Patient education: Surgery to fix a broken bone (The Basics)

What is a fracture? — A "fracture" is another word for a broken bone. There are different kinds of fractures, depending on how the bone breaks. When a bone breaks, it might crack, break all of the way through, or shatter.

How are fractures treated? — Treatment depends, in part, on the type of fracture that you have and how serious it is. The goal is to have the ends of the broken bone line up with each other so that the bone can heal.

For more severe fractures, you might need surgery to put the broken bones back in the correct position.

How are broken bones fixed with surgery? — This can be done with something called "open reduction and internal fixation" surgery. During the surgery:

●The doctor moves the broken pieces of bone into the correct place. This is called "reduction."

●They will also use some type of hardware to hold the bone in place while it heals. This is called "internal fixation." The hardware can include metal plates, rods or nails, pins, wires, or screws (figure 1).

Most of the time, the hardware used to hold the bone in place goes inside the body. It can stay in place after the bone heals or, in some cases, the doctor will remove it. For some kinds of broken bones, the doctor uses pins or screws that go through the skin and into the bone. They are attached to a metal bar that is outside of the body. This is called an "external fixator." It is removed when the bone is healed.

Most fractures take weeks to months to heal. Fractures in children usually heal faster than fractures in adults.

How do I prepare for my surgery? — Surgery to fix a broken bone might be done right away after the injury, or the doctor might schedule it for a few days later. The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. They might send you to get additional imaging tests, such as a CT scan or MRI. Imaging tests create pictures of the inside of the body.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●What help you will need when you go home – For example, you might need to use crutches or a wheelchair, or have someone stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during surgery? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure you do not feel pain during the procedure. Types of anesthesia include:

•Regional – This type of anesthesia blocks pain in 1 area of your body, such as an arm, leg, or the lower half of your body. If you get regional anesthesia, you might be awake. Or you might get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●You might get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will make a cut (incision) in the skin over your broken bone. Then, they will use special tools to move the bones back to their proper place. The doctor uses metal plates, rods or nails, pins, wires, or screws to hold the pieces of bone in place.

●The doctor will close your incisions and cover them with clean bandages. Next, they might put a splint or cast on to protect the area and limit movement. This will help your bones stay in the proper place as they heal.

●The length of the procedure depends on the type and location of the fracture.

What happens after surgery? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. You might have to stay in the hospital for a few days, based on the type and location of the fracture. Some people are able to go home the same day of the surgery.

As you recover:

●You might feel groggy or confused for a short time. You might also feel sick to your stomach or throw up. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●If your surgery was on your shoulder, arm, or hand, you might get a sling. If your surgery was on your hip, leg, or foot, you might need to use crutches, a walker, or a wheelchair after surgery.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine to help with pain, if needed. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of an open reduction and internal fixation surgery? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Infection

●Bleeding

●Nerve damage

●Blood clots

●The bone not healing correctly

●Hardware becoming loose or causing pain

What else should I know? — Before you go home from the hospital, make sure that you know what problems to look for and when you should call the doctor. Make sure that you understand your doctor or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Surgery to fix a broken bone – Discharge instructions (The Basics)
Patient education: Fractures (The Basics)
Patient education: How to care for your cast (The Basics)
Patient education: How to care for your child's cast (The Basics)
Patient education: How to care for a splint (The Basics)
Patient education: Managing pain after surgery (The Basics)
Patient education: Setting a broken bone in adults (The Basics)
Patient education: Setting a broken bone in children (The Basics)
Patient education: Pin, plate, or screw removal (The Basics)

Patient education: Cast and splint care (Beyond the Basics)