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Surgery for a broken bone

If you break a bone in your arm or leg, you may just need to wear a splint, cast or brace to hold it in place while it heals. But sometimes a broken bone will need to be fixed with surgery using metal plates, rods or pins.

You may hear your surgeon refer to your broken bone as a fracture, which is the medical term.

Bone is a living tissue so if it breaks (fractures), it can heal itself. But broken bones have to be held in place (immobilised) long enough to make sure they heal in the right position. And, depending on the break, you may need to have an operation to move your bones into the correct place and fix them there. Your body will then produce new bone to join the broken parts together.

Because everyone’s injury will be different, your care may not be quite as we describe here as it’ll be adapted to suit you.

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  • Preparation Preparing for surgery for a broken bone

    The type of anaesthetic you have for your operation will depend on which bone you’ve broken. You may have local or regional anaesthesia, which will completely block pain from the area but you’ll stay awake during the operation. Alternatively you may have a general anaesthetic. This means you’ll be asleep during the operation.

    A general anaesthetic can make you sick so it’s important that you don’t eat or drink anything for six hours before your operation. Follow your anaesthetist’s advice and if you have any questions, don’t be afraid to ask.

    You may need to wear compression stockings to keep your blood flowing during the operation, or have an injection of an anticlotting medicine called heparin. These will help to prevent deep vein thrombosis (DVT).

    You may be given antibiotics before your operation to help reduce the risk of you getting an infection.

    Your surgeon will talk to you about what will happen before, during and after your procedure, and any pain you might have. It’s really important that you understand what’s going to happen and what to expect so you’re prepared. Your surgeon should go through the risks as well as the benefits. Think about any questions you want to ask – maybe write them down in advance so you don’t forget. Before your operation you’ll be asked to sign a consent form so you need to know what’s involved before going ahead with this.

  • Alternatives What are the alternatives to surgery for a broken bone?

    There are a number of alternatives to surgery, which include the following. Whether or not these are an option for you will depend on a number of things, not least how severe your fracture is.

    • A splint, which is a long, narrow piece of plaster, fibreglass or metal, can hold broken bones in place, particularly just after an injury. Your doctor will secure the splint in place using tape, velcro or a bandage. It 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 can support your arm if you’ve broken your upper arm, elbow or shoulder.
    • A cast is a hard and rigid protective covering that 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 you’ll still be able to move the broken area a little.

    Traction is a treatment that’s sometimes used in hospital. It brings your bones into line with each other using a gentle but steady pulling action. This is done by attaching weights to your skin using tape, or to your bone using metal pins. These are used to pull your bones together. You might need to have traction before surgery if you’ve broken your leg.

  • The procedure What happens during surgery for a broken bone?

    Open surgery

    After the anaesthetic has taken effect, your surgeon will make a cut to open up the area where the break is. Before your surgeon can fix your bones in place, they will need to move them back into their usual position. This is called reducing the fracture.

    Your surgeon will then use a combination of metal wires, pins, screws, rods and plates to securely fix your bones in place. These are made of stainless steel, high-strength alloy metal or titanium. Metal rods or nails sit inside your bone, while screws and metal plates attach onto the surface of it. These are designed to work with your body so they shouldn’t cause any allergic reaction.

    Your surgeon will close your skin using stitches or staples. You may have a cast or splint put on to protect your bone as it heals.

    External fixation

    In this type of operation, your surgeon will drill pins through your skin and into your bone above and below where the break is. They will then join these together with a metal bar that’s placed on the outside of your body. This will stabilise your bone and make sure it heals in the right position.

    Keyhole surgery

    It may be possible to have keyhole surgery, such as a knee arthroscopy. In this type of operation your surgeon will make small cuts in your skin and insert supporting plates to fix the break. You usually recover from this type of surgery faster than with open surgery but it isn’t suitable for all broken bones. Ask your surgeon if it’s an option for you.

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  • Aftercare What to expect afterwards

    You may need to rest until the effects of the anaesthetic have passed. You might have some discomfort as the anaesthetic wears off. But you’ll be offered pain relief as you need it.

    If you’ve had surgery for a broken arm, you may be given a sling or splint for support while it heals. If you’ve broken your leg, you might be given crutches or a walking frame to stop you from putting weight on it as it heals.

    How long you need to stay in hospital will depend on the type of break you have and whether you have any other injuries. When you do leave hospital, make sure someone can take you home. And it’s a good idea to ask someone to stay with you for a day or so while the anaesthetic wears off.

    Having a general anaesthetic can affect you in ways you may not expect. You might find that you’re not so coordinated or that it’s difficult to think clearly. This should pass within 24 hours. In the meantime, don’t drive, drink alcohol, operate machinery or sign anything important.

  • Recovery Recovering from surgery for a broken bone

    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.

    You’ll probably have questions after your operation, for example about when you can use your arm or put weight on your leg. Talk to your surgeon about this so you feel clear about what you can and can’t do. It’s important to keep in mind that the pain from a fracture may go before your bone has fully healed. Even though it may feel better, remember not to put too much stress on it too soon.

    You may need to have some of the screws, pins and metal plates removed when your bones have healed. This will depend on the type of fracture you have and where it is. Sometimes the metal parts stay in place for the rest of your life.

    Your surgeon may arrange for you to see a physiotherapist (a health professional who specialises in maintaining and improving movement and mobility). They can help you to build up strength in your bones and muscles and to ease any stiffness. Your physiotherapist may give you an exercise programme to follow, which helps you get the full range of movement back. For more information see our FAQ: Why are physiotherapy exercises so important after surgery?

    How long it takes for a fracture to heal and for you to recover depends on which bone you broke and the type of break. It may take several months to completely get back to normal but ask your surgeon to give you a more exact idea of this.

  • Side-effects Side-effects of surgery for a broken bone

    All procedures carry some risk but it’s difficult to say how these apply to you as they vary for everyone. Talk to your surgeon for more specific information about this.

    There are some general side-effects associated with surgery for a fracture. These are mostly temporary and could include some pain, as well as swelling and bruising.

  • Complications Complications of surgery for a broken bone

    Complications are when problems occur during or after the operation. We’ve explained some of the main complications of surgery for a broken bone here.

    • You may get an infection in your wound or in your bone, but this can be treated with antibiotics.
    • Your bone may not heal fully, or it may heal in the wrong position. This can happen if your bone is infected or if you use your injured arm or leg too much before it has healed properly. If your bone doesn’t heal properly, you may need another operation.
    • Your nerves or blood vessels (arteries and veins) may be damaged when you break your bone, or there’s a chance this could happen during your operation. Damaged nerves may cause some loss of movement or feeling. Damage to your blood vessels may affect the blood supply to your arm or leg.
    • A broken bone 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 your muscle properly. This is extremely painful and you may need to have an operation called a fasciotomy to release the pressure on your muscle.
    • You may develop deep vein thrombosis (DVT), particularly if you can’t move around for a while. To try to prevent this, you may be advised to wear compression stockings and be given an injection of the medicine heparin during your operation.
  • FAQ: Why is physiotherapy important after surgery? FAQ: Why is physiotherapy important after surgery?

    Answer

    Physiotherapy and exercise can build up strength in your bones and muscles. This can help you to get the full range of movement back.

    More information

    If you break your arm or leg for example, it will be held in place to help the bone heal properly. You may have a cast or a sling on after your operation. Because your muscles aren’t moving and working as they normally would they can become weak. If your bone is broken near a joint, this can also cause stiffness. Without treatment, you will have some discomfort and difficultly moving after your bone 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). They will develop an exercise programme for you, which will help you to exercise your arm or leg while your bone heals. This will help to maintain or build up strength in your muscles and bones to make sure you recover as fully as possible. Exercises can also help to ease any stiffness.

    Your physiotherapist can also give you help and advice about how to use crutches or a walking frame safely.

  • FAQ: Why would I need an operation rather than just a cast? FAQ: Why would I need an operation rather than just a cast?

    Answer

    Whether you need surgery to treat a broken bone or have a cast depends on the type of fracture you have and where it is. Some breaks don’t heal well if they are treated with a cast.

    More information

    Some breaks need to be fixed using surgery, rather than held in a cast, to help them heal properly. The main types of breaks that you’ll need to have an operation to fix are described below.

    • Open fracture. This is when a broken bone breaks through your skin. This kind of break 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 broken bone that can’t be lined up properly or kept in place will need 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 which need to be lined up and fixed in place using surgery.
    • A broken bone across a joint will need to be fixed in place to stop you developing osteoarthritis in later life.
    • A fracture of your thigh bone (femur). You’ll usually need to have surgery for this type of break.
  • FAQ: Will the plate in my leg set off a metal detector? FAQ: Will the plate in my leg set off a metal detector?

    Answer

    It’s possible, but this doesn’t happen often.

    More information

    The metal parts used to fix broken bones are made of stainless steel, high-strength alloy metal or titanium. If they are left in place for your bone to heal, they may set off detectors, for example when you go through security at airports.

    If the metal in your leg has previously set off a metal detector, tell the security officer before you go through screening.

  • Resources Resources

    Sources

    • Ankle fractures. BMJ Best Practice. www.bestpractice.bmj.com, published 3 October 2014
    • Overview of fractures, dislocations, and sprains. The Merck Manuals. www.merckmanuals.com, published December 2014
    • Fractures (broken bones). American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published October 2012
    • Fractured humerus. PatientPlus. www.patient.info/doctor, reviewed 19 September 2014
    • Wrist fractures. BMJ Best Practice. www.bestpractice.bmj.com, published 4 August 2014
    • Supracondylar humerus fractures. Medscape. www.emedicine.medscape.com, published 16 September 2014
    • General principles of fracture care. Medscape. www.emedicine.medscape.com, published 27 January 2014
    • Elbow injuries and fractures. PatientPlus. www.patient.info/doctor, reviewed 29 July 2014
    • Internal fixation for fractures. American Academy of Orthopaedic Surgeons. www.orthoinfo.org, published March 2014
    • Forearm fractures. Medscape. www.emedicine.medscape.com, published 29 October 2013
    • Femur injuries. Medscape. www.emedicine.medscape.com, published 15 July 2013
    • Griffin D, Parsons N, Shaw E, et al. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. BMJ 2014; 349:g4483. doi:org/10.1136/bmj.g4483
    • Open fractures. Medscape. www.emedicine.medscape.com, published 4 February 2014
    • Complications from fractures. PatientPlus. www.patient.info/doctor, reviewed 12 May 2014
    • Removal of hardware. American Orthopaedic Foot and Ankle Society. www.aofas.org, accessed 26 February 2015
    • Wetter OE. Imaging in airport security: past, present, future, and the link to forensic and clinical radiology. Journal of Forensic Radiology and Imaging 2013; 1(4):152–60. doi:10.1016/j.jofri.2013.07.002
    • Metal implants. Transportation Security Administration. www.tsa.gov, published 24 April 2014
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