NYU Langone surgeons perform open reduction and internal fixation using regional or general anesthesia. This procedure is used to set a broken shoulder or elbow bone and stabilize the bone fragments so they can heal.
In the shoulder, a surgeon may perform this technique to repair a broken clavicle or proximal humerus.
In the elbow, open reduction and fixation may be performed for a fractured distal humerus, the upper arm bone, or olecranon, the bony tip of the elbow. Fractures of the radial head or scapula usually don’t require surgery, but if a fracture interferes with joint function or breaks the skin, doctors may need to operate.
In an open reduction, a surgeon makes an incision over the fractured bone to see the pieces of a broken bone and assess how well they can be put back together. If any bone fragments are too small to be put back into position, the surgeon may remove them.
After the bones are in the correct position, a surgeon fixes them into place using stainless steel wires, plates, or screws. These parts stay in the body permanently and keep the bones in place while they heal and grow back together. In repairing a fractured olecranon, the surgeon may also use thin, strong pieces of wire to hold the bone fragments in place.
If necessary, the surgeon also repairs injured soft tissues during surgery. After the surgeon has completed the procedure, he or she closes the incision with stitches or staples.
Your surgeon may use a bone graft, which is a small piece of living bone tissue, to replace any pieces of bone that were lost as a result of the injury. A bone graft may be obtained from a person’s own body—typically the hip—or from a donor through a bone bank.
When implanted into a fractured bone, the graft acts as scaffolding on which new, healthy bone cells grow. Over time, the graft fuses with the original bone, forming one solid bone.
Internal fixation may not be the most effective treatment option if an injury causes the elbow to dislocate—meaning the bones of the elbow joint separate from each other—in addition to an elbow fracture. This type of injury can make setting the bone more difficult.
A surgeon may use an external fixation device, which is worn outside the body, to keep the bone fragments from moving and to prevent the elbow from dislocating again. The device is a hinged metal frame that surrounds the injured elbow. It stabilizes the fracture using wires or pins that are inserted through the skin and into the affected bone.
After a period of healing, your surgeon removes the device.