After a fracture, the pieces of a broken bone need to be set and stabilized, so the fragments can’t move while the bone heals. Most of the time, a doctor uses a cast or sling to stabilize a bone immediately after a fracture.
Sometimes surgery is also required to put bone fragments in place, and doctors secure them with screws, rods, or plates. If a bone was not properly stabilized after a fracture, or if a prior surgery wasn’t effective, your NYU Langone surgeon can reset bone fragments to help them align and heal.
There are several surgical approaches to putting the broken pieces of a bone in place. The approaches vary based on the location of the fracture, whether surgery was previously performed on the bone, when the injury occurred, and whether devices, such as screws, rods, and plates, have already been used to put bone fragments in place.
Surgical procedures are performed using general or regional anesthesia. A surgeon makes an incision to access the affected bone and uses surgical instruments to put the bone fragments in the correct place. If a bone has healed but the pieces don’t line up straight—which is referred to as a malunited fracture—a surgeon may cut and reset the bone.
Regardless of the surgical approach, your doctor uses either internal or external fixation to prevent the reconnected bone fragments from moving after they have been set.
Internal fixation involves the use of devices that hold the bone fragments in place beneath the skin. For example, a surgeon may place a metal plate across a break in a bone and then insert screws to fix it into place. Often, these devices remain in the bone permanently, even after the bone heals.
Internal fixation may not be the most effective treatment option if there is damage to the soft tissue surrounding a fracture, or if there is an infection in the bone. A surgeon may elect to wait for these issues to resolve before implanting screws or other devices.
The surgeon may also use an external fixation device, which is a rigid frame that surrounds the injured part of the body. The frame stabilizes the bone using wires or pins that prevent the bone fragments from moving.