Muller, Proc R Soc Med 1963 - Internal Fixation for Fresh Fractures and for Non-Union

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Internal Fixation for Fresh Fractures and for Non-Union

Muller·Proc R Soc Med·1963·38 citations·Review article

Free Full Text·DOI·PubMed

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Muller lays out the founding principles of the AO/ASIF group for internal fixation of fresh fractures and non-unions. He argues that anatomic reduction plus absolute stability allows immediate mobilization and prevents 'fracture-disease.' The paper introduces the concept of primary bone healing and defends interfragmentary compression using clinical series and animal experiments.

Key Findings

In a series of 188 tibial fractures stabilized by compression screws or plates, over 70% achieved primary bone healing with no visible external or internal callus. None developed Sudeck's dystrophy, and no external support beyond a weight-relieving caliper was used.
More than 100 non-unions and pseudarthroses united within months using compression fixation alone. No bone graft, no resection of interposed scar or sclerotic bone, and no external support were needed, and patients mobilized within the first 8 postoperative days.
Cortical bone healed without periosteum or endosteum when both were excluded by a Millipore membrane in a pig radius defect, showing no necrosis at 30 days. This is the histologic basis for 'primary bone healing' by direct haversian remodeling.
Self-tapping screws in thick cortical bone reached over 180°F, hot enough to kill bone cells before the screw seats. Redesigned serrated screws inserted through pre-drilled, hand-tapped holes stayed fully anchored at 3 months, while ordinary self-tapping screws showed only connective tissue between threads.
Interfragmentary compression did not decay over 3 months of healing. In a sheep metatarsal osteotomy fixed at 40 kg, measured pressure tended to increase rather than diminish, countering the fear that compression is quickly lost to resorption.
Compression across an epiphyseal screw produced new bone, not osteolysis, with denser lamellae on the pressure side. Muller uses this to argue compression stabilizes rather than destroys bone.
Discussant Nicol fixed only 23% of 1,414 long-bone fractures, ranging from 64% of ankles down to just 2.4% of tibiae. He argued the subcutaneous tibia does badly when fixation fails and that rigidity, not compression, is the true osteogenic factor.

Board PearlAbsolute stability with interfragmentary compression produces primary bone healing — cortical union without visible callus — and can unite non-unions without grafting.

Internal Fixation for Fresh Fractures and for Non-Union

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|

Internal Fixation for Fresh Fractures and for Non-Union

Muller·Proc R Soc Med·1963·38 citations·Review article

Free Full Text·DOI·PubMed

|

Muller lays out the founding principles of the AO/ASIF group for internal fixation of fresh fractures and non-unions. He argues that anatomic reduction plus absolute stability allows immediate mobilization and prevents 'fracture-disease.' The paper introduces the concept of primary bone healing and defends interfragmentary compression using clinical series and animal experiments.

Key Findings

In a series of 188 tibial fractures stabilized by compression screws or plates, over 70% achieved primary bone healing with no visible external or internal callus. None developed Sudeck's dystrophy, and no external support beyond a weight-relieving caliper was used.
More than 100 non-unions and pseudarthroses united within months using compression fixation alone. No bone graft, no resection of interposed scar or sclerotic bone, and no external support were needed, and patients mobilized within the first 8 postoperative days.
Cortical bone healed without periosteum or endosteum when both were excluded by a Millipore membrane in a pig radius defect, showing no necrosis at 30 days. This is the histologic basis for 'primary bone healing' by direct haversian remodeling.
Self-tapping screws in thick cortical bone reached over 180°F, hot enough to kill bone cells before the screw seats. Redesigned serrated screws inserted through pre-drilled, hand-tapped holes stayed fully anchored at 3 months, while ordinary self-tapping screws showed only connective tissue between threads.
Interfragmentary compression did not decay over 3 months of healing. In a sheep metatarsal osteotomy fixed at 40 kg, measured pressure tended to increase rather than diminish, countering the fear that compression is quickly lost to resorption.
Compression across an epiphyseal screw produced new bone, not osteolysis, with denser lamellae on the pressure side. Muller uses this to argue compression stabilizes rather than destroys bone.
Discussant Nicol fixed only 23% of 1,414 long-bone fractures, ranging from 64% of ankles down to just 2.4% of tibiae. He argued the subcutaneous tibia does badly when fixation fails and that rigidity, not compression, is the true osteogenic factor.

Board PearlAbsolute stability with interfragmentary compression produces primary bone healing — cortical union without visible callus — and can unite non-unions without grafting.

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