Fracture surgery is an orthopedic procedure required when a broken bone cannot heal or align properly using non-operative methods, such as casting or splinting. When bone fragments are significantly separated or unstable, a surgeon must intervene to restore the bone’s normal anatomy. The goal of this intervention is to achieve precise anatomical realignment and secure stability, creating the optimal environment for the body’s natural healing process.
Criteria for Surgical Intervention
Orthopedic surgeons decide on surgery when a fracture presents characteristics that make successful healing unlikely with non-surgical treatment. A primary indication is an unstable fracture, where the bone fragments cannot be held in a satisfactory position by a cast or splint alone. This instability often occurs with displaced fractures, where the pieces are so far apart or misaligned that they cannot be manually reduced from outside the skin.
Fractures that involve a joint surface, known as intra-articular fractures, often require surgery to restore the smooth congruence of the joint. Precise realignment is necessary to reduce the risk of post-traumatic arthritis and preserve long-term joint function. An urgent reason for intervention is an open or compound fracture, where the bone has broken through the skin, introducing a high risk of deep infection and requiring immediate cleansing and stabilization.
Surgery is also required when a fracture compromises nearby nerves or blood vessels, a situation that demands immediate realignment and stabilization to prevent permanent tissue damage. Certain fracture patterns or locations, such as some hip fractures, are known to heal poorly without the mechanical support provided by surgical fixation. In these cases, the operation prevents a failed healing response, known as nonunion.
Primary Surgical Techniques
One common approach is Open Reduction and Internal Fixation (ORIF), which involves making an incision to directly access the fracture site. The surgeon physically moves the bone fragments back into their correct anatomical position, a step called reduction, while visually confirming proper alignment. Fixation is then performed using hardware like metal plates and screws to hold the fragments securely against each other.
Another widely used method, particularly for long bones like the femur or tibia, is Intramedullary Nailing. This procedure involves inserting a specialized rod down the hollow center of the bone, known as the medullary canal. The rod acts as an internal splint, stabilizing the entire length of the bone. It is secured with screws at both ends to prevent shortening or rotation of the fracture fragments.
External Fixation is a temporary or definitive technique often reserved for complex injuries, such as highly contaminated open fractures or those with severe soft tissue damage. The surgeon inserts pins or screws into the bone above and below the injury site. These pins protrude through the skin to connect to a rigid frame outside the body, stabilizing the bone while allowing injured soft tissues time to heal or be monitored.
The Role of Implants and Fixation Hardware
The internal and external metal components used in fracture surgery are known as fixation hardware or implants. These devices, typically made from biocompatible materials like stainless steel or titanium, provide the mechanical support necessary to maintain the bone’s alignment while the biological healing process occurs. They bear the body’s load and counteract muscle forces, allowing the bone to knit back together without displacement.
Hardware such as plates and screws are fixed to the surface of the bone, while rods are placed inside the central canal. In most cases, this internal hardware remains in the body permanently once the fracture has fully healed. The bone grows around and incorporates the implant, which becomes a silent part of the skeletal structure.
Hardware may need to be removed in a subsequent procedure if it causes pain, irritation to nearby soft tissues like tendons, or if an infection develops. Temporary devices, such as external fixators, are always removed once the patient is stable enough for definitive internal fixation or once sufficient bone healing has occurred.
Post-Operative Care and Rehabilitation
After fracture surgery, immediate care focuses on managing pain and preventing infection at the incision site. Pain is controlled using prescribed medications and non-pharmacological methods like elevation and applying ice to reduce swelling. Patients must carefully follow instructions for incision care, including keeping the surgical site clean and dry, and monitoring for signs of infection.
A structured rehabilitation program, often involving physical therapy, is a necessary part of the recovery process. Therapy typically begins with gentle exercises to restore a pain-free range of motion in nearby joints that may have become stiffened by immobilization. The surgeon provides a specific weight-bearing protocol, which may start as non-weight bearing before progressing to partial or full weight-bearing as healing advances.
The time required for the bone to fully heal structurally is distinct from the time needed for rehabilitation. While bone consolidation may take several months, the rehabilitation phase, focused on regaining strength, endurance, and full mobility, can continue for a longer period. Adherence to the prescribed physical therapy regimen and weight-bearing limits is essential to prevent re-injury and achieve the best long-term outcome.