Osteosynthesis (metal osteosynthesis) of fractures

Metal osteosynthesis — is an operation during which fragments of a broken bone are aligned and fixed using metal plates, screws, rods, or wires. The constructs hold the bone fragments in the correct position, creating conditions for their union. Osteosynthesis is used mainly for complex and unstable fractures when a plaster cast cannot provide sufficient fixation of the bone.

At the «Oxford Medical» medical center, metal osteosynthesis is performed by experienced orthopedic traumatologists using modern surgical techniques. The fixation method is selected individually, taking into account the characteristics of the fracture, in order to ensure proper bone union and restoration of the function of the injured limb.

There are two main types of metal osteosynthesis — internal and external. They differ in the method of fixation of bone fragments. In internal osteosynthesis, metal structures are placed on the surface of the bone or inside it. In external osteosynthesis, a special apparatus is used, which is fixed externally using rods or wires inserted into the bone.

Internal metal osteosynthesis is divided into several types:

• Plate osteosynthesis. Bone fragments are connected with a metal plate, which is secured with screws. This method is often used for fractures of the forearm, humerus, and lower leg.
• Intramedullary osteosynthesis. A metal rod is inserted into the canal inside the bone, which holds the fragments in the correct position. This method is usually used for fractures of the femur and tibia.
• Fixation with screws or wires. Bone fragments are fixed with metal screws or wires, sometimes together with other fixation devices. The method is used, in particular, for fractures of the small bones of the hand and foot and for some intra-articular fractures.

External metal osteosynthesis is most often used for complex open fractures, significant soft tissue damage, or for temporary stabilization of the bone before a subsequent operation. The external apparatus allows the fragments to be held in the required position while providing access to the damaged tissues for wound treatment and dressing changes.

Titanium, titanium alloys, and medical-grade stainless steel are most often used for fracture fixation. These materials are strong, corrosion-resistant, and highly compatible with body tissues.

Titanium plates are used for fractures because of their low weight, strength, and low risk of allergic reactions. Stainless steel also withstands loads well, but it may contain nickel, to which some people have increased sensitivity.

According to a systematic review of studies published in PubMed, titanium implants may have advantages over steel implants for some types of fractures, but there is no universally superior material.

Doctors at Oxford Medical explain: when selecting metal constructs for osteosynthesis, the orthopedic traumatologist takes into account the location of the fracture, the condition of the bone, and the load on it. The material and type of fixation device are selected to ensure the stability of the fragments until they unite.

Metal osteosynthesis may be used for both closed and open fractures. Surgical fixation is most often required for complex fractures of the femur, lower leg, and forearm. Surgery may also be necessary if an ankle fracture is accompanied by displacement of the fragments and impaired joint stability. The orthopedic traumatologist determines the need for surgery after examination, taking into account the nature of the injury, the condition of the surrounding tissues, and the possibility of treatment without surgical intervention.

The possibility of performing metal osteosynthesis depends on the patient's general condition, concomitant diseases, and the nature of the injury. Some conditions require preliminary treatment or temporary postponement of the operation.

The main contraindications and limitations:

• a severe general condition of the patient that does not allow the operation to be performed safely;
• an active infection in the area where the metal construct is to be placed;
• significant soft tissue damage that complicates internal fixation;
• severe blood clotting disorders that could not be corrected.

Most of these limitations are not absolute. If necessary, concomitant conditions are treated first or another method of fracture fixation is selected. In particular, according to the recommendations of AO Foundation, in cases of significant soft tissue damage, the operation may be performed in two stages: first, an external fixation device is temporarily installed, and after the condition of the tissues improves, internal fixation of the bone fragments is performed using plates and screws.

Preparation for metal osteosynthesis includes examination of the damaged bone and assessment of the patient's general health condition. This helps plan the operation, select the method of anesthesia, and reduce the risk of complications.

As part of preparation for surgery, the following are usually prescribed:

• a consultation with an orthopedic traumatologist and an anesthesiologist;
• X-ray examination of the damaged area, and, if necessary, computed tomography;
• a complete blood count, coagulogram, and other laboratory tests if indicated;
• electrocardiography and additional examinations depending on the health condition.

Before the intervention, it is necessary to inform the doctor about the medications you are taking, especially those that affect blood clotting. You should also mention allergic reactions and previous experience with anesthesia.

Before planned surgery, it is usually recommended not to eat for 6–8 hours. Drinking water is often allowed no later than 2 hours before anesthesia, but the anesthesiologist provides the exact recommendations.

If the fracture requires urgent surgical intervention, the necessary examinations are carried out within a short period of time. In this case, doctors take into account the patient's general condition, concomitant diseases, and the time of the last meal.

Metal osteosynthesis is performed under general or regional anesthesia. The method of anesthesia is selected depending on the location of the fracture, the complexity of the operation, and the patient's health condition.

The main stages of the operation:

• Access to the fracture site. The surgeon makes one or several incisions in the area of the injury.
• Alignment of the fragments. The bone fragments are returned to the correct anatomical position.
• Placement of the metal construct. Depending on the type of fracture, the bone is fixed with a plate and screws, a rod, or other fixation devices.
• Fixation control. The position of the bone fragments and the metal construct is checked using X-ray equipment. After this, the wound is sutured and a sterile dressing is applied.

The duration of the operation depends on the complexity of the fracture and the selected fixation method. The intervention usually takes about 1–2 hours, but in cases of significant damage it may take longer.

At Oxford Medical, metal osteosynthesis operations are performed by experienced orthopedic traumatologists in a modern surgical inpatient facility. The operating rooms are equipped for complex interventions, including a C-arm, which makes it possible to monitor the position of the bone fragments and metal fixation devices directly during the operation.

After the intervention, the patient remains under the supervision of medical staff in a comfortable inpatient room. Doctors monitor the patient's condition, provide the necessary pain relief, and give recommendations regarding further recovery. The duration of hospitalization is determined individually depending on the extent of the operation and the patient's well-being.

During the first days after metal osteosynthesis, pain, swelling, and bruising may occur in the area of the operation. These manifestations usually gradually decrease during the healing process. However, as after any surgical intervention, there is a risk of complications.

Possible complications include:

• infection of the postoperative wound;
• delayed bone union or nonunion;
• displacement, loosening, or damage to the metal fixation devices;
• deep vein thrombosis, especially after operations on the lower limbs;
• irritation of the surrounding tissues by the metal construct.

The risk of complications depends on the severity of the fracture, the condition of the bone tissue, concomitant diseases, and adherence to recommendations during recovery. To detect possible problems in a timely manner, the doctor schedules follow-up examinations and, if necessary, X-ray studies.

Doctors at Oxford Medical recommend not delaying seeking medical attention if pain or swelling increases, redness or discharge from the wound appears, or body temperature rises. Sudden shortness of breath, chest pain, or a sudden disturbance of sensation or blood circulation in the limb requires urgent medical attention.

The characteristics and duration of recovery after metal osteosynthesis depend on the location of the fracture, the complexity of the operation, and the rate of bone union. Rehabilitation usually begins in the first days after the intervention with permitted movements and is gradually supplemented with exercises to restore muscle strength and joint mobility.

The main recommendations for the recovery period:

• Wound care. Keep the dressing clean and dry and attend dressing changes. Sutures are usually removed after 10–14 days if the wound heals without complications.
• Limitation of loads. Do not overload the injured limb. After operations on the leg, crutches or a walker may be needed for some time.
• Therapeutic exercise. Perform the recommended exercises to restore joint mobility and strengthen muscles, gradually increasing their complexity.
• Follow-up examinations. Visit an orthopedic traumatologist and undergo X-ray examinations to assess bone union.

Bone union may take from several weeks to several months. The metal construct holds the fragments in place but does not replace the natural process of bone healing.

According to the recommendations of AO Foundation, after fixation of lower leg fractures, the load on the leg can in many cases be increased gradually, approximately after 6–8 weeks, if the examination results confirm bone union. At the same time, with some fixation methods, weight-bearing walking is permitted much earlier, so there is no single timeframe for all patients.

The price of metal osteosynthesis is calculated individually and depends on several factors:

• the complexity of the fracture and the extent of the operation;
• the type of metal construct and the number of fixation devices;
• the type of anesthesia;
• the duration of the hospital stay.

You can view the prices in advance here.

Make an appointment for a consultation with an orthopedic traumatologist at Oxford Medical by phone or through the online appointment form on the website. The doctor will conduct an examination, determine the optimal treatment method, and provide guidance regarding the cost of the operation.

The information is provided for informational purposes and does not replace a consultation with a doctor.

Sources:

• US National Library of Medicine
• AO Foundation — AO Surgery Reference
• AO Foundation — Fracture Fixation and Aftercare