Stress shielding after fracture fixation is a result of the higher stiffness of the implant, which results in bone loss as a consequence of decreased physiologic loading of the bone according to Wolff's law. Stainless steel, although leads to an excellent union rate, eliminates dynamic loading that is needed to maintain bone strength.
Open reduction internal fixation (ORIF)
advantages: early mobilization of the limb with physiological load, malunion is rare and mobilization of the patient is accelerated
disadvantages: the stiffness and Young's modulus of the implant material are much higher than cortical bone - these high rigidity material prevents load transfer to the healing bone, therefore is unfavorable for fracture callus remodeling
External fixation
External fixation (e.g. pins, wires (Schanz screws, Steinman pins, Kirschner wires, cerclage wires) is considered flexible fixation. These implants ensure micromovement at the fracture site, which is essential in the healing process.
To reduce the rigidity of the implant and to prevent stress shielding after fracture fixation, implants made with polyether-ether-ketone (PEEK) can be used.
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