This chapter addresses anyone who is eager to appreciate the biological and biomechanical basis of fracture managementthe why

and how of the way bone reacts to intervention thus facilitating the choice of the appropriate procedure for any fracture problem. It offers a review of the basic rationale for the interested clinical user, rather than precise data for scientists. The literature quoted contains data concerning the special features discussed. For more extensive references the scientific literature should be consulted. In spite of worldwide research, much remains unknown or controversial. We will, therefore, consider the facts and abstain from far-reaching interpretations. The main goal of internal fixation is to achieve prompt and, where possible, full function of the injured limb with rapid rehabilitation of the patient. Although reliable fracture healing is only one element in functional recovery, its mechanics, biomechanics, and biology should be understood. For biological or biomechanical reasons it is often necessary to sacrifice some strength and stiffness. For internal fixation, neither the strongest nor the stiffest implant is necessarily optimal. Internal fixation cannot permanently replace a broken bone but provides temporary support. Under critical conditions, the mechanical requirements may be more demanding than the biological advantages. Every surgeon must determine which combination of technology and procedure best fits his experience, environment, and in particular the demands of the patient.

Before choosing an implant material, several aspects have to be considered. Depending on the requirements, the stronger and more forgiving stainless steel may be preferable to the electrochemically inert and biologically superior and more deformable but less strong titanium. In other situations it may be more favorable to use titanium, especially in its pure c.p. titanium f