Surgery for broken bones is usually done using general anaesthesia. This means you will be asleep during the operation. You may be asked to follow fasting instructions before you have a general anaesthetic. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon or anaesthetist's advice.
If you’re having surgery for a broken leg bone you may be asked to wear compression stockings and/or have an injection of an anticlotting medicine called heparin to help prevent deep vein thrombosis – blood clots forming in the veins in your legs.
You may be given antibiotics before your operation to help prevent an infection.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.
If you have fractured a bone in your arm or leg there are a number of alternatives to surgery. These are listed below.
- A splint can be used to keep broken bones immobilised, particularly just after an injury. A splint is a long, narrow piece of plaster, fibreglass or metal secured in place using tape, velcro or a bandage. The splint doesn’t go all the way around your limb, so it may be more comfortable than a cast if you have a lot of swelling.
- A sling may be used to support your arm if you have broken your elbow or shoulder.
- A cast is a hard and rigid protective covering which holds your bone in place and helps it to heal. Casts can be made of plaster of Paris or fibreglass.
- A brace is similar to a cast but it allows you to move in a limited way.
Traction is a treatment sometimes used in hospital. It brings your bones into line with each other using a gentle but steady pulling action. Weights are used to pull the bones together and these are attached to your skin using tape, or to your bone using metal pins. Traction can be used as an initial treatment, for example, before surgery and is sometimes used for leg fractures.
Talk to your surgeon about the treatment options available to you.
Your surgeon will make a cut to open up the area where the fracture is. Before the bones can be fixed in place, he or she will need to move them back into their usual position. This is called reducing the fracture.
Once the bones are in the right place your surgeon will use a combination of metal wires, pins, screws, rods and plates to securely fix your bones in place. Metal rods or nails sit inside your bone while screws and metal plates attach onto the surface of your bone.
In most operations your surgeon will then close your skin using stitches or staples. You may have a cast or brace put on to protect your bones as they heal.
In other operations metal plates and screws are attached above and below your fracture. Your surgeon will then line the bone up in its normal place and attach screws to metal bars outside your skin. The metal bars are fixed together to form a frame and this holds the bones in the proper position so that they can heal.
You may need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.
If you have had surgery for a broken arm, you may be given a sling or splint to keep it supported while it heals. If you have broken your leg, you will be given crutches or a walking frame to use to support you, so that you don't put any weight on your leg.
How long you will need to stay in hospital will depend on the type of fracture you have and whether you have other injuries. You will need to arrange for someone to drive you home.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
It’s important to follow your surgeon’s advice about using your arm or putting weight on your leg after your operation. The pain from a broken bone usually goes before your bone has fully healed, so it’s important not to put too much stress on it too soon. Your surgeon will tell you when you can put weight on your leg or begin to use your arm.
Depending on the type of fracture you have and where it is, you may need to have some of the screws, pins and metal plates removed when your bones have healed. However, sometimes the metal parts remain in place for life. The operation to remove the screws, pins and metal plates is usually much quicker than when they are put in.
Your surgeon may arrange for you to see a physiotherapist, a health professional who specialises in maintaining and improving movement and mobility. He or she can help you to build up strength in your bones and muscles and to ease any stiffness. You may be given an exercise programme to follow, which will help to get back a full range of movement in the affected area.
How long it takes for a fracture to heal, and for you to get back to your usual activities, depends on the type of fracture and where it is. For example, a fracture of your thigh bone may take between four and six months to fully heal, whereas a fracture of your lower arm may take three to six months.
As with every procedure, there are some risks associated with surgery for broken bones. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.
You may have some pain after your operation. The affected area may also be swollen and bruised. This should get better after a few days. If your pain or swelling gets worse, tell your surgeon straight away.
Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in your leg (deep vein thrombosis, or DVT).
The main complications of surgery for a broken bone are listed below.
- The bone may not heal fully, or it may heal in the wrong position. This can happen if the bone becomes infected or if you use the affected arm or leg too much before it has healed properly. If your bone doesn’t heal properly you may need a further operation.
- Your nerves or blood vessels may be damaged when the fracture happens or during your operation. Damaged nerves may cause some loss of movement or feeling in your arm or leg. Damage to your blood vessels may affect the blood supply to your arm or leg.
- You may develop an infection in your wound or in the bone. This can be treated with antibiotics.
- A fracture can lead to compartment syndrome. This happens when your muscles swell. Your muscles sit inside a capsule of tissue called fascia, so they don’t have much room to expand. When your muscles swell, the pressure increases and blood can’t flow into the muscle properly. This causes severe pain. An operation called a fasciotomy may be needed to release the pressure on the muscle.
I’ve had surgery for a broken bone. Why are my physiotherapy exercises so important?
Physiotherapy and exercise can build up strength in your bones and muscles, which will help you to get back full movement in your arm or leg.
After a fracture your arm or leg may be immobilised to help the bone heal properly, for example, you may have a cast or a sling on after your surgery. Because your muscles aren’t moving and working as they normally would they can become weak. If your fracture is near a joint then this can also cause stiffness. Without treatment this can cause discomfort and difficultly moving after the fracture has healed.
After your operation your surgeon may refer you to a physiotherapist, a health professional who specialises in maintaining and improving movement and mobility. He or she will develop an exercise programme for you, which will help you to exercise your arm or leg while the bone heals. This helps to maintain or build up strength in your muscles and bones and helps to make sure you recover fully. Exercises can also help to ease any stiffness.
Your physiotherapist can also help you to use crutches or a walking frame safely.
Why would I need an operation for a fracture, rather than a cast?
Whether you need surgery to treat a fracture or a cast depends on the type of fracture you have and where it is. Some fractures don’t heal well if they are treated using a cast.
Some types of fracture need to be fixed using surgery, rather than immobilised in a cast, to help them heal properly. The main types of fracture that need surgery are listed below.
- Open fracture. This is when a broken bone breaks through your skin as it fractures. This kind of fracture needs to be cleaned well and any dirt or other materials removed before it can be put back in place. This helps to prevent infection.
- A fracture that can’t be lined up properly or kept in place. This needs an operation to fix it securely. Sometimes a piece of bone or a tendon gets trapped in the bone ends and this also needs to be repaired using surgery.
- Comminuted fracture. This is when your bone has broken into three or more pieces. These pieces need to be lined up and fixed in place using surgery.
- A fracture across your joint. This will need to be fixed in place to stop you developing osteoarthritis in later life.
- A fracture of your thighbone (femur). If you don’t have surgery for this type of fracture you will need to spend months in bed before your bone heals enough for you to stand on it.
If you have questions about your operation, speak to your surgeon for advice.
Will the plate in my leg set off the metal detector in the airport?
It's possible, but this doesn't happen often.
The metal parts used to fix fractures are made of stainless steel, high-strength alloy metal, or titanium. If they are left in place to heal your fracture they may set off the detectors when you go through security at places like an airport. However, most won’t.
If you know that the metal in your arm or leg has previously set off a metal detector, tell the security officer before you go through screening.
- General principles of fracture care treatment and management. eMedicine. www.emedicine.medscape.com, published January 2010
- Fractures: an overview. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published 2000
- Overview of fractures. The Merck Manuals. www.merckmanuals.com, published December 2008
- Fractures. International Society for Fracture Repair. www.fractures.com, accessed 23 January 2012
- Venous thromboembolism, reducing the risk. National Institute for Health and Clinical Excellence (NICE), January 2010. www.nice.org.uk
- Supracondylar humerus fractures treatment and management. eMedicine. www.emedicine.medscape.com, published August 2009
- Femur shaft fracture. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published August 2011
- Tibia (shinbone) shaft fractures. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published March 2010
- Adult forearm fractures. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published July 2011
- Distal humerus fractures. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published April 2010
- Compartment syndrome. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published October 2009
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