Fractures, or broken bones, are one of the most common traumatic injuries requiring surgery. Surgical fracture fixation is necessary when the bone cannot heal correctly through conservative treatment (such as casting) due to its location, complexity, or the degree of misalignment.

Types of surgical fracture fixation:

• Open Reduction & Internal Fixation (ORIF):
  This procedure involves making an incision to access the fracture site and then realigning the bones into their normal position (open reduction). After realignment, internal fixation devices such as metal plates, screws, or rods are used to stabilize the bone and hold it in place during the healing process.
  
  • Indications: Complex fractures, such as comminuted fractures (where the bone is shattered into multiple pieces), fractures in joints, or fractures that involve important structures like blood vessels and nerves.
    
  • Recovery: Post-surgery, the patient may need a period of immobilization, followed by physical therapy to restore range of motion and strength.
    
    

    External fixation:
    

    In some cases, particularly for fractures that are exposed (open fractures), an external fixation device may be used. This involves placing pins into the bone through the skin and connecting them to an external frame that stabilizes the bone.
    

    • Indications: Severe fractures with significant soft tissue damage, open fractures, or fractures in unstable areas.
      
    • Recovery: This method may require several weeks of healing before a follow-up surgery can be performed to remove the external fixators.
      
      

      Intramedullary nailing:
      

      For certain fractures (especially in long bones like the femur or tibia), an intramedullary nail (IM nail) is inserted inside the bone to provide internal stabilization.
      

      • Indications: Fractures in long bones, such as the femur or tibia, particularly those that are aligned but require stabilization.
        
      • Recovery: This technique generally allows for faster healing with less disruption to the surrounding muscles and tissues.
        
        

        Complex fracture:
        

        A complex fracture involves multiple bone fragments or significant damage to surrounding soft tissues, often affecting crucial areas such as joints or regions near vital structures like blood vessels and nerves. Surgical intervention is typically necessary when conservative methods cannot achieve proper alignment or healing.
        

        • Indications: These fractures are characterized by severe misalignment or multiple bone fragments, often requiring surgery due to the involvement of vital structures or joints.
          
        • Recovery: Post-surgery, patients typically require immobilization and guided physical therapy to regain function. The recovery process may take longer due to the complexity of the injury, often involving careful monitoring and staged rehabilitation to ensure complete healing and restored mobility.
          

          Revision Surgery in Fracture:
          

          Revision surgery is required when previous fracture fixation fails or complications arise.
          

          • Indications: It is indicated when the initial treatment fails due to complications like infection, hardware malfunction, or improper alignment. Patients may experience persistent pain, instability, or deformity after the first surgery, necessitating revision.
            
          • Recovery: The recovery phase after revision surgery is typically extended, as it involves correcting earlier complications. A detailed rehabilitation plan with gradual weight-bearing and strengthening exercises is crucial for regaining function and stability.
            
            

            Non-United Fracture (Nonunion):
            

            Nonunion occurs when a fracture fails to heal within the expected timeframe, leaving the bone unstable and causing ongoing pain.
            

            • Indications: This condition often arises due to poor blood supply, inadequate stabilization, or factors like smoking or diabetes that hinder healing. Surgery is often necessary to promote healing.
              
            • Recovery: Recovery from nonunion treatment often requires advanced techniques like bone grafting or fixation devices to stimulate healing. Postoperative care includes immobilization, followed by progressive physiotherapy to restore strength and functionality over several months.
              
              

              Malunited Fracture (Malunion):
              

              Malunion occurs when a fracture heals in an incorrect position, causing deformity or impaired function.
              

              • Indications: Surgical correction is required when the misalignment causes functional impairment or chronic discomfort that interferes with daily activities.
              • Recovery: Recovery focuses on reestablishing proper alignment and function, often through corrective surgery. Physical therapy is integral to regaining strength and mobility, with recovery timelines depending on the severity of the deformity and the surgical approach used.

In cases where complex trauma has caused irreparable damage to the joints, joint replacement surgery may be necessary. Common joints that may require replacement after severe trauma include the hip, knee, and shoulder.

• Total Hip Replacement (THR): This procedure is often performed when the hip joint is severely damaged by fractures or degenerative conditions such as osteoarthritis. In trauma cases, fractures to the femoral head or neck can lead to the need for a hip replacement.
  
  • Procedure: The surgeon removes the damaged portions of the hip joint (the femoral head and acetabulum) and replaces them with artificial components made of metal, ceramic, or plastic.
    
  • Recovery: The recovery process typically takes 3-6 months, and physical therapy plays an essential role in restoring mobility and strength.
    
• Total Knee Replacement (TKR): For severe knee injuries or fractures, especially when the cartilage is worn down, a total knee replacement may be needed.
  
  • Procedure: The damaged knee joint is replaced with a prosthetic joint. The surgeon removes the damaged cartilage and bone, then inserts a metal and plastic artificial joint.
    
  • Recovery: Recovery involves rehabilitation to regain full knee function. It usually takes about 3-6 months to return to daily activities.
    
• Shoulder replacement: In cases of complex trauma, such as fractures to the shoulder joint or advanced arthritis, a shoulder replacement may be required.
  
  • Procedure: The damaged parts of the shoulder joint are removed and replaced with artificial components. Depending on the injury, a total shoulder replacement or reverse shoulder replacement (where the ball and socket are swapped) may be performed.
    
  • Recovery: Recovery time can vary depending on the individual and the type of procedure, but full recovery may take up to a year, with rehabilitation focusing on restoring range of motion.

Arthroscopy is a minimally invasive surgical technique used to diagnose and treat joint injuries. It involves inserting a small camera (arthroscope) into the joint through small incisions, allowing the surgeon to view and repair internal damage without making large cuts.

Indications:

• • Ligament injuries (such as ACL tears).
  • Cartilage damage (e.g., meniscus tears in the knee).
  • Joint infections or inflammation.
  • Removing debris or damaged tissue from joints.
    
• Procedure: The surgeon makes small incisions and inserts the arthroscope, along with specialized surgical instruments, into the joint. Damaged tissues, such as torn ligaments, meniscus, or cartilage, are repaired or removed.
  
• Recovery: Recovery is generally quicker than traditional open surgeries, with many patients able to return to normal activities within a few weeks to a few months, depending on the injury.