Fracture Fixation

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What is fracture fixation?

Fracture fixation is a procedure designed to stabilise fragmentary bone following fracture, prevent deformity and support healing. This can involve the use of plates, screws, pins, rods, nails or external frames.

Indications and contraindications for fracture fixation

Fracture fixation is typically employed for the treatment of:

Long bone fractures: to restore alignment and prevent secondary deformity.

Non-healing fractures: where primary fixation may support healing, including for delayed or non-union.

Complex fractures: where the fracture is highly unstable, involves multiple bone fragments, or occurs at or near joints.

Open fractures: where there is a serious risk of infection and a need to address soft tissue injury and stabilize the fracture.

Pathological fractures: where the bone is weakened by disease.

Contraindications for fracture fixation include:

Poor general health, including significant comorbidities or recent severe injury.

Severe swelling, risking soft tissue breakdown and serious infection.

Active infection.

Vascular insufficiency

Benefits and complications of fracture fixation

Benefits

Provides immediate stabilisation of the broken bone.
Permits proper alignment during healing.
Allows for rapid healing.
Restored mobility and functionality.

Known complications

Post-operative infection
Deep vein thrombosis (DVT) and pulmonary embolism.
Loosening and migration of hardware.
Nerve injury
Vascular injury and bleeding.
Muscle weakness, joint stiffness, or instability.
Non-union or Malunion.

The surgery

Common surgical approaches include Open reduction and internal fixation (ORIF), typically using plates and screws; closed (or open) reduction and internal fixation, which commonly utilises intramedullary nails or minimally- invasive percutaneous techniques (MIPO); and, closed, open or gradual reduction with an external fixation device.

Preparation prior to surgery

You will receive a thorough health assessment: including medical history. You may be advised to modify certain lifestyle factors and you may be referred to another specialist. You may be asked to stop taking certain medications as your surgery date approaches. X-rays, CT scans, and MRIs will be used to evaluate your condition and plan your surgery.
Skin and bowel preparation: On the evening before your surgery, you will be asked to wash your limb using the sponge provided at your pre-admission clinic. A skin test may be administered if an iodine allergy is suspected. You will also be provided medicine to help you evacuate your bowels prior to surgery.
Patient education: if neccessary, you may speak with a physiotherapist who can advise you on post-operative mobility.

On the day of the surgery

You will be asked to complete your surgical paperwork and will meet with the anaesthetist.
The surgical site will be prepared.
You will be administered general or regional anaesthesia.
An incision will be made, as required to allow for implant insertion and/or fracture reduction.
The most appropriate fixation hardware will be inserted.
Fracture alignment and stability will be confirmed by x-ray.
Any neccessary soft tissue repair or reconstruction will be completed.
The wound will be sutured and dressed.
The limb may be immobilised using a cast or backslab.

After your surgery

Pain and swelling: You may experience pain in the affected limb. You will be prescribed painkillers to manage these symptoms.
Mobilising: A cast splint or brace will normally be used to immobilise the affected limb. Crutches may be used during healing if your fracture was lower limb. In this case, you may also require assistive devices, including grab bars or a raised toilet seat, to improve mobility at home. You may assume weightbearing only under supervision. Normal activties may normally be resumed after 3-12 weeks depending on the location and character of the fracture, although it may be advisable to avoid sports and other high-impact activities for up to a year after surgery. Physiotherapy may be neccessary depending on the location of the fracture.
Aftercare: after 6 weeks, you will be asked to complete further X-rays to assess healing, and at three, six and twelve months after your surgery for the same reason. You may be prescribed blood thinners to reduce the risk of a clot developing.

Concerns

If you are concerned about your pain level, or develop significant bleeding, fever or redness around the surgical site, please contact us immediately. For after-hours support, contact the hospital at which your surgery was completed. They will contact Prof. Al Muderis on your behalf.

Norwest Private Hospital: (02) 8882 8882

Macquarie University Hospital: (02) 9812 3000