Bone fracture repair

Definition

Bone fracture repairs are surgical procedures to realign and stabilize broken bones (fractures) with plates, nails, screws, or pins. Bone grafts may be used to allow for proper healing or to speed the healing process.

Description

While the patient is pain-free, using general or local anesthesia, an incision is made over the fractured bone. The bone is placed in proper position, and screws, pins, or plates are attached to or placed in the bone temporarily or permanently. Alternatively, long bones may be fixed with nails placed in the bone cavity.

Any disrupted blood vessels are tied off or burned (cauterized). If examination of the fracture shows that a quantity of bone has been lost as a result of the fracture, especially if there is a gap between the broken bone ends, the surgeon may decide that a bone graft is essential to avoid delayed healing. Bone grafting may be performed using the patient’s own bone, usually taken from the hip, or using bone from a donor.

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, with screws then passed through the bone and through a hole in the pin.

In some cases, after this stabilization, the microsurgical repair of blood vessels and nerves is necessary. The skin incision 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 as an emergency procedure to prevent infection. The washing process may need to be repeated if the wound becomes infected.

Indications
Surgical repair is recommended for complicated fractures that are not able to be realigned (reduced) by external, nonsurgical methods. This is especially true of fractures that involve joints, as misalignment of joint surfaces may contribute to the development of arthritis.

Risks
Risks for any anesthesia include the following:

     
  • Reactions to medications  
  • Problems breathing

Risks for surgery include the following:

     
  • Bleeding  
  • Infection

Expectations after surgery

The advantage of surgery is that it often allows early mobility and faster healing than nonsurgical treatment. The long-term prognosis depends on the severity of the fracture.

It not necessary to remove an internal fixation device unless it causes problems.

Convalescence
The length of the hospital stay depends on factors such as the condition of the bone, the presence of infection, the state of the blood and nerve supply, and presence of other injuries. Most fractures heal by 6 to 12 weeks. Children’s bones heal rapidly, usually in 6 weeks.

Johns Hopkins patient information

Last revised: December 3, 2012
by Levon Ter-Markosyan, D.M.D.

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