Plate and screw fixation for broken bones: how it works, risks and recovery

Most broken bones heal in a cast. When the bone is too far out of position, or too unstable to hold its position in a cast, surgeons may fix it from the inside. East Kent Hospitals explains that surgery is needed if the bone is too far out of place or reduction, putting the bone back in position, cannot correct it, and that surgical treatments include metal pins or plates and screws to hold the bones in place.

The procedure is often called open reduction and internal fixation. Open means the surgeon makes a cut to reach the bone, reduction means moving the bone fragments back into position, and internal fixation means holding them with metalwork inside the body. The Northern Care Alliance leaflet on wrist surgery describes the surgeon making a cut, moving the bones to a better position and placing a plate, which is held in position with screws, before the skin is closed with stitches.

The metalwork is a temporary scaffold, not a replacement. The bone itself still has to heal, and the plate and screws hold the fragments steady while it does.

The NHS says that for a broken leg, treatment depends on the type of break and how bad it is, and may include a cast, traction in small children with a broken thigh bone, or surgery for serious breaks in which plates, rods or screws may be used to keep the bones in position while they heal. For a broken hip, the NHS says you will need surgery, and depending on age and the type of break this may be to fix the bones with screws, nails, rods or plates, or to replace part or all of the hip joint.

The decision depends on the bone, the pattern of the break, whether the joint surface is involved, the skin and swelling, and your general health and activity level. The Northern Care Alliance leaflet notes that a fracture left in a poor position in plaster may not heal as well and may make arthritis, pain and disability more likely, so surgery is offered when it is likely to give a better result.

For a wrist, the Northern Care Alliance says the surgeon can only operate if the swelling is not too great, so keeping the arm raised helps reduce swelling and pain while waiting. For a broken leg, the NHS advises avoiding eating or drinking in case surgery is needed, and following advice from the hospital or fracture clinic.

The anaesthetic may be general, where you are asleep, or regional, where only an area is numb and you remain awake. If you smoke, East Kent Hospitals advises stopping while the fracture heals, because smokers are more likely to have problems with tissue healing and infection after injuries or surgery.

During a wrist operation, the Northern Care Alliance describes a tourniquet on the upper arm to limit bleeding, X-rays taken as the bones are moved, a cut over the wrist, the plate and screws, then stitches that may be dissolvable or need removal in 10 to 14 days. A plaster cast may be fitted for extra support and removed after 3 to 6 weeks.

Afterwards the area feels sore. The leaflet says it is extremely important to keep the arm raised for at least the next week to bring swelling down and to keep the fingers moving to stop them becoming stiff. East Kent advises keeping uninjured joints moving, doing the exercises given, keeping the cast dry and using a sling for the first few days.

Every operation has risks. The Northern Care Alliance leaflet classes pain as common, in the range of 1 to 5%, and describes rare complications under 1%: infection, which may need antibiotics or, if severe, a further operation including removal of the plate; nerve and blood vessel damage causing numbness or weakness, which may be temporary or, very rarely, permanent; compartment syndrome, a build-up of pressure in the forearm that needs an emergency operation; and the fracture slipping despite surgery.

It also lists stiffness and arthritis, which may be more common if the fracture involves the joint, and complex regional pain syndrome, which is pain, swelling or stiffness around the site that can occur even months after the injury. The risks for other sites differ, and your surgeon should explain the ones that matter for your bone.

• Increasing pain, swelling or tightness that is not relieved by elevation.

• Numbness, pins and needles or a pale, blue or cold hand or foot.

• Redness, discharge, a bad smell or fever.

• A cast that feels too tight or rubs.

Healing time depends on the bone. The NHS says a broken leg usually takes 6 to 12 weeks, sometimes longer, with follow-up appointments and physiotherapy for several months after the cast is removed to reduce stiffness. For a broken hip the NHS says you will usually spend around 1 to 4 weeks in hospital, start physiotherapy soon after surgery and may not get back the same strength and movement as before.

The NHS advises that if you are recovering from a broken leg and the pain gets worse, you have a very high temperature, your leg or toes become numb, swollen or turn blue or white, or your cast is too tight or smells bad, you should get help from NHS 111.

Often not. The Northern Care Alliance leaflet says removal of the plate is not usually necessary unless there is infection or severe restriction in movement or pain. If the hardware is irritating tendons or skin, or causes problems, removal may be considered once the bone has healed. Discuss this with your surgeon rather than assuming it will or will not be needed.

Fracture surgery is provided on the NHS through trauma and orthopaedic services and fracture clinics, often as an emergency or within days of injury. Private hospitals also offer fixation, particularly for planned or sports-related cases, but major trauma and complex fractures are usually managed in NHS trauma centres.