Observations concerning different patterns of bone healing using the PointContact Fixator (PC-Fix) as a new technique for fracture fixation

The recent trend in all surgical disciplines has been the development of te chniques in minimally invasive surgery and the optimal maintenance of the b lood supply to the bone fragments during osteosynthesis. Currently, the Poi nt Contact Fixator (PC-Fix) has been introduced as a new implant for the st abilization of forearm bones. This plate-like splint and screw fixation sys tem, which actually acts as an internal fixator, is characterized by minimi zed isolated contacts to the bone and proven angular stability of the monoc ortically locked screws. By using the PC-Fix, a further reduction of damage to the blood supply to the bone is achieved. Since 1994,38 patients have been treated with this new device; we have revi ewed the radiographs of 52 consolidated forearm fractures/osteotomies in ac cordance with the patterns of bone healing associated with the different me thods of implant application according to the fracture type. In the groups in which traditionally precise reduction, interfragmentary compression and stable fixation was achieved (N=31), we found in 71% an absence of perioste al callus (direct bone healing). In the groups in which compression and adaptation were combined, or even ma in fragments adapted without compression, with wedges remaining unreduced i n soft tissue connection (N=21), we found a visible external callus in 81% (indirect healing) (P = 0.002). Indirect healing after internal fixation is no longer regarded as a disturb ance to healing, but is a goal in itself. The appearance of callus is a wel come sign indicating a prompt and positive reaction in the course of bone u nion which will lead to progressive fracture immobilization. When using the PC-Fix in a "biological way", callus formation and solid union take place earlier than in conventional plating. The new internal fixator offers substantial technical and mechanical advant ages in fracture treatment. Therefore, it is an ideal implant to satisfy th e requirements of modern biological osteosynthesis without compromising the restoration of axial alignment, rotation, length and postoperative functio nal treatment.