The evolution of indirect reduction techniques for the treatment of fractures

During the last decade, classic AO/ASIF techniques for internal fixation sh ifted from direct reduction and rigid fixation to biologic internal fixatio n using indirect reduction techniques. Biologic internal fixation is charac terized by the preservation of bone and soft tissue vascularity and relativ e rather than absolute mechanical stability, Reduction is achieved by using soft tissue traction while obtaining axial and rotational alignment and th e correct length. Stabilization is performed when possible by compression p lating for load sharing or by bridge plating in comminuted fractures, Advan cements of these techniques and the development of newer implants that mini mize vascular damage have contributed to the development of biologic intern al fixation, By using indirect reduction, by using longer plates to improve the mechanical leverage, and by applying fewer screws to avoid unnecessary damage to the bone, fracture union rates were high. There also was a decre ased need for supplemental bone grafting, All of these factors provided sta ble fixation and allowed early motion.