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Fracture Repair

Last updated May 10, 2018

Approved by: Maulik P. Purohit MD MPH

A Fracture Repair (Fracture Reduction) procedure involves two main methods, Open Reduction and Closed Reduction.


Background Information:

What are the other Names for the Procedure?

  • Fracture Reduction

What is Fracture Repair surgical procedure?

A Fracture Repair (Fracture Reduction) procedure involves two main methods, Open Reduction and Closed Reduction:

  • Open Reduction is a surgical intervention technique that realigns the broken bones during surgery and uses orthopedic devices, such as plates, screws, and rods, to sustain a proper position of the bone allowing it to heal
  • Closed Reduction is a surgical treatment method that involves realigning the broken bones back to its proper anatomic position, without making an incision at the fracture site

What part of the Body does the Procedure involve?

A Fracture Repair may involve any broken bone(s) of the body.

Why is the Fracture Repair surgical procedure Performed?

A Fracture Repair procedure is performed to restore a broken bone to its normal and properly functioning position.

What are some Alternative Choices for the Procedure?

A Fracture Repair (Fracture Reduction) procedure remains the gold standard approach for treating bone fractures.

What are the Recent Advances in the Procedure?

A Fracture Repair (Fracture Reduction) procedure remains the gold standard approach, in the management of bone fractures.

What is the Cost of performing the Fracture Repair surgical procedure?

The cost of Fracture Repair (Fracture Reduction) procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused by the information regarding a Fracture Repair and on what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
  • They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.aurorahealthcare.org/yourhealth/healthgate/getcontent.asp?URLhealthgate=%2214812.html%22

http://www.mgo.md/FractureReduction.cfm

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

Prior to Fracture Repair surgical procedure:

How is the Fracture Repair surgical procedure Performed?

  • In an Open Reduction surgical procedure, one or more incisions are made over the site of the fracture
  • The surgeon then realigns the bone fragments back to its normal anatomical position
  • Usually, special orthopedic devices, such as plates, screws, or rods, are used to hold the newly aligned bone in place
  • Once the bone fragments are realigned in a secured position, a cast or splint is applied

Where is the Procedure Performed?

A Fracture Repair is usually performed in an out-patient surgery center facility, a physician’s clinic/office, a hospital, or an emergency room.

Who Performs the Procedure?

The procedure is performed by any of these medical personnel, with assistance from an anesthesiologist:

  • Orthopedic surgeon
  • General surgeon
  • Emergency room physician
  • Family doctor

How long will the Procedure take?

The procedure time is dependent on the bone(s) involved. It may vary between a few minutes to a few hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Normally local anesthesia is not used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
  • A physician will request your consent for the Fracture Repair procedure using an Informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for the Fracture Repair procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Fracture Repair surgical procedure?

Before a Fracture Repair procedure, the patient may need to undergo certain tests such as:

  • Routine blood test
  • X-ray of the fracture site
  • CT scan of the affected area

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Fracture Repair (Fracture Reduction)?
  • Why is this procedure necessary?  How will it help?
  • How soon should I get it done? Is there an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed? 
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • How long will it take to recover? When can I resume normal work?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • How many such procedures have you (the physician) performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • What are the costs involved?

During the Fracture Repair surgical procedure:

What kind of Anesthesia is given, during the Procedure?

The procedure can be performed under conscious sedation, or deep sedation, or under general anesthesia with muscle relaxants.

How much Blood will you lose, during the Procedure?

  • For a Closed Reduction procedure, there is no blood loss involved
  • For an Open Reduction procedure, the amount of blood loss is dependent on the type of fracture

What are the possible Risks and Complications during the Fracture Repair surgical procedure?

There are general factors that increase the risk of complications during the procedure, which include:

  • Obesity: Generally greater the degree of obesity, greater is the surgical risk
  • Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk 
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness, such as autoimmune disorders, chronic infections
  • Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgery are:

  • Excessive bleeding
  • Formation of blood clots
  • Misalignment of the bone fragments
  • Infection
  • Accidental injury to the facial nerves
  • Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Fracture Repair surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise. 

After the Fracture Repair surgical procedure:

What are the possible Risks and Complications after the Fracture Repair surgical procedure?

The possible risks and complications that may arise after a Fracture Repair are:

  • Infection in the surgical wound
  • The bone fragments may heal improperly, causing alignment problems or mismatched joints
  • Non-healing of the repaired bones
  • Abnormal pressure on surrounding nerves, resulting in nerve damage

What is the Prognosis after the Surgery?

The prognosis is excellent, when the procedure is performed by experienced hands.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Persistent, severe, or increasing pain
  • Abnormal swelling of tissue
  • Discoloration of tissues
  • Signs of infection
  • Fever
  • Dizziness
  • Muscle aches
  • Fever
  • Feeling sick
  • Complications associated with prescription medications used for the treatment

What Post-Operative Care is needed at Home after the Fracture Repair surgical procedure?

At home, the following post-operative care is recommended, after a Fracture Repair procedure:

  • Resume regular/daily activities, as early as possible (under advice by the physician). This aids in a faster recovery
  • Elevate the affected extremity (e.g. hand or leg) while resting, to prevent formation of blood clots and reduce the possibility of swelling
  • Complete the course of prescribed medication
  • Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain
  • Adhere to the physical therapy and rehabilitation program regimen
  • Mechanical aids, such as crutches or a walker, may be used to help recover faster
  • Resume driving, only when it is safe to do so (as determined by your physician)
  • Immediately for a few weeks after the surgery/procedure, have a diet consisting of foods, high in fiber. Also increase your fluid intake, in order to prevent constipation that might occur due to reduced physical activity levels

How long does it normally take to fully recover, from the Procedure?

It takes about 4 to 6 weeks (sometimes even longer) to fully recover from the procedure

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Fracture Repair surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The outpatient facility, physician’s office or hospital
  • An anesthesiologist (if anesthesia was administered)
  • Orthopedist, family doctor, or general surgeon
  • Emergency room physician

The patient is advised to inquire and confirm the type of billing, before the Fracture Repair (Fracture Reduction) procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: July 17, 2013
Last updated: May 10, 2018