal fixation in the setting of complex soft tissue injury, followed
by early rehabilitation can lead to superior functional outcomes.
When plate and screw fixation systems were initially
developed for the hand, they were simply modeled after the large long fragment
fracture fixation systems.
However, with the passage of time and with a better understanding of the
structural requirements of the hand skeleton, materials and technology,
implants have been designed specifically for the hand and wrist. This review
will outline the advances in implant design and technology in the management of
fractures of the hand and wrist, along with a brief overview of salient
historical aspects of internal fixation of the hand and wrist.
Published by the New England Hand Society 2005.