While the patient is pain-free, using general or local anesthesia, an incision is made over the fractured bone. The bone is placed in proper position, and screws, pins, or plates are attached to or placed in the bone temporarily or permanently. Alternatively, long bones may be fixed with nails placed in the bone cavity. Any disrupted blood vessels are tied off or burned (cauterized). If examination of the fracture shows that a quantity of bone has been lost as a result of the fracture, especially if there is a gap between the broken bone ends, the surgeon may decide that a bone graft is essential to avoid delayed healing. Bone grafting may be performed using the patient's own bone, usually taken from the hip, or using bone from a donor. If bone grafting is not necessary, the fracture can be repaired by the following methods: - One or more screws may be inserted across the break to hold it
- A steel plate held by screws may be drilled into the bone
- A long, thick metal pin (sometimes called a rod or nail) with holes in it, may be driven down the shaft of the bone from one end, with screws then passed through the bone and through a hole in the pin.
In some cases, after this stabilization, the microsurgical repair of blood vessels and nerves is necessary. The skin incision is then closed. If the broken bone has pierced the skin, the bone ends need to be washed with sterile fluid in the operating room as an emergency procedure to prevent infection. The washing process may need to be repeated if the wound becomes infected.
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