Fractures (Broken Bones)

Fractures are one of the most common injuries in medicine today. They are the most common reason that patients will visit an urgent care, physician’s office or an emergency room. Fortunately, at Premier Orthopaedic and Trauma Specialists we have multiple surgeons who focus the majority of their time and energy on the treatment of fractures. In the past, for years and years, fractures have been treated by just about any orthopedic surgeon with unreliable results. Starting in the late 1900s, a focus on orthopedic trauma as a specialty was developed and encouraged by the American Academy of Orthopaedic Surgeons.

Today, we truly understand the importance of orthopedic trauma physicians who focus mainly on the treatment of fractures and undergo additional training to that end. This is important for fractures who need surgery, but also very important for patients whose injuries may not need surgery – sometimes this decision is crucial to the overall outcome.

Our physicians spend a majority of their time treating patients who present in emergency rooms but are also available for referral for treatment of simple and complex fractures.

Why Would I Need a Surgery to Repair a Fracture?

As mentioned above, sometimes the most important part of treating a fracture is the decision of whether to pursue surgery or not. It requires an experienced orthopedic surgeon to evaluate x-rays and sometimes order more complex imaging to make the decision. Fractures can be treated very simply with casts or just immobilization, but at times will need complex intervention to place rods or plates and screws to stabilize the fractures.

How Do I Know I Need a surgery to Repair a Fracture?

The easiest way to know if you will need surgery to repair your fracture is to obtain a consultation from an orthopedic surgeon. During this consultation, there will be a physical examination, evaluation of imaging, and then a decision on whether surgery will be needed or if a cast or splint suffices. Depending on the complexity of the injury, sometimes the orthopedic surgeon will recommend getting further imaging, like a CT scan or an MRI.

Interestingly enough, MRIs are not very helpful in fracture treatment and are not used frequently. Although many patients feel MRIs are the gold standard in treating most injuries, they are not very helpful in fracture surgery.

How Does Surgery Work for a Fracture?

As one can imagine, fractures come in all shapes and sizes. You can break your pinky finger or break your femur bone.

For most patients who start as a consultation in the office, surgery will usually be done in the outpatient setting. After your evaluation and the decision for surgery is made, we will start working towards planning. This usually requires some basic blood work or evaluation of heart function, depending on age. The surgeon’s office will also work with your insurance company to verify insurance coverage and patient obligations.

Most fracture surgeries are done under general anesthesia; sometimes your anesthesiologist will recommend a nerve block to assist with pain control. A nerve block utilizes ultrasound to find the nerves and employs numbing medicine, just as your dentist would for your teeth. This helps lessen feeling and hence the pain after surgery. The treating surgeon and the anesthesiologist will work as a team to help make the experience as comfortable as possible.

During surgery, the orthopedic surgeon will usually make an incision and use intraoperative x-ray, also called fluoroscopy, in order to place the bones back in the correct position. Depending on which bone it is and how badly it is broken, there is usually a combination of wires, plates, rods or nails, and screws. These are all used to help stabilize the injury and allow early motion and function.

Usually, the hardware placed inside of the body is left in for life – however there are certain circumstances where it can be removed the hardware if it is bothering the patient. This should be decided prior to or after surgery with your orthopedic physician.

Preparing for Surgery

When preparing for surgery, you will get pre-operative instructions from the office, including your surgery date, the requirements for eating and drinking prior to surgery, and what time to show up at the hospital.

Usually when having outpatient surgery, most patients will be instructed to not eat anything 6 to 8 hours prior to surgery, and usually not have anything to drink for a few hours prior to surgery. These rules are made to ensure patients have a safe experience with anesthesia.

Early Recovery and Getting Back to Normal Activity

The goal of fracture surgery in the modern day is to allow for early range of motion. We use plates, screws and rods to stabilize bones and allow the nearby joints to start moving, which allows the patient to recover from swelling and pain much sooner. Some fractures require immobilization in a cast or something similar and those instances will be explained to you by your orthopedic team.

Realistic Expectations Post-Surgery

Our goals here at Premier Orthopaedic and Trauma Specialists is to restore as much of your function as possible. It is important that you have a conversation with your physician prior to surgery to discuss what their expectations are for your long-term recovery.

Risks and When to Call the Office

While the prognosis after fracture surgery is excellent in the hands of a highly experienced surgeon, it is still major surgery that comes with risk. While low, there is a risk of blood loss, pain, blood clots, infection and hardware failure.

Patients will typically follow up with our office a few weeks after surgery, however patients should call us immediately if they experience any of the following potential complications.

• A fever of over 101
• Worsening pain at the incision site
• Worsening or foul-smelling discharge at the incision site
• Any redness or swelling in the leg. This is often a sign of deep vein thrombosis or DVT

Typically, the benefits of a fracture surgery, in the form of reduced pain and improved lifestyle, far outweigh the risks of surgery, however every patient has a unique circumstance. We encourage you to contact our office and schedule appointment with one of our surgeons to discuss whether revision surgery may be the best option for you and answer any questions about the procedure itself and life after surgery.