Bone fracture repair

Answer 1

Definition

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 speed the healing process.

Description

While the patient is pain-free, using general or local anesthesia, a surgical cut is made over the fractured bone. The bone is placed in proper position. Screws, pins, or plates are attached to or placed in the bone temporarily or permanently. Or, 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, the bone may be taken 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. 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 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

Risks for any anesthesia include the following:

• Reactions to medications
• Problems breathing

Risks for surgery include the following:

• Bleeding
• Infection

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.

Outlook (Prognosis)

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

Most fractures heal in 6 - 12 weeks. Children's bones heal rapidly, usually in 6 weeks.

Answer 2

If a bone fracture is severe, a bone graft may be used to help speed the healing process. In this example, a metal plate is also used and secured with screws.

Reviewed By

Review Date: 10/06/2008

Thomas N. Joseph, MD, Private Practice specializing in Orthopaedics, subspecialty Foot and Ankle, Camden Bone & Joint, Camden, SC. Review provided by VeriMed Healthcare Network.

Answer 3

Definition

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.

Description

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

Risks for any anesthesia include the following:

• Reactions to medications
• Problems breathing

Risks for surgery include the following:

• Bleeding
• Infection
• 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.

Outlook (Prognosis)

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.

References

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.

Reviewed By

Review Date: 07/28/2010

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.