Fracture Fixation Surgery

Most broken bones heal well in a plaster cast. Some don't: the pieces have shifted too far, the bone is in several fragments, the break runs into a joint, or it has come through the skin. Left in a cast, these can heal crooked or short, or not at all, and a joint that heals with a step in its surface wears out early.

Fracture fixation surgery puts the pieces back in position (reduction) and holds them there (fixation) while your body heals the bone. In open reduction and internal fixation (ORIF), the surgeon opens the skin over the break, lines up the fragments and fixes them with a metal plate and screws. Long bones such as the thigh and shin are often fixed with a rod (intramedullary nail) passed down the hollow centre of the bone through small cuts.

The metal holds the bone, but your body does the healing, usually over 6 to 12 weeks, and longer for the shin, in smokers and with diabetes. The big gain is that nearby joints can move far sooner than in a cast, so there's less stiffness and muscle wasting.

Our emergency department runs 24 hours with a dedicated trauma bay and hands over to the orthopaedics and trauma team. Our theatres have C-arm machines, which show live X-ray images during surgery, and a range of plates, screws and nails. When a fracture comes from thin, osteoporotic bone, we also look at your bone health so it's less likely to happen again.

Your surgeon uses X-rays, and often a CT scan, to judge whether a break will heal well without an operation. Fixation is usually advised in these situations.

Your surgeon sets how much weight the limb can take, and usually raises it after each follow-up X-ray. Pain isn't a reliable guide, because a fixed bone can feel fine well before it has healed.