![]() Anatomical reduction of small fragments is difficult if vascular supply to the fragment is to remain intact. Small comminuted fragments incorporate quickly into the bony callus if left with a vascular pedicle. The key feature of a minimally invasive approach is preservation of the vascular supply to the comminuted fragments at the fracture site. Open surgical approaches can be either traditional or minimally invasive. When technically feasible, closed reduction and stabilization is the optimal method of treatment. The success of biologic fracture management depends on the type of surgical approach. Biologic fracture management encourages early callus formation this early callus shares the load with the implant system, thus reducing the chance of implant failure. The implant system must be able to support any amount of force placed on the fractured bone during the early healing phase, because the fracture has not been anatomically reconstructed into a solid bony column. Stabilization of fractures using the principles of biological fracture management is performed with the same type of implant systems used with traditional fracture repair, including externally and internally applied devices. Conversely, fractures reconstructed to a single fracture gap have high strain, which reduces the stimulus for bone callus formation. Preservation of multiple fracture gaps avoids high interfragmentary strain, favoring bone healing ( Figure A). 1-7 It can be used with all types of fractures, but is particularly helpful for stabilizing comminuted fractures that are difficult to reconstruct. Biologic fracture management is a technique used to optimize the effectiveness of well-documented principles of indirect bone healing. ![]()
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