Surgical procedure in which fractures of long bones such as the thigh, lower leg, and upper arm are stabilized with intramedullary nails, plates, or screws to restore weight-bearing function.
Indication
- Displaced fractures of the femur (thigh bone), tibia (lower leg bone), and humerus (upper arm bone)
- Multifragmentary (comminuted) long bone fractures
- Open fractures (injuries in which skin integrity is disrupted and the bone is exposed)
- Long bone fractures involving the joint surface (intra-articular)
- Pathological fractures (occurring on the background of tumors or osteoporosis)
- Fractures unsuitable for conservative treatment, with high risk of shortening or malunion
Preparation
- No food or drink for 8 hours before the procedure (for anesthesia)
- Use of blood thinners is adjusted with physician approval
- Detailed evaluation with blood tests, ECG, chest X-ray, and CT/MRI when needed
- Consultation with relevant specialties for chronic conditions (heart, lung, diabetes)
- Smoking should be remembered to negatively affect fracture healing and stopped early when possible
How it's performed
- Vital signs are continuously monitored, and blood products are prepared if needed
- General or regional (spinal/epidural) anesthesia is administered by the anesthesiologist
- The skin is sterilized, the surgical area is draped, and a pneumatic tourniquet is used if needed
- Depending on the fracture type, an intramedullary nail (a metal nail placed inside the bone), a plate-and-screw construct, or an external fixator (external fixation device) is selected
- Fixation is confirmed and bone alignment is checked under fluoroscopy (mobile X-ray)
- Tissues are closed in layers; a drain is placed when needed and a dressing is applied
Post-procedure
- Hospital stay is generally 3-7 days (varies according to the fracture site and accompanying conditions)
- Controlled movement with a physiotherapist starts on the first or second day; weight-bearing time is determined by the fracture type
- Walking with assistive devices (crutches, walker) is typical for 4-12 weeks in most cases
- Full recovery takes 3-6 months; return to sports activities is generally 6-9 months
- Regular follow-up X-rays (weeks 2, 6, 12, and 24) and physical therapy sessions
Risks
- Infection (risk increases especially in open fractures)
- Bleeding, hematoma, and rarely the need for blood transfusion
- Deep vein thrombosis (clot in the leg veins) and pulmonary embolism
- Delayed union, malunion, or non-union (pseudoarthrosis)
- Nerve or vascular injury (rare but can be serious)
- Fat embolism (a rare but serious complication, especially in femur fractures)
- Breakage or loosening of the fixation hardware
FAQ
When can I start walking after surgery?
It depends on the location and type of the fracture and the fixation method used. In some fractures, early walking with assistive devices (within the first week) is possible, while in others walking without weight-bearing for 6-12 weeks may be recommended. Your physician will provide your individual program.
Is the fixation hardware (nail/plate) removed?
In most patients, the hardware can be left in place after the union is complete. However, removal may be considered for pain, irritation, infection, or in young patients 1-2 years later. The decision is individualized.
How long is the total recovery process?
Bone union generally takes 3-6 months. Full functional recovery (muscle strength, balance, normal gait) may take 6-12 months. Smoking, diabetes, and age can prolong this period.
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