Bone is a living tissue, and when a bone breaks, it can heal itself. However, the bone has to be held in place (immobilised) to make sure it heals in the right position.
This can sometimes be achieved using non-surgical methods, such as a sling or plaster cast. But if this isn’t possible, you may need to have surgery to fix the broken parts of your bone together with a metal plate, rod (also called an intermedullary nail) or pins and a frame (also called external fixators). Plates are fixed to the outside of your bone and hold the broken segments together, whereas rods are inserted inside your bone. Pins pass into your bone through your skin and are fixed outside your body with a frame.
Once your bone has been fixed in place, your body will produce new bone to join the broken parts together.
What are the alternatives?
You may not need surgery if your broken bone can be held in place using non-surgical methods, such as a sling or plaster cast.
Another alternative to surgery is traction. This involves using weights to pull the bones in your leg into place, while they heal. However, this treatment involves a long stay in hospital, and isn’t used very often any more.
Whether or not your surgeon advises surgery depends on a number of factors individual to you, including whether you have any other injuries, the type of fracture, your age and how active you are.
Preparing for surgery for a broken bone
Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery. It can also delay fracture healing.
Your surgeon or another healthcare professional will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.
Surgery for broken bones is carried out under general anaesthesia. This means you will be asleep during the operation. You will be asked to follow fasting instructions before you have a general anaesthetic. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon or anaesthetist’s advice.
You may be asked to wear compression stockings and/or have an injection of an anticlotting medicine called heparin to help prevent blood clots forming in the veins in your legs. You will usually be put on an antibiotic drip before surgery. This is to reduce your risk of getting an infection during surgery.
What happens in surgery for a broken bone?
The device used to fix your broken bone will depend on a number of factors. Rods are more commonly used for broken legs and plates and screws for broken arms. Pins and frames tend to be used as a temporary measure for broken legs or if you have severe injury to your leg or arm.
Your surgeon will first position your arm or leg to line up the broken parts of bone. He or she will then make a small cut to reach your bone. This may be at the top of your arm or leg or in your knee or elbow, depending on which bone you have broken. Your surgeon will then insert the rod down the centre of your arm or leg bone.
Plates and screws
To fix a plate, your surgeon will make a cut through the skin and muscle along the length of your arm or leg. He or she will manoeuvre the broken fragments of bone back into position and then insert the plate so that it is lined up against the length of your bone. The plate will be fixed in place with metal screws.
Your surgeon will insert the pins through your skin in your broken arm or leg and fix them together with metal bars. Your surgeon may replace the pins and frame for a plate or rod after two to three weeks.
Your surgeon may use X-rays during the surgery to make sure the plate, rods or pins are positioned correctly. Your surgeon will close your wound with stitches or staples and cover it with a sterile dressing.
What to expect afterwards
Your surgeon or nurse will give you painkillers to help with any discomfort as your anaesthetic wears off.
You may need to keep your arm or leg elevated at first. If you have had surgery for a broken arm, you may be given a sling or splint to keep it supported while it heals. If you have broken your leg, you will be given crutches to use so that you don’t put any weight on your leg. If you have metal pins inserted, you will be told how to keep the insertion points clean.
You will usually be able to go home after one to two days, as long as there are no complications.
You will be started on a rehabilitation programme as soon as possible. A physiotherapist will give you some exercises to do to start getting the movement back in your arm or leg.
Recovering from surgery
If you had surgery for a broken leg, you may be able to start putting some weight on it within a few weeks of your operation, and you may be able to return to work within two weeks if your occupation doesn’t involve any physical work.
It usually takes about six to 10 weeks to make a full recovery from surgery for a broken arm or leg, but this depends on a number of factors, including your age and the type of surgery you have had, so it’s important to follow your surgeon’s advice.
The length of time your dissolvable stitches will take to disappear depends on what type you have. However, they should usually disappear in about three to six months.
Surgery for broken arms and legs is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.
- You will feel tired and need to rest as the effects of the anaesthetic wear off.
- You are likely to have some pain where the nail or plate was inserted. You will be given painkillers, however, tell your surgeon if the pain persists.
Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, or DVT).
- Your broken bone may not heal (non-union), or heal in the wrong position (mal-union). This is uncommon, but your surgeon will X-ray your bone during your follow-up appointments to check how well it is healing and discuss further treatment options with you if necessary.
- Damage to a nerve – this may cause some loss of movement or feeling in your arm or leg. This is uncommon and when it does happen, it tends to only be temporary.
- If you had a rod inserted in your knee for a broken leg, you may continue to have knee pain over the long term. Talk to your surgeon if this happens.
- Infection. If you develop an infection, your surgeon will give you antibiotics to take or you may be put on an antibiotic drip. If the infection spreads, you may need to have the infected tissue removed.
- Compartment syndrome – this is when the nerves and blood vessels become compressed, and can lead to tissue death as your leg or arm doesn’t receive enough blood. You may feel extreme pain in the affected limb. If you develop compartment syndrome, you will need to have immediate surgery to relieve the pressure.
The exact risks are specific to you and differ for every person, so we haven’t included statistics here. Ask your surgeon to explain how these risks apply to you.