The operative measures necessary to dissociate fragments which have become firmly ankylosed together, and perhaps to adjacent bones as well and to saw off sufficient bone from each fragment in such planes as will restore the outline of the necessarily shortened bone, are often bloody and difficult and may be fraught with danger to important adjacent vessels and nerves.

The frequent occurrence of these cases must be well known to surgeons generally, though I can readily understand any individual deluding himself into the idea that he has managed to avoid them in his practice by some skill peculiar to himself.

Considering the unfortunate physical condition of many of these patients and the misery distress, and financial loss they and those dependent on them have experienced through the gross inefficiency of the so-called science of which they are the victims, it seems little short of ridiculous to read the statements of surgeons that such mechanical disability is a rare sequence of fracture, and that it can usually be obviated by the use of massage and passive movements at an early date.

That massage and passive movements serve to diminish the disability and pain which would otherwise ensue if these fractures were left for an indefinite period in rigid casings is quite familiar to me, but to regard such measure alone as being the best scientific treatment and not merely adjuvant, suggests a want to perception of the mechanics of the skeleton.

The second group of cases, namely that of un-united or imperfectly untied fractures, is due also to the same unscientific treatment of fractures. Looking through the text- books, I find any number of reason given for non-union of broken bones, the vast majority of which appear to be utterly without foundation any experience. The surgeon is only too anxious to lay what blame he can upon the patient or his tissue, and seems inclined to regard as possible any factor other than the obvious inefficiency of his treatment.

It may be that in some few cases of simple fracture non-union result from some cause which could not be obviated by proper treatment, but I have never come across one instance in which union would not have resulted in all probability if efficient operative measures had been adopted though a very large number have come under my observation. I would also like to express an opinion on the subject differs completely from that of those who have written about them. My experience and their statements are not be reconciled, since I believe that un-united fracture is of comparatively common occurrence.

If one sees a compound fracture soon after the receipt of the injury, the skin should be efficient cleansed, and the wound opened up and swabbed out thoroughly with tincture of iodine. This drug seems to exert a maximum amount of damage to any organisms that may be present, while it does a minimum amount of harm to the tissue. In most cases it is well to wait till the wound has healed before any attempt is made to secure the fragments together by plates and screws.

Should it be advisable to secure the fragments in apposition while the wound is doubtfully or certainly septic, I employ a long plate, and secure it by screws inserted into each fragments at as great a distance as possible from the seat of fracture. By this means even if the screws are infected the damage done by the inflammatory process is separated by a considerable intervals from the opposing surface of the fragments and so it does not interfere with the union of the bones to one another.

The screws, even though infected will retain the plate in position for a length of time sufficient to ensure union. Then they can be removed with the plate. For this reason in an infected wound, or in wound that may be infected it is wise to place the plates in such a situation that they can be removed easily should this necessity arise. When there is any evidence or suspicion of infection, some arrangement should be made for drainage, which is never called for in the case of simple fractures.

I am sorry to say that the most disastrous cases of septic infection of fractures which I have had to treat have resulted from the fouling of simple fracture during the introduction of a plate.

W. Arbuthnot Lane
Sir William Arbuthnot Lane, Bt, CB, FRCS, Legion of Honour (4 July 1856 – 16 January 1943), was a British surgeon and physician. He mastered orthopaedic, abdominal, and ear, nose and throat surgery, while designing new surgical instruments toward maximal asepsis. He thus introduced the "no-touch technique", and some of his designed instruments remain in use.
Lane pioneered internal fixation of displaced fractures, procedures on cleft palate, and colon resection and colectomy to treat "Lane's disease"—now otherwise termed colonic inertia, which he identified in 1908—which surgeries were controversial but advanced abdominal surgery.
In the early 1920s, as an early advocate of dietary prevention of cancer, Lane met medical opposition, resigned from British Medical Association, and founded the New Health Society, the first organisation practising social medicine. Through newspapers and lectures, sometimes drawing large crowds, Lane promoted whole foods, fruits and vegetables, sunshine and exercise: his plan to foster health and longevity via three bowel movements daily.