Bone fracture repair is surgery to fix a broken bone using plates, nails, screws, or pins. Bone grafts may be used to allow for proper healing or to assist in the healing process.
While you are pain-free under general or local anesthesia, a surgical cut is made over the fractured bone. The bone is placed in the proper position. Screws, pins, or plates are attached to or placed in the bone temporarily or permanently. Long bones may be fixed with nails placed in the bone cavity.
Any disrupted blood vessels are tied off or burned (cauterized). If a lot of bone has been lost due to the fracture (especially if there is a gap between the broken bone ends), the surgeon may decide to do a bone graft. Bone grafting may be performed using the patient's own bone, usually taken from the hip. Or, bone taken from a donor can be used.
If bone grafting is not necessary, the fracture can be repaired by the following methods:
One or more screws may be inserted across the break to hold it.
A steel plate held by screws may be drilled into the bone.
A long, thick metal pin (sometimes called a rod or nail) with holes in it may be driven down the shaft of the bone from one end. Screws are then passed through the bone and through a hole in the pin.
In some cases, blood vessels and nerves are repaired with microsurgery. The opening in the skin is then closed. If the broken bone has pierced the skin, the bone ends need to be washed with sterile fluid in the operating room to prevent infection. The washing process may need to be repeated if the wound is dirty or becomes infected.
Why the Procedure Is Performed
Surgical repair is recommended for complicated fractures that cannot be realigned (reduced) by nonsurgical methods. This is especially true of fractures that involve joints. Poorly aligned joint surfaces may contribute to the development of arthritis.
Risks for any anesthesia include the following:
Reactions to medications
Risks for surgery include the following:
Injuries to nerves, vessels, and tendons
After the Procedure
Surgery often allows patients to regain movement and heal faster than nonsurgical treatment. Your long-term outlook depends on the severity of the fracture.
It is usually not necessary to remove an internal fixation device unless it causes problems.
The length of the hospital stay depends on the:
Condition of the blood and nerve supply
Condition of the bone
Presence of an infection
Presence of other injuries
Severity of the fracture
Most fractures heal in 6 - 12 weeks. Children's bones heal rapidly, usually in 6 weeks.
Browner BD, DeAngelis JP. Emergency care of musculoskeletal injuries. In: Townsend CM Jr., Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 21.
Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.