After a fracture revision or surgery, we often get questions from patients: Why is the bone block not tightly closed? Does the fracture have to be “tightly closed”? No! The consequences of pursuing a “tight fracture”: 1. Disrupting blood circulation and forming bone discontinuity. In order to pursue the effect of fracture repositioning “tightly”, you must repeatedly repair the fracture, or open the fracture, expose the fracture end, the broken bone block to be leveled to neat, these operations will inevitably destroy the blood circulation of the bone block, so that the broken bone block becomes an “island” without blood supply, and it takes a long time for the blood vessels to grow back. Tissue healing requires an abundant blood supply, and the healing of the fracture block “island” with a broken blood supply is of course very difficult, and bone resorption can occur, which is why the fracture block is “tightly closed” at the beginning of the operation, and then the fracture slowly appears as a gap, followed by bone discontinuity. This is the reason why the fracture is “tightly closed” at the beginning of the surgery, but slowly a gap and bone discontinuity appear. This is why the fracture is “tightly closed” at the beginning of the operation, but slowly a gap and bone discontinuity appear. 2. In modern society, there are more and more patients with traumatic fractures, and the public and even some doctors have misconceptions about fracture treatment, for example, they think that fracture repositioning must be “tightly sewn”, but in fact, it is not necessary. A patient had a comminuted fracture of the femoral stem due to a car accident, and the local doctor performed an incisional reduction and internal fixation of the plate. Since the fracture was a comminuted fracture, there were large pieces of broken bones, and the surgeon put the broken bones in place during the surgery, fixed the fracture end with a very long plate, and also used multiple wires to bind the fracture pieces. The post-operative film showed that the anatomical repositioning was basically achieved, and it was a “beautiful” X-ray film, so the doctor was proud of the patient and seemed to be happy. However, after 3 months, no scab growth was visible, and after 6 months, there was still no scab growth, and a gap appeared at the fracture end, and after a year, not only was the scab still not growing, but the gap at the fracture end was getting bigger and bigger, forming a bone discontinuity. At one and a half years, the bone at the fracture end was obviously resorbed, and a bone defect of about 1 cm appeared, with the nail loosening and the plate buckling. The joint stiffness also occurred because he was afraid to move the joint for a long time. A “beautiful surgery” with a “tight fit” failed. Another patient with a comminuted femoral stem fracture also due to a car accident. The patient was treated with a closed pinning procedure using a small 5 cm long incision in the hip and inserted a locked intramedullary nail for fixation without cutting the fracture end and without deliberately resetting the fracture block at the fracture end, but only roughly prying the large bone block with a steel pin. The postoperative radiographs showed a functional fracture, with the large bone block not tightly repositioned, but mostly located around the fracture end and basically parallel to the longitudinal axis of the femoral stem. The films were not as beautiful as the previous patient. However, 3 months after surgery, more bone scabs appeared at the fracture end, and the patient started partial weight-bearing with early joint movement. 6 months later, the bone scabs continued to grow and were continuous, and 9 months later, healing was achieved and joint function was restored. The third example is a child. A supracondylar fracture of the humerus was first manipulated and the x-ray showed that a functional reduction was achieved with 2/3 alignment, which was a perfectly acceptable result. However, the child’s father was not satisfied and asked for a new repositioning, but the doctor did not think it was necessary. He was finally satisfied. However, a year later, the child developed a pronounced inversion of the elbow, and it became more and more severe, so he had no choice but to undergo another orthopedic surgery for inversion of the elbow. The above example illustrates that fracture treatment is necessary to obtain healing with minimal trauma and maximum functional recovery of the limb. In order to achieve this goal, the fracture should be satisfactorily repositioned, properly fixed, and functionally exercised to obtain the best functional recovery. What is a satisfactory reduction? If the fracture is internal to the joint, strict reduction of the fracture is required, i.e., “anatomic reduction”; if the fracture occurs in the backbone of the extremity, functional reduction of the fracture is accepted. In addition to satisfactory repositioning and secure fixation, good blood circulation to the fracture site is required to achieve fracture healing. If blood circulation is extensively compromised, it is not only detrimental to fracture healing, but also to the eventual functional recovery of the limb. Repeated revision can disrupt the circulation and make the fracture completely “anatomically repositioned”, requiring extensive stripping of the periosteum, which can damage the circulation even more and eventually affect the healing of the fracture, resulting in delayed healing and non-healing, or “bone discontinuity”. For patients, once again, you should stop pursuing the “tightest stitch”! For doctors, you should explain the reasoning clearly to your patients!