Surgery for a broken bone

Surgery for broken bones involves fixing your broken bone into the right place for it to heal. This may be done with or without metal plates, rods, wires, screws, or pins. The type of surgery you have will depend on which bone you’ve broken.

Preparing for surgery for a broken bone

Initial care

If you have any other injuries or medical conditions, your doctor will aim to get these under control first. You might need to have some tests, including:

• blood tests
• X-rays
• MRI scans
• an electrocardiogram (ECG)



Sometimes, your broken bone may be held in place with pins (external fixation) while you wait for further surgery. You can read more about this technique in the What happens during surgery for a broken bone section below.

Your healthcare team will discuss with you exactly what to expect before, during and after surgery. This will include the potential risks and benefits involved. If you’re unsure about anything, don’t be afraid to ask any questions. You’ll need to sign a consent form before the surgery can go ahead, so it’s important to make sure you feel fully informed.

Anaesthesia

The type of anaesthetic you’ll have for your operation will depend on your general health and which bone you’ve broken. It might be a local, regional, spinal or general anaesthetic.

• A local anaesthetic involves having an injection to numb a small area of your body, where the operation will be – such as a finger or toe.
• A regional anaesthetic involves having an injection to numb a larger, or deeper part of your body. A spinal anaesthetic can be into your back to numb the lower part of your body.Or you have a regional anaesthetic around your shoulder to numb your arm.
• A general anaesthetic will mean you’re asleep and won’t feel anything anywhere in your body during the operation.

If you’re having a general or spinal anaesthetic, you’ll need to stop eating and drinking for a period of time beforehand. Your hospital will tell you exactly when. It’s important to follow their instructions.

Preventing DVT and infection

You may need to wear compression stockings or have an injection of an anticlotting medicine before your surgery. These will help to prevent deep vein thrombosis (DVT). See our Complications of surgery for a broken bone section for more information on DVT. You may also have antibiotics before your operation to help reduce the risk of an infection.

What happens during surgery for a broken bone

There are two main types of fracture surgery:

• open reduction and internal fixation
• external fixation

Open reduction and internal fixation (ORIF)

In open reduction and internal fixation surgery, your surgeon will make a cut in your skin to reach the broken bone. They’ll move the broken pieces of bone back into their normal position. This is called reducing the fracture.

Your surgeon will then securely fix your bones in place with a combination of:

• metal wires
• pins
• screws
• rods
• plates

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

External fixation

In external fixation surgery, your surgeon fits pins through your skin and into your bone, above and below the break. These are joined with a metal bar or sometimes a frame, on the outside of your body. This makes sure your bone stays in place and heals in the right position.

External fixation is usually used:

• for more severe or complex fractures
• for open fractures (if your bone has pierced the skin and you have an open wound)
• to hold unstable fractures in place before further surgery to fix them permanently

What to expect after surgery for a broken bone

You’ll need to rest until the effects of the anaesthetic have gone. You might have some discomfort as the anaesthetic wears off, but you’ll be offered pain relief if you need it. How long you need to stay in hospital will depend on the type of break you have, if you have any other injuries and how you feel.

You may need to wear a splint or cast after the operation. This will support your bone while it heals. If you’ve had surgery for a broken leg, your surgeon will tell you whether or not you can put weight on it straightaway. Sometimes your healthcare team may give you crutches or a walking frame to help you walk.

After a general anaesthetic, you might find that you're not as coordinated or that it's difficult to think clearly. This should clear up within 24 hours. In the meantime, don't drive, drink alcohol, operate machinery, or sign anything important. If you’re going home on the same day that you’ve had a general anaesthetic or sedative, you should organise for someone to take you home. They should also stay with you for the first 24 hours.

Recovery from surgery for a broken bone

How long it takes for a fracture to heal depends on which bone was broken and the type of break. It can be anywhere from a few weeks for a bone in your fingers or hand to several months for broken leg surgery. This is usually quicker in children.

Your surgeon should be able to give you a timeframe for how long they’d expect it to take. They’ll be able to tell you when you can start moving the affected area or putting weight on it too. If you still need pain relief after surgery, you can take over-the-counter painkillers, such as paracetamol or ibuprofen if you can take it.

You may also have physiotherapy to help with your recovery and rehabilitation. A physiotherapist can help you to build up strength in your bones and muscles and ease any stiffness. They may give you an exercise programme to follow, which will help you get the full range of movement back. Your physiotherapist can show you how to move around safely while you recover. They may give you advice about using crutches or a walking frame properly.

Plates, screws and other metal implants used in your surgery don’t usually need to be removed. But if they’re causing irritation or other problems, your surgeon may recommend that they’re taken out. You’ll need another operation to do this.

Complications of surgery for a broken bone

Many of the complications associated with surgery for broken bones can also happen because of the fracture itself. These include the following.

• Infection in your wound or bone. Antibiotics can usually treat this.
• Damage to nerves or blood vessels during your operation.
• Your bone may take longer than usual to heal or it may heal in the wrong position. If your bone doesn’t heal properly, you might need to have another operation.
• Compartment syndrome. This is a medical emergency. If your pain is a lot more than you expect, call the hospital immediately. It happens when pressure builds up in the tissues around your broken bone, so blood can’t flow into the area properly. It can happen because of the fracture itself or after surgery. It’s extremely painful. It needs urgent surgery to release the pressure.
• Deep vein thrombosis (DVT). This is when blood clots develop in the deep veins in your legs. Your affected calf or leg may look bigger than your other calf or leg. It can be dangerous if a clot moves to your lungs (pulmonary embolism). You may need to wear compression stockings and have an injection of an anticlotting medicine to prevent this.
• Fat embolism syndrome. This is when fat gets stuck in a blood vessel, causing a blockage. It can be caused by the fracture or the surgery. A fat embolism is rare but serious and needs urgent treatment. The symptoms include breathing problems, fever, headaches, confusion, and a rash of tiny red spots on your skin.

There will also be complications specific to different types of broken bones. Your surgeon will explain the possible risks of your surgery and how these may affect you.

Alternatives to surgery for a broken bone

Other treatments for a broken bone are listed below. Your surgeon can explain if these are an option for you. This will depend on several things, such as the type of fracture you have and where it is.

• A sling. This can be an option if you’ve broken your collar bone or for some breaks in the upper arm.
• A cast. This is a hard and rigid protective covering that goes all the way around the affected arm or leg, such as a plaster cast. These are usually used for broken bones that need to be held in place for several weeks to heal.
• A splint. This is a hard device that supports your broken bone while it heals. Unlike a cast, it doesn’t tend to go all the way around the affected area. Splits are usually used if it’s a broken bone that only needs a few days to heal, such as broken fingers, hands, and ankles.
• A brace. This is similar to a cast. They’re used for fractures across a joint, such as your knee, where a hinge in the brace means you can bend your knee.
• A special type of boot. These are padded, supportive boots you can wear that may be used for foot and ankle fractures.