Extract
Although great advances have been made in fracture care, treatment failures
are not uncommon. High-energy injuries that result in bone devitalization, or
open fractures that are associated with bone loss, can be followed by
postoperative infection or, if treated with inadequate methods, may result in
the development of a pseudarthrosis. These complex problems require much care
before healing can occur. Since the development and use of stainless steel in
orthopaedics in the 1920s, surgeons have tried to use advances in metallurgy
and implant design to assist fracture-healing. Nails were improved with
locking technology, while simple plates were transformed into blade plates,
compression plates, and now locking plates. External fixation was
revolutionized by G. Ilizarov with the development of distraction
osteogenesis. Stainless steel itself was altered to create vanadium,
Vitallium, and now titanium alloys. While all of these techniques have
decreased the rate of nonunion, they have not completely solved the problem
because there are limits to what metal can do to affect the biology of
fracture-healing.