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Orthopedic surgery requires a wide variety of implants to reconstruct the musculoskeletal system. Each area has unique mechanical requirements, but many surgical principles remain constant throughout the appendicular skeleton (extremities), and many of these principles are carried over into the axial skeleton (spine). The universal goal of surgical intervention in the spine or the extremities is to provide painless musculoskeletal function.


Implants are used for joint and ligament reconstructions, soft tissue repairs, fusion, and fracture fixation. Postoperative complications related to orthopedic devices that are commonly seen in an ED include implant failure, loss of fixation, nonunion, malunion, and infection. Unlike other body tissues, musculoskeletal infections most often present with severe pain and pressure (abscess/pyarthrosis) or with a draining sinus tract, and present less frequently with fever or sepsis. This is also true of infectious complications related to orthopedic devices.


Whether the goal is fracture healing or joint fusion (arthrodesis), there are several implant options that one uses to achieve these goals. Table 275.1-1 reviews the categories of bone-to-bone fixation. The type of implant dictates the relative stability of the bony interface, thereby dictating the type of healing, the time of immobilization, and the return to function.

Table Graphic Jump Location
Table 275.1‐1 Stabilizing Bone‐to-Bone: Common Orthopedic Implants, Expected Time to Heal, and Radiographic Findings  

Internal Fixation


Plates and Screws


Plates with screws are used to provide stability while bone unites in the setting of fracture, osteotomy, or joint arthrodesis. When managing fractures with plates, the bones are often placed in direct contact, and healing usually occurs without the large amount of callus formation seen with casting or intramedullary nailing (Figure 275.1-1). Therefore, it is often difficult to determine when fracture union is complete, and it is not uncommon for the fracture line to be visible >1 year after surgery (Figure 275.1-2).


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