Surgery for Nonhealing Fractures

NYU Langone orthopaedic surgeons may recommend surgery to set and stabilize a broken bone. This is usually necessary if periodic X-ray or CT images of a fracture indicate that the bone is not healing and three or more months have passed since the injury.

A surgeon may also implant a piece of bone tissue, called a bone graft, to help the bone fragments grow together. Surgery can help the bone heal, relieve chronic pain, and restore function in the affected body part.

Open Reduction and Fixation

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.

Bone Graft

An NYU Langone surgeon may implant a piece of bone tissue, called a bone graft, during a procedure to stabilize a broken bone. Bone grafts provide a scaffold consisting of stem cells and proteins that stimulates the healing process and helps new bone cells grow.

Your surgeon may use an autograft, a small piece of bone that he or she removes from another part of your body, typically the top of the pelvis. A doctor obtains this tissue during the same procedure he or she performs to stabilize the bone.

If removing a piece of your bone is not possible—due to other health concerns, for example—your surgeon may use an allograft, which is donor bone tissue.

After the surgeon implants the tissue at the fracture site, your own bone cells begin to grow and eventually replace the graft tissue with healthy new cells.

What to Expect After Surgery

Recovery from surgery varies, depending on the location of a fracture, the extent of surgery, whether a bone graft was removed at the same time as stabilization, and whether internal fixation devices, such as screws and plates, were used. 

Most people remain in the hospital for a few days after surgery, so doctors can monitor the early stages of healing and respond quickly to any possible complication, such as infection.

Our pain management specialists provide medication to help you remain comfortable. These experts are available 24 hours a day and prescribe pain relievers for you to take at home, if necessary. 

Depending on the location of the fracture, your surgeon may provide a cast, brace, or sling to immobilize the affected body part. If the fracture is located in the hip, leg, or foot, your doctor may recommend crutches or a cane to help you move around without putting weight on the injured limb.

The length of time the affected bone should be immobilized depends on the location and severity of the fracture. It also depends on how quickly the fracture heals after surgery.

Your doctor schedules monthly follow-up visits. During these appointments, he or she assesses healing using X-rays or CT scans.

Our surgeons also work closely with NYU Langone physical therapists and physiatrists, who are doctors specializing in rehabilitation, to help you mobilize the joint or joints affected by the fracture. For example, if a nonunion fracture is located in the leg, physical therapy can help you maintain range of motion in the knee and hip, and build strength in the muscles that surround and support those joints.

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