Indications

Internal fixation is often the best means of holding a reduced fracture. It may be indicated for:

• fractures that require open reduction - only rarely does internal fixation not follow operative reduction
  
  
• displaced intra-articular fractures which are sufficiently large to interfere with joint function
  
  
• major avulsion fractures with disruption of an important muscle mechanism or ligament - for example, those of the greater tuberosity of the humerus, the patella, the olecranon, or the intercondylar of the tibia
  
  
• Salter Harris type III and IV epiphyseal fractures - require accurate anatomical reduction to avoid epiphyseal arrest or deformity
  
  
• fractures known to heal poorly - for example, those of the femoral neck, Galeazzi fractures, amd Monteggia fracture dislocations
  
  
• delayed union - may respond to internal fixation and a bone graft
  
  
• pathological fractures - underlying bone disease may prevent healing
  
  
• multiple fractures - where both bones of one limb, or the same bone in both limbs are fractured, it may be best to fix one and manage the other conservatively
  
  
• fractures in patients who are difficult to nurse - due to disability, infirmity, or psychiatric problems - may be unable to tolerate cast immobilisation or to co-operate with traction methods