[30 years of osteosynthesis: developments in surgical fracture treatment over the last three decades]

The primary objective of surgical fracture management by means of osteosynthesis used to be achieving the maximum fracture stability possible; this maxim has given way over time to a more biological approach. Advances in the technical development of implants, including their material properties, have created the conditions for osteosynthetic procedures with minimal soft tissue disruption. The technical conditions of modern external fixator systems allow an unlimited number of assemblies matched to the requirements of each individual patient. Special changes in plate holes and interlocking nails have increased the angular and axial stability of the assembly and are particularly suitable for fractures with inferior bone quality, for example in the case of osteoporosis. Navigated osteosynthetic procedures permit reliable and low-risk implantation of implants in anatomically challenging regions. Out of the sometimes distressing experiences of early osteosynthetic procedures where postoperative radiographs showed delayed or absent bone healing, grew the realisation that good vascularity of the soft tissues and bones is a prerequisite for good healing and a timely and favourable outcome. This means that in each individual case an appropriate implant and stabilization method should be selected by the surgeon, who is not only familiar with anatomy but also with soft-tissue-conserving (minimally invasive) operative techniques.