Perfect anatomical restoration and perfect freedom of joint movement can be obtained simultaneously only by internal fixation. It is possible to argue that most of the difficulties of closed fracture treatment can be traced to the prevention of joint stiffness. Closed methods can offer anatomical restoration only if the start of joint movement is delayed. It is the significance of delay in starting joint movement which is the crucial point in understanding closed methods.

The ultimate recovery of full joint function after a fracture depends on many factors and not only on early exercise. This is suggested by the fact that the end results of conservative treatment, after a slow start, can often be surprisingly good, while those of operative methods, after a very promising start, can sometimes be disappointing. It is therefore obvious that we must review the factors which govern the recovery of joint movement following a fracture, so far as we know them.

In studying the stiffness of a joint following a fracture of an associated bone the greatest danger to the furtherance of knowledge is the too facile acceptance of simple mechanistic explanations. It is probable that the processes concerned with the recovery of joint function are of great biological complexity. Too often there is a tendency to think of stiff joints in terms of stiff engine-bearings or of rusty door-hinges and, with this childlike concept, to devise apparatus to loosen the stiffness by repeated mechanical movements.