Fracture Fixation with Plates, Screws, Nails and Fixators
In fractures that need surgery, the bone fragments are placed in the right position and held with plates, screws, nails or a fixator until they heal.
Some fractures heal in a cast, while others need surgical fixation to hold the fragments in the right position. The aim of fixation is for the bone to heal at the right length, alignment and rotation, and for the patient to start moving as early as possible.
Which fractures need surgery?
- Markedly displaced fractures
- Fractures that extend into and disrupt the joint surface
- Unstable fractures that a cast cannot hold
- Open fractures
- Multi-fragment fractures and injuries involving several bones
- Fractures that have not healed or have healed in the wrong position
Fixation methods
Plates and screws
Metal plates placed on the surface of the bone are fixed with screws. They are preferred especially for fractures around joints, forearm fractures and whenever the joint surface must be restored precisely. Locking plates give stronger fixation in weaker bone.
Screws
Screws alone may be enough for small fragments and some fractures inside joints.
Intramedullary nails
For fractures of long bones such as the thigh and shin bones, a nail is placed inside the marrow canal. It is inserted through small incisions, disturbs the fracture site very little and often allows early weight bearing.
External fixators
Pins passed through the skin into the bone are connected by a frame outside the body. They are used in open fractures with severe soft tissue damage, as temporary fixation in multiple injuries, and in bone lengthening and deformity correction.
The operation
The fracture is planned in detail with X-rays and, when needed, CT. The fragments are reduced with open or closed techniques and the implants are placed under real-time X-ray (fluoroscopy) control. In open fractures, wound cleaning and antibiotics are an essential part of treatment.
Recovery
Fixation holds the fragments steady until the bone heals, but healing itself still depends on the bone’s biology. How much weight you can bear depends on the fracture and the fixation. Regular X-rays and physiotherapy are part of recovery. Stopping smoking and eating well support healing.
What to watch for after surgery
Redness, discharge, increasing pain or fever at the wound can be signs of infection and should be checked without delay. Patients with an external fixator need to clean the pin sites regularly. Follow-up X-rays are taken at intervals to confirm healing and that the implants are in place.
Frequently asked questions
Can metal implants stay in the body?
Yes. Most implants can stay for life if they cause no problems. Those that cause discomfort can be removed after the bone has healed.
Will I set off airport metal detectors?
Some large implants can trigger detectors. You can carry a document describing your implant if needed.
When can I put weight on the limb?
It depends on the fracture and the fixation method. Some fractures fixed with an intramedullary nail allow early weight bearing, while weight bearing is delayed for a few weeks in fractures inside joints.
Can I have an MRI after fracture surgery?
Most implants used today are MRI compatible. Simply inform the team about your implant before the scan.
The information on this page is general and does not replace an examination. An examination is needed to decide which treatment suits you.