It is over thirty years since Arbuthnot Lane published his Operative Treatment of Fractures; but we still cannot compare conservative and operative principles from the viewpoint of basic science because the fundamental nature of fracture repair still eludes us. The best we can do is to compare the results of clinical practice; but there are so many variables (comminution, sepsis, mechanical details of the operation, blood supply, level of fracture, different observers, etc.) that a series of one or two hundred cases, which is a large series for any one operator, is soon reduced to statistical insignificance. Attempts to control the conditions of the fracture by using experimental animals have yielded nothing of importance compared with what we have learned ‘the hard way’ by developing operative techniques on the human subject.

The followers of Lane and Sherman believed that the failures of internal fixation would ultimately be eliminated by improved technique. We now know that internal splints are exposed to truly enormous forces and are subject to the phenomenon of failure by fatigue. Improvements in the design of plates and screws have reduced, but not eliminated, the mechanical failures which were common when techniques derived from the woodworker were used. The change to using electrolytically inert metals has only slightly diminished our problems, though there is no excuse for returning to the brass screws and reactive steel plates with which Lane himself achieved sufficient success to establish the method.