In this BoardsCast episode, we begin Tobias Chapter 41 — Internal Fracture Fixation with the decision that should come before implant selection:
Strategy first. Hardware second.
Before choosing a plate, nail, or screws, the surgeon has to decide whether the fracture should be anatomically reconstructed or biologically bridged.
That starts with separating two concepts:
- Alignment = restoring length, axis, and rotation
- Apposition = restoring fragment-to-fragment contact
Alignment matters in every repair. Perfect apposition does not.
We break down:
- Why anatomic reconstruction restores both alignment and apposition
- How reconstructed bone can share load with a neutralization implant
- Why absolute stability favors primary bone healing
- The biologic price of reconstruction: more exposure, periosteal damage, fragment manipulation, and disruption of the fracture hematoma
- Why articular fractures are the major exception and demand accurate reconstruction
- How biological osteosynthesis uses indirect reduction to preserve blood supply and hematoma
- Why bridging restores length, alignment, and rotation without chasing every fragment
- How bridging promotes secondary healing and callus formation
- The difference between traditional open reconstruction, open-but-do-not-touch, and minimally invasive osteosynthesis
- Why biological fixation does not mean unstable fixation
- Why a bridging implant must carry most or all of the load until callus restores continuity
The key surgical question is not just:
“Can I reconstruct this fracture?”
It is:
“Should I reconstruct it?”
—
🎁 Simini Bonus
Claim your free sample of Simini Protect Lavage (just cover shipping):
https://www.simini.com/evaluation-kit
Listen On: Spotify | Apple Podcasts | Amazon Music
