Introduction
The aim of surgery is to restore the normal shape of the bone and to fix it solidly so that it is not kept in a plaster for so long. Restoring the shape of the bone in a displaced fracture will minimise the risk of problems (e.g.: stiffness, pain, arthritis) down the track.
Indications
Surgery is recommended for displaced fractures. Where there is significant amount of separation or poor alignment between bone fragments.
It is also recommended in those wishing an earlier return to function / work / sport as the period of immobilisation is shorter.
Closed Reduction
In kids fractures and a small number of adult fractures, the bones may be realigned simply with a closed reduction. Here the arm is manipulated so that the bones line up and then placed in a plaster for 6 weeks.
Open reduction Internal Fixation (ORIF)
The majority of displaced adult fractures need open Reduction Internal Fixation (ORIF) Surgery. During ORIF surgery, the bones are lined up back in their normal position and fixed with a plate and screws.
The surgery is under general anaesthesia and is performed as day only in hospital. Surgery is most commonly performed through a small incision (4-5cm) near the wrist.
An x-ray is taken during the operation to ensure the bones are back in normal position and that screws are placed correctly.
Recovery
- Day surgery.
- Start hand / finger movement immediately after surgery.
- Start gentle wrist movement 2 weeks after surgery.
- Drive at approximately 2 weeks.
- Sports and manual labour can commence as early as 6 weeks in some cases.
Results
Some stiffness is expected and may months to improve. This is mostly minor, and the majority of patients get enough movement and strength back and return to normal activities after surgery.
Risks and complications
These include:
- Plate / Screw irritation. The hardware can rarely irritate the tendons. Plates and screw can be removed once the fracture is healed. In most cases, this is not necessary.
- Infection <2%.
- Stiffness.
- Nerve/Blood Vessel Damage <1%.
- Arthritis – if the fracture doesn’t heal correctly.