Fracture Fixation
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What is Fracture Fixation?
Medically known as open reduction internal fixation (ORIF), or simply internal fixation, this surgical procedure is performed to repair broken bones (fractures) by resetting and stabilizing them in their correct position. In medical terms, resetting the bones into position is known as “reduction”.
Fracture reduction may be performed either as a closed (without surgical incisions) or open (with surgical incisions) procedure, depending on the extent of the fracture. A closed procedure will rely on splints and casts to immobilize the fractured area and allow it to heal. Meanwhile, an open procedure uses implants made from durable materials, such as stainless steel, to hold the bones in place and support gradual bone healing.
The Purpose of Fracture Fixation
Fracture fixation focuses on stabilizing fractures by resetting (reducing) them into their original position. Proper alignment restores the bones to their normal anatomical position, followed by stabilizing them to prevent the bones from moving or shifting. Restricting bone movement is vital to ensure broken bones heal and fuse correctly, which may help restore the affected limb’s overall mobility and flexibility. It also aims to reduce the risk of complications that could delay healing, such as infection or functional issues, such as stiffness, that can impact your limb’s range of motion. Most of the time, joint mobility is encouraged immediately after fracture fixation to minimize stiffness.
Types of Fracture Fixation
Both open and closed fixation offer similar results in setting the bone to facilitate its recovery, but when they are used depends on various factors.
Closed Fixation
Closed fixation is the commonly used option for treating most cases of fractures by immobilizing the injured limb. It uses an external fixation device, such as a splint or cast, to immobilize and support an injured limb, allowing the fracture to heal correctly. The procedure is less invasive compared to open fixation and is suitable for treating fractures that are difficult to access surgically, such as those in the pelvis.
However, in some cases, pins and screws that penetrate the skin may be used to secure an external fixation device for additional support. The procedure may require minimally invasive surgery to insert these pins or screws before the external fixator can be installed. It may also require X-ray guidance to ensure the procedure can proceed with accuracy of pin placement.
Open Fixation
If the nature, severity, and location of the fracture make closed fixation difficult, open fixation techniques may be recommended instead. It is an invasive procedure that involves surgically inserting screws, plates, or rods to align and stabilize broken bones. The procedure aims to align and stabilize the bones to support proper healing. It may also help minimize complications by directly limiting or preventing movement at the fracture site.
Open fixation is typically prescribed to treat fractures of long bones, such as the femur (thigh bone), or fractures at the joints. It may also be suited to treat fractures affecting weight-bearing bones, reducing complications to your overall mobility and balance. The implants used for open fixation are made of stainless steel or other durable, biocompatible materials, making them safe for human use.
How Fracture Fixation is Performed
Your doctor will carefully assess your condition during the initial consultation, through a physical examination and diagnostic tests to determine the nature and location of the fracture. They will then recommend either an open or closed fixation procedure for the fracture based on the assessment results. Before the procedure, you may be administered with a local or general anaesthetic to minimize pain or discomfort.
Closed Fixation Procedure
Once sedation takes effect, the doctor will carefully reposition the bones back into their proper positions and confirm alignment and position with X-rays. They will then apply a cast or splint on your limb to stabilise the bone and prevent it from shifting around to ensure it heals properly while causing minimal complications.
If pins or screws are needed to secure the external fixators, the doctor may need to make small incisions in your skin. The doctor will use X-ray imaging to determine drilling locations, then carefully drill holes into the bone in the designated areas (where applicable). They will also avoid nearby muscles, tissues, and other structures that may be in the way during drilling.
After drilling, the doctor will insert surgical pins or screws into the drill holes. The pins are subsequently connected to rods, which are clamped together to hold the broken bones securely in place. Minor adjustments will ensure the fractured bones are aligned before the rods’ clamps are tightened. The incisions may not be closed immediately to allow for wound drainage and can be treated locally with antiseptic dressings.
If the external fixation procedure is temporary, you will be monitored regularly to ensure the external fixator performs its role until you make a full recovery. Follow-up surgery may be scheduled to remove the external fixation device, after which physiotherapy and gentle home exercises can help gradually restore the limb’s mobility.
Open Fixation Procedure
Once you are sedated, the doctor will first clean and prepare the surgical area before making an incision through the skin to reach the broken bones. They may gently move various structures, including muscles and other soft tissues, aside to access the surgical area. The doctor then performs the reduction by carefully realigning the broken bones.
With the bones in position, the doctor uses surgical implants to secure them in place. The implants may be screws, plates, wires, or pins. If necessary, a metal rod is inserted through the middle of the bone for additional stability. Once the implants are attached, the doctor will perform final checks to ensure the procedure was performed correctly and may carry out any additional surgical procedures, if necessary, such as removing loose bone fragments. Afterwards, the doctor will carefully close the incisions, and you will be moved to the recovery room for observation before returning to the ward.
Frequently Asked Questions
What are the risk associated with fracture fixation?
Open fracture fixation surgery carries risk of infection or improper healing, especially in complex fractures or those involving multiple bones. It is therefore essential to follow post-operative care instructions to minimize the risk of such complications.
How long does recovery take after an open fracture fixation?
Recovery may depend on various factors, including your age (senior citizens may have slower recovery rates due to lower bone density) and the type of fracture fixation performed. Fractures may take several weeks or months to heal. Most small bone fractures heal in about 6 weeks. Some long bone fractures take 3 to 4 months to heal. More severe cases could take a year or more to achieve good joint movement and limb strength. Your doctor will advise you on postoperative care instructions to help with your recovery and minimize complications.
Are implants from an open fracture fixation permanently left in place even after the fracture heals?
In some cases, fracture fixation implants may be left permanently in place, if they do not cause functional complications after healing. There may be instances where the implants are only temporary additions that can later be removed via surgery once your fracture heals. Your doctor will outline what to expect from your treatment and address any questions you might have regarding the use of implants.
