Surgical procedure in which displaced or unstable fractures of small bones such as fingers, wrist, foot, and ankle are stabilized with plates, screws, or pins.
Indication
- Displaced finger, wrist, foot, or ankle fractures
- Small bone fractures involving the joint surface (intra-articular fractures)
- Fractures that cannot be held in proper position with conservative treatment (cast, splint)
- Open fractures or cases accompanied by soft-tissue injury beneath the skin
- Comminuted (multi-fragment) small bone fractures
- Fractures associated with tendon, nerve, or vascular injury
Preparation
- No food or drink for 6-8 hours before the procedure (for anesthesia)
- Blood thinners are adjusted with physician approval
- Preoperative blood tests and ECG when appropriate
- Detailed assessment of the fracture with plain X-ray and CT if needed
- Known allergies and current medications must be reported to the physician
How it's performed
- Vital signs are continuously monitored and IV access is established
- Local anesthesia, regional nerve block, or general anesthesia is administered depending on the region
- The skin is sterilized and the surgical area is covered with sterile drapes
- A small incision is made over the fracture to access the area, and fragments are placed in their anatomic position
- The fracture is stabilized with fixation materials such as plates, screws, or Kirschner wires (K-wires)
- Fixation is verified with fluoroscopy (mobile X-ray); tissues are closed in layers and a splint is applied if needed
Post-procedure
- Most cases involve same-day discharge or 1 night in hospital
- Keeping the wound clean and dry during the first week and proper splint use
- Fixation for 2-6 weeks depending on physician advice, followed by gradual range-of-motion exercises
- Physiotherapy sessions for hand and foot are recommended for most patients
- Healing is monitored with follow-up X-rays (typically at 2, 6, and 12 weeks)
Risks
- Infection and wound healing problems
- Bleeding and hematoma
- Nerve or vascular injury (especially in hand and foot regions)
- Delayed union or insufficient healing (nonunion / pseudoarthrosis)
- Loosening of fixation hardware or need for later removal
- Joint stiffness and persistent restriction of motion (especially in intra-articular fractures)
FAQ
Will the fixation hardware (screws/plates) be removed later?
If they cause no problems, screws can often be left in place. However, in cases of skin prominence, pain, restricted joint movement, or infection, they may be removed after the fracture has healed (usually 6-12 months later).
When can I use my hand or foot after surgery?
It depends on the location of the fracture and the fixation method. In most cases controlled motion begins within the first 1-2 weeks, weight-bearing between 4-8 weeks, and return to full activity may take 6-12 weeks.
Could it have healed without surgery?
Some non-displaced, stable fractures that do not involve the joint heal successfully with cast or splint treatment. However, displaced, intra-articular, or unstable fractures usually require surgical fixation to restore proper anatomic alignment.
Related Information
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