Until 1842 there was no general anaesthesia in the West.
Antibiotics were only used widely after 1935 and safe modern antibiotics from 1955.
Surgery for fractures prior to 1935 was a very high risk proposition with a very high death rate.
Modern surgery for fractures started in the 1960s and evolve enormously until the early 2000s.
For the last 20 years there has been a more gradual evolution and expansion of use of surgery for fractures.
Some would argue we have reached "peak" surgery with few advances possible from here.
It is always good to consider non-surgical options.
Most fractures can be treated without surgery. There are 3000 years of history documenting this.
When considering surgery the benefit must outweigh the risks.
Having a 'modern' operation does not automatically guarantee a better outcome.
Studies of wrist fractures show that for most fractures the functional outcome of using a plaster cast is the same as an operation.
Collar bone (clavicle) fractures are commonly operated upon now, but almost all of these will heal without surgery, and for most people with minimal loss of function. Clavicle surgery can have huge complications.
Most spinal fractures can be treated with pain killers and early movement. Even using braces has been shown to make little difference to long term outcomes.
It is important to discuss non-surgical options with Mr Knight
People having fracture surgery need to have patience, persistence and perspective.
There is a surgical adage: "We heal with steel". Nothing could be farther from the truth. The end of the operation is just the end of the beginning.
Surgery is an injury added to your existing problem. You have to recover from both to get maximum benefit.
It is common to take 12-24 months to obtain full recovery.
It isn't just the bone that gets broken. All the soft tissue around the bone is injured.
Psychological recovery after fractures can affect physical recovery. Depression is common and it slows down activity, which slows down recovery.
Fracture surgery has a much higher complication rate than other surgery.
Infection and failure of the bones to join are common reasons for repeat surgery.
Repeat surgery for removal of implant metal is not routine anymore, but if undertaken further delays final recovery.
The best place to find this information is under the "Consent" page. Click here to go there.
There are some fractures that are always better with surgery.
Broken hips, thigh bones and shin bones are almost always better with surgery.
Spinal cord injury in association with a fracture is always operated upon.
Fracture associated with infection or tumour almost always requires an operation.
If you need an operation you are lucky. Right now surgeons are safer and more technically competent that we have every been in history, and we are only getting better with time.
The oldest person Mr Knight has performed a hip replacement for a fracture, was 108 years old.
It is a person's global health and their pain disability that dictates whether they should have an operation not their age.
For each decade of age over 60 there is a 100% increase in the risk of surgery, however this applies to populations not to individuals.
Some 90 year olds are healthier than some 70 year olds.