In 1852, the Dutch military surgeon Matthysen devised a method to coat and infuse cotton bandages with gypsum to make the first casting bandages. 6,7 The use of plaster was first described in 1798 by British surgeons who had observed Persians using gypsum. 3 Bandages with lime and egg white have also been recorded by Arabic physicians. 5Įarly methods to stabilize fractures recorded by Hippocrates included linen splints stiffened with gum and plaster bandages suffused with resins, gums, and waxes. Although lay bonesetters have not been accepted by many mainstream medical communities, 4 present-day bonesetters in developing nations may still have their services preferred over modern medical techniques. 3 In developing nations, “bonesetters” in Asia, Africa, and in native populations of North and South America have typically been non-medically trained practitioners treating fractures and reducing joint dislocations with skills developed using an apprentice model. 3 He noted the five following principles of care: antisepsis, reduction, traction, bandaging, and splinting. 2Īt approximately 400 b.c., Hippocrates wrote three books “Fractures,” "Articulations, and “Instruments of Reduction” for fracture management. 1 Egypt was also the site of the earliest examples of active fracture care (e.g., splints) on an unhealed femur fracture, dated around 300 b.c. 1 The earliest documentation of fracture care was in the Egyptian “Edwin Smith” papyrus, circa 1600 b.c. Through the 20th century, the nonsurgical treatment of closed fractures (i.e., when bone is broken, but skin intact) have been the standard of care. This may be of particular benefit to patients with higher surgical risks, minimizing exposure to treatments that are not only more invasive and expensive, but that can impose greater postoperative risks. Nonoperative methods for closed fractures can sometimes be more safely delivered even with more difficult fractures. CONCLUSIONSīased on the results of this literature review, orthopedic providers should consider the preferable outcomes associated with nonoperative fracture management such as lower infection rates, the possibility of rapid functional improvements and lower healthcare costs. In this paper, the authors review the history of closed extremity fracture treatments, outline contemporary studies regarding treatments of non-displaced fractures, and discuss the recent literature that has informed orthopedic surgeon-patient decision-making discussions regarding closed fracture management. More recently, there has been an increased promotion in the medical literature to evaluate the clinical outcomes of nonsurgical treatment of common upper and lower extremity closed fractures. Over the last 150 years, aseptic technique, anesthesia, antibiotics, and internal implants have changed how orthopedic specialists approach fracture care. Fracture treatment has been documented since the times of ancient Egyptian and Greek civilization, with fracture reduction techniques and the apparatus for immobilization developed over three millennia.
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