What is a fracture fixation?

What is a fracture fixation?

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Fracture fixation is a surgical procedure performed to stabilize and align broken bones (fractures) to promote proper healing. When there is a fracture, some degree of injury also occurs to the soft tissues surrounding the bone. The goal of fracture fixation is to restore the normal alignment and function of the fractured bone, allowing it to heal in the correct position.

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There are various methods of fracture fixation, including:

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1. Internal Fixation: In this method, implants such as metal plates, screws, rods, or nails are surgically placed inside the body to hold the fractured bones in proper alignment.
2. External Fixation: In this method, external devices such as metal pins or wires are attached to the bone through the skin to stabilize the fracture from the outside.

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The choice of fracture fixation method depends on factors such as the type, extent and location of the fracture, the age and health of the patient, and the surgeon's preference and expertise.

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Fracture fixation is performed to prevent further damage to surrounding tissues, promote bone healing, and reduce the risk of complications such as non-union (when the bone fails to heal), malunion (when the bone heals in a misaligned position), or joint stiffness. After the surgery, patients typically undergo rehabilitation, which may include physical therapy, to regain strength, mobility, and function in the affected area as the bone heals and stabilizes. The length of recovery and rehabilitation varies depending on the severity and location of the fracture, as well as the individual's overall health.

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Who can benefit from a fracture fixation?

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Fracture fixation can benefit individuals with various types of fractures, particularly those with more severe or complex fractures that require stabilization and alignment to promote proper healing. People who can benefit from fracture fixation include:

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1. Fractures with Displacement: Fractures in which the broken bone ends are not in proper alignment can benefit from fracture fixation to realign the bones and promote proper healing.
2. Comminuted Fractures: Fractures that result in multiple bone fragments can benefit from fracture fixation to stabilize the fragments and prevent further damage.
3. Open Fractures: Fractures that involve an open wound where the bone penetrates the skin require immediate attention and may benefit from fracture fixation to reduce the risk of infection and promote healing.
4. Fractures in Weight-Bearing Bones: Fractures in bones that bear significant weight, such as the femur, tibia, or bones in the foot, can benefit from fracture fixation to facilitate proper weight-bearing during the healing process.
5. Fractures in Joints: Fractures that occur near or involve a joint can benefit from fracture fixation to restore joint alignment and function.
6. Certain Fractures in Children: Fractures in growing children may benefit from fracture fixation to ensure proper alignment and growth of the affected bone.
7. Fractures in Elderly or Osteoporotic Individuals: Fractures in elderly individuals or those with osteoporosis may require fracture fixation to stabilize the bone and prevent further fractures.
8. Fractures with Risk of Non-Union or Delayed Healing: Some fractures have a higher risk of non-union (when the bone fails to heal) or delayed healing. Fracture fixation can help promote bone union and prevent complications.

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The decision to perform fracture fixation depends on various factors, including the type and location of the fracture, the severity of the injury, the age and overall health of the patient, and the surgeon's expertise. In some cases, conservative treatments such as casting or splinting may be sufficient for simple and stable fractures, while more complex or displaced fractures may require surgical fixation.

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The primary goals of fracture fixation are to stabilize the fractured bone, promote proper alignment for healing, reduce the risk of complications, and facilitate the return to normal function and activities. Each patient's unique circumstances and individual health factors will influence the suitability and potential benefits of fracture fixation. A qualified medical professional, such as an orthopedic surgeon, will evaluate the specific fracture and recommend the most appropriate treatment plan for the best possible outcome.

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After a fracture fixation: What to expect

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After fracture fixation surgery, the recovery process is crucial to ensure proper healing and successful rehabilitation. The specific expectations and timeline can vary depending on the type and location of the fracture, the extent of the surgery, and individual healing factors. Here are some general guidelines for what to expect after a fracture fixation:

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1. Hospital Stay: The length of hospital stay varies depending on the complexity of the surgery and the type of fracture. For some simple fractures, patients may be able to go home on the same day of surgery, while more complex cases may require a longer hospital stay.
2. Pain Management: You may experience some pain and discomfort at the surgical site after surgery. Your healthcare team will provide pain medications to manage post-operative pain.
3. Immobilization: Depending on the type of fixation used (internal or external), you may need to wear a cast, splint, or brace to immobilize the fractured bone and promote healing. The duration of immobilization will depend on the type of fracture and the surgeon's recommendations.
4. Restricted Activities: Your surgeon may provide specific instructions on restricted activities to avoid putting excessive stress on the healing bone. This may include limitations on weight-bearing, lifting, or certain movements.
5. Physical Therapy: In some cases, physical therapy may be initiated soon after surgery to help maintain joint mobility and prevent muscle atrophy. As the bone heals and the immobilization period ends, physical therapy will focus on regaining strength, flexibility, and function in the affected area.
6. Follow-up Appointments: You will have regular follow-up appointments with your surgeon to monitor the healing progress, check the surgical site, and remove sutures or staples if used.
7. Gradual Return to Activities: The timeline for returning to daily activities and work will depend on the type of fracture, the extent of surgery, and individual healing. Your surgeon and physical therapist will provide guidance on when you can safely resume various activities.
8. Bone Healing: The time it takes for the fractured bone to heal varies depending on factors such as the type of fracture, the patient's age and overall health, and the location of the fracture. Healing is assessed by the physician using radiological and clinical examinations. Generally, children heal within 4 to 6 weeks, adolescents within 6 to 8 weeks, and adults within 10 to 18 weeks. 
9. Scar Management: If the surgery involves an incision, proper scar management may be advised to minimize scarring and promote healing.

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It's important to follow your surgeon's post-operative instructions diligently to promote healing and prevent complications. Adhering to restrictions, attending follow-up appointments, and participating in physical therapy exercises are essential for a successful recovery.

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Every individual's recovery process is unique, and each patient's progress may vary. Your healthcare team will monitor your healing progress and provide guidance throughout the recovery period to ensure the best possible outcome and a safe return to normal activities.

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How can physical therapy help? 

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Physical therapy plays a critical role in the recovery process after fracture fixation surgery. A physical therapist will design a personalized rehabilitation program to promote healing, restore strength and flexibility, and help you regain function and mobility in the affected area. Here's how physical therapy can help with recovery from a fracture fixation:

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1. Pain Management: Physical therapists use various modalities  such as ice, heat, electrical stimulation, and ultrasound to manage post-operative pain, reduce muscle tension and swelling around the surgical site.
2. Joint Mobility and Flexibility: During the early stages of recovery, physical therapists focus on gentle range of motion exercises such as passive to active range of motion with or without assistance to maintain joint mobility and prevent stiffness in the surrounding muscles and joints. As the patient improves, manual and self-stretching exercises as well as joint mobilization are prescribed to increase the range of motion of restricted tissues and regain lost joint play without stressing the fracture site.
3. Strengthening Exercises: As healing progresses, physical therapists prescribe strengthening  exercises to increase strength, endurance and performance  of the muscles around the affected area and the adjacent joints. Initially, light resistance exercises through the available range are utilized. Once the bone is radiologically healed, progressive and repetitive resistance exercises are initiated. 
4. Weight-Bearing Progression: For weight-bearing fractures, physical therapists guide patients through a gradual progression of weight-bearing activities, it includes the use of partial weight bearing if the lower extremity is affected and non-stressful activities if the affected area is the upper extremity, to safely regain strength and stability while protecting the healing bone.
5. Functional Adaptations: If there is a lower extremity fracture, alternative modes of walking, such as the use of crutches or a walker, are taught to the patient who is allowed out of bed. The choice of assistive device and gait pattern depends on the fracture site, the type of immobilization, and the functional capabilities of the patient. The patient’s physician will prescribe the amount of weight bearing allowed on the affected extremity. 
6. Functional Training: Once the fractured bone is healed, and as the joint play, range of motion, muscle strength, endurance and performance improve, functional training is initiated. It involves practicing activities that simulate the physical demands of a patient's work or desired recreational or sport activity. Simulated activities and drills enable a patient to receive feedback on correct mechanics. 
7. Balance and Proprioception: Specialized exercises are included to improve static and dynamic balance as well as joint position sense and control, which are important for stability and fall prevention during the recovery period especially if the lower extremity is affected.
8. Scar Tissue Management: If there is restricting scar tissue, the physical therapists may perform scar tissue mobilization techniques to mobilize the scar as well as to promote tissue healing and reduce scar adhesions around the surgical site.
9. Aerobic Conditioning: As soon as the patient tolerates repetitive activity without pain and discomfort, the physical therapist will initiate safe aerobic exercises that do not stress the fracture site until it is healed. This type of exercise will help the patient to improve his/her cardiopulmonary fitness.
10. Education on Home Exercises: Physical therapists educate the patients about fracture fixation procedure, its various methods, indications and benefits as well as the role and importance of postoperative rehabilitation programs. They also provide a specialized home exercise program for each patient and teach them how to incorporate it into their daily routine to reinforce the interventions and promote optimal recovery.  
11. Monitoring Progress: Physical therapists continuously assess your progress and modify the treatment plan as needed to ensure a successful recovery.

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Physical therapy is essential to optimize your recovery after fracture fixation surgery. The therapist's expertise and guidance are instrumental in promoting healing, preventing complications, and helping you regain strength, flexibility, and function in the affected area. Consistent participation in physical therapy exercises and adherence to your therapist's recommendations will lead to the best possible outcome, allowing you to gradually resume your normal activities with reduced pain and improved function. It's important to communicate openly with your physical therapist and follow the prescribed exercises and guidelines to achieve the most favorable results from your rehabilitation program.

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