In 1776, the year when America declared its independence, Edward Gibbon released his book The Decline and Fall of the Roman Empire. He concluded, rightly or wrongly, that the fall of the empire was mainly due to barbarian invasions and the spread of Christianity. Since Gibbon's day, many others have observed that great nations and institutions, after reaching the pinnacle of power and success, gradually decline because of internal degradation. Arnold Toynbee, another British historian, is reported to have said, “An autopsy of history would show that all great nations commit suicide.” I am using these pronouncements to create an analogy with the condition of the orthopaedic discipline. The metaphor is based on observations on the manner in which our profession appears to be showing symptoms suggestive of decline. The technological explosion that began in earnest in the 1960s has changed the face of orthopaedic surgery. As a result, its representative organizations, such as the American Academy of Orthopaedic Surgeons, the American Orthopaedic Association, the American Board of Orthopaedic Surgery, and state and regional orthopaedic societies, expanded their territory and became large, comprehensive business-like organizations. Simultaneously, the unrestrained growth of subspecialization began, leading to the creation of twenty-six subspecialty societies to date. The overemphasis on the fragmentation of orthopaedics into subspecialties incited other surgical and medical disciplines to erode the orthopaedic territory as they perceived that orthopaedics was no longer an eclectic body of knowledge but rather splintered groups with a territory consisting of one or several operations. Within a very short time, areas traditionally the purview of the orthopaedist became either partially or completely the possession of other disciplines: neurosurgery, in a number of institutions, is now in virtual control of all conditions of the spine. Plastic surgery includes in its territory the treatment of fractures from the phalanges …