Fracture fixation

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What is a fracture?

A fracture is a break in a bone. This may result in deformity and pain. In addition, some fractures are known to have poor healing rates (a non-union).

Because of these, modern fracture treatment often consists of ‘internal fixation’ which means fixation using plates, screws or nails which are inside the body (as opposed to external fixation which is pins or wires outside the body).

As some fractures may result in deformity, poor function or post traumatic degeneration, your surgeon may recommend fixation. While some fractures may heal in a plaster or sling, there can be pain for several weeks while the fracture is unstable and fixing these allows earlier return to function and patients may elect to have treatment by internal fixation for this reason.
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Fractured shoulder before and after plate and screw fixation

How is internal fixation done?

While the patient is under anaesthesia, cuts are made in the skin and a surgical approach through or between muscles used to gain access to the fracture. The fracture is aligned then fixation appropriate to the fracture used to stabilise the bone. Examples of these are:
  • Plate and screw constructs
  • Wires
  • Nails or rods.
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Left: Forearm plate     Right: Femoral nail

What are the surgical risks?

Around 1–2% This is greater in open fractures where the fractured bone has penetrated through the skin. Antibiotics are given at the time of surgery to lower this risk.
Damage to blood vessels, tendons or nerves
Skin nerves can sometimes be cut resulting in an area of numbness to the skin. This often reduces significantly over 6–12 months. Any structure in the surgical field may potentially be injured although your surgeon is careful to prevent this.
Stiffness of joints
Fractures close to a joint often result in stiffness and fractures which go into and disrupt the joint surface may result in post-traumatic arthritis. Fixing these fractures allows early movement as the fracture is stabilised and this helps the joint regain movement.
Failure of fixation
Sometimes, the hardware may not have sufficient purchase in bone especially with osteoporosis (brittle or fragile bones) resulting in it pulling off or cutting out of bone. Surgeons can only fix fractures but not cause them to heal directly. If a fracture fails to heal, the metalwork which bears the load going through the bone may fatigue and fail/break.
Deep vein thrombosis
Any fracture, especially of the pelvis or lower limb can cause a blood clot. Your surgeon will advise you on medications or other ways of minimising this. One of the best ways of preventing a clot is to allow early movement of the limb which allows the blood to circulate normally.
Fat embolism
This is an incompletely understood phenomenon where fat or marrow from the bone can enter the bloodstream and cause difficulties with breathing. It can be life-threatening, but fortunately, is very rare.
Complex regional pain syndrome
Another rare complication where patients can develop extreme pain to minimal provocation (eg. light touch), and develop muscle wasting and joint stiffness. Treatment of this condition is done in conjunction with a pain specialist and occupational or physiotherapist.

It is important to be informed that complete recovery may not be possible after some fractures, however, this is usually a lot better compared to leaving the fracture untreated.

Will the metalwork need to be removed?

After surgery, x-rays at intervals are usually required to look for fracture healing and to ensure there is no complication with the fixation. Sometimes, the fixation can cause discomfort or pain especially in areas of the body where there is not a lot of soft tissue coverage such as the elbow or knee. In these circumstances, once the fracture is healed, the fixation can be removed.

Removal is usually straightforward (but not always!). Many of these can be done as a day case. There is a risk of infection, and the risk of injury to nerves and blood vessels is actually higher due to scar tissue being present from the previous operation. Very rarely, heroic attempts to remove fixation which is broken or buried deeply in bone causes more harm than good and is not worth the risk.


With modern fracture fixation techniques, the functional outcomes from many fractures are improved. Your surgeon will be happy to discuss the options best suited to achieving the optimal outcome in your injury.
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DVT and PE

Fractures: An Overview
Fractures: Types and Treatment
Growth Plate Fractures
Helping Fractures Heal (Orthobiologics)
Stress Fractures

Foot and Ankle Fractures
Ankle Fractures
Calcaneus (Heel Bone) Fractures
Lisfranc (Midfoot) Fracture
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Hip Fractures
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Hip Fracture Facts
Live it Safe: Prevent Broken Hips
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Common Knee Injuries
Hamstring Muscle Strain
Fractures of the Proximal Tibia
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Shinbone Fractures Overview
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Thighbone (Femur) Fracture
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Sprains and Strains: What's the Difference?
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