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by HEALTHYJOINTCLUB » Thu Sep 05, 2013 8:56 pm

Dr.A.Mohan krishna.
M.S.ORTHO.MCh Ortho(U.K)
Consultant Orthopedic surgeon
Apollo Hospitals, jubilee hills,
For appointment :Call:040-23607777 (6591)

Human body is made of structural frame work of bones to which muscles and ligaments are attached. Bone is made up of living tissue which has ability to grow, repair and remodel. When bone gets fractured it can heal itself t in abnormal position or sometimes it heals by forming a fibrous tissue. However fractured bone needs to be held in natural (Anatomic) position to heal in normal way.
This can be achieved by two methods.
Non-operative, methods like plaster or sling immobilization can be tried in some fractures. Some of the fractures can be treated by applying traction which aid in aligning and maintaining length of the bone. But it does not work with all the fractures.
Surgery for the broken bones to fix them can be achieved by metal plate with screws, rods (intramedullary rods), pins and frames (External fixator). Preparing for surgery for a broken bone
Normally bone is fractured following a traumatic episode like accidental fall, road traffic accident or hit by heavy object. It is important first to stabilize vital parameters of the patient in the emergency room and rule out other associated injuries. Your surgeon will discuss with you regarding the procedure, postoperative protocol, pain management and physiotherapy. These details might help you to ask risks and benefits of the procedure and also to sign for consent for the surgery. Surgery is carried out under general anesthesia or regional anaesthesia or block depending on the fracture location and anaesthetist’s preference. You will asked to be on empty stomach for at least six hours prior to the surgery for planned surgical fixation. You will be started on IV fluids, preoperative antibiotics and analgesics till you are ready for surgery.
During the surgery
The choice of implant used for fixing the bone depends on the type of fracture, associated injuries and surgeon’s preference in some instances.
Plates and screws:
In order to fix plate and screws surgeon has to make cut through the skin and muscle along the length of arm or leg. Surgeon manipulates the broken ends of bone to align them to regain original length and then fix plate to the bone with help of screws.

Nails and Rods:
Nails and rods are also called intramedullary or interlocking nails. These are mostly inserted after reduction of fracture by closed methods. Surgeon makes a small cut on the skin and muscle at the one end of the bone to make entry for insertion of nails. The canal of the bone is reamed with special reamers to the diameter of the nail and nail is inserted with aid of special zigs. Most of the times these nails are locked with help of screws on both ends to maintain rotational stability.
External fixators:
In case of some open fractures or fractures near the joint where fracture fixation by plates and screws are not possible, broken bones can be aligned and stabilized by external fixators. Surgeon inserts pins through small incisions over the bone and these pins are aligned with clamps and metal bars. In case of open fractures it aids the surgeon to make regular dressing and after the wound settles surgeon may prefer to fix the fracture with plates or nails.

After the surgery:
Immediately after the surgery you would be observed in recovery room and later shifted to ward. You will be given antibiotics and painkillers in the form of injections for 3 to 4 days. Oral foods are allowed after 4 to 6 hours after the procedure depending on type of anaesthesia given. You would be advised to keep your operated limb elevated. In case of surgery to broken upper limb bones you would be given a splint, brace and sling to support until the wound heals. If you had surgery for broken bones of leg or thigh you would be given a walker or crutches to avoid putting weight on operated leg. In case of external fixator you would be advised regarding cleaning of pin insertion sites.
You would be advised range of motion and other necessary exercises depending on the location of fracture under the guidance of physiotherapist. You would be discharged with 3 to 4 days after the surgery unless there are no complications.
A follow up advice for dressing and suture removal would be given to you at the time of discharge.

Recovery from surgery:
In case of fracture fixation surgeries you will be advised follow up every 6 weeks in initial 3 months with x ray film. In case of lower limb fractures if healing is in progress partial weight bearing is adviced after 6 weeks and full weight bearing by the end of 3 months. In some case it may be delayed depending on the fracture pattern and severity of the fracture. You may return to your work within 2 to 3 weeks if occupation does not involve physical stress. But the fully recovery from surgery to the healing of the fracture depends on number of factors like age, severity of injury, type of fixation chosen and it is important to follow surgeon’s advice.
Risks and complications:
Risks and complications are associated with any type of surgery. In order to give your consent before surgery you should be aware of these.
General complications of any surgery are hypersensitivity reactions to anaesthetic drugs, bleeding complications, blood transfusion reactions, or chance of developing blood clots in the viens resulting deep vein thrombosis (DVT).
Complications during and after fixing fractured bones are
1. Accidental damage to nerve or blood vessel.
2. Superficial or deep infection: If surgeon suspects infection he may advice you to continue antibiotic either as oral or by injectable route. If the infection persists and spreads a revision surgery may be necessary.
3. Delayed Union: sometimes the signs of fracture union might be delayed depending on the number of factors. In such cases you may put additional supplement drugs which may enhance healing process.
4. Non Union: surgically stabilized bone sometimes fail to heal. Non union may be seen following broken implants .Patients usually complains of pain and sound at the fracture site. Surgeon decides regarding further management weather to perform a revision surgery with new implant with additional need for bone grafting.
5. Mal union: healing of fracture in wrong position, which is not routinely seen, but surgeon can notice during follow up period and advise you appropriate management.
6. Implant failure: on rare occasions there may be fatigue failure of implant resulting in non union and some time mal union at the fracture site. Revision surgery might be necessary with a new implant with or without need of bone grafting.
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