Osteosyntese

Osteosynthesis, also called osteosyntese, is a surgical method to fix and stabilize bone fragments using mechanical devices to achieve accurate alignment and enable bone healing. It encompasses internal fixation, where implants are placed inside the body, and external fixation, where devices brace bones from outside the skin.

Internal fixation commonly uses plates and screws, intramedullary nails, and wires. Plates are contoured to the bone and fixed with screws to hold fragments in position. Intramedullary nails provide central, load-sharing stabilization within the marrow cavity. External fixation uses pins or wires connected to external frames.

Modern osteosynthesis emphasizes biological principles to preserve soft tissues and blood supply. Key aims are anatomic or near-anatomic reduction, stable fixation to permit early mobilization, and minimal disruption of the periosteal blood supply and fracture hematoma. Minimally invasive percutaneous osteosynthesis (MIPO) seeks to achieve fixation with limited soft-tissue damage.

Indications include acute fractures requiring stable alignment, complex multi-fragmentary injuries, articular fractures, nonunions, and bone defects. The choice of fixation depends on fracture pattern, bone quality, patient age, and soft-tissue condition. In pediatric patients, growth considerations guide implant selection and timing.

Complications can include infection, hardware irritation or failure, loss of reduction, malunion or nonunion, and injury to surrounding structures. Hardware removal may be required after healing in some cases.

The development of plate-and-screw constructs and intramedullary devices in the 20th century shaped modern osteosynthesis, enabling stable fixation while allowing early rehabilitation.