OPEN REDUCTION &

INTERNAL FIXATION OF
FRACTURES

Presented By Siti Nur Rifhan Kamaruddin

 OVERVIEW
DEFINITION: Surgical procedure to fix a severe bone
fracture or to repair a joint.
Open Reduction means surgery is needed to
realign the bone fracture into the normal position
Indication for Open reduction
- When close reduction fails
- Large articular fragment needs accurate
positioning
- Avulsion fractures
Generally, Open Reduction is the first step to
internal fixation
Internal fixation refers to the steel rods, screws or
plates used to keep the bone fracture stable in order to
heal the right way.
 If properly applied, internal fixation
holds a fracture securely so that
movements can begin at once- with
early movement, the fracture
disease (edema, stiffness) is
abolished
Speed is not an issue. Pt can leave
hospital as soon as the wound is
healed.
Weight bearing should be avoided
even though the bone moves in one
piece, the fracture is not united.
 Infection is the main concern.
Risk of infection:
- The Patient: Devitalized tissues, a
dirty wound and unfit patient are
all dangerous
- The Surgeon: Thorough training, a
high degree of surgical dexterity,
adequate assistance are essential
- The Facilities: A guaranteed
septic routine, a full range of
implants.
 INIDICATIONS FOR INTERNAL
FIXATION
Fractures that cannot be reduced
Fractures that are unstable and prone to re-
displacement after reduction(e.g midshaft
fractures of forearm and some ankle fractures)
Fractures that unite poorly and slowly
(fractures of the femoral neck)
Pathological fractures bone disease may
prevent healing
Multiple fractures, where early fixation
reduced risk of general complication
Fractures in patients who present severe
nursing difficulties.
 TYPES OF INTERNAL
SCREWS
FIXATION
Interfragmentary screws (lag
screws) are useful for fixing
small segments onto main
bone
WIRES
Stiff, Kirschner wires can hold
bone fragments together.
Often insert percutaneously
without exposing the fracture
Used in situations where
fracture healing is predictably
quick.
PLATES & SCREWS
Useful for treating both tubular & flat
bones.
When used on tubular bones, firm
coaption of fragments can be achieved
by compression device before tightening
the screws.
Plates can be shaped. e.g Buttress
plates are often used to prop up
the overhang of an expanded
metaphysis- as in fixing fractures
of proximal tibial plateau.
 In tension-band plating, the
plate is applied on the tension
side of the bone so that
tension forces on the plate
side of bone are converted to
the more advantageous side.

Anti-glide plates: By fixing

the plate over the tip of a
spiral or oblique fracture and
then using the plate as a
reduction aid, the anatomy
can be restored with minimal
stripping of soft tissues.
INTERMEDULLARY NAILS
Suitable for long bones.
A nail (or long rod) is inserted into the
medullary canal to splint fracture,
rotational forces are resisted by
introducing locking screws which
transfix the bone cortices and the nails.
Nails can be used with or without prior
remaining if the medullary canal
reaming achieves an interference fit
which further improves facture stability.
Though at the expense of some
damage to the intermedullary supply.
 COMPLICATIONS OF INTERNAL FIXATION

Most complications are due to

poor technique, poor
equipment
or poor operating condition.
Infection
- Iatrogenic Infection :
- Most common cause of chronic Osteomyelitis
- Quality of Patent's tissues and open
operation are the predisposing factor. Not
the metal implant.
- If infection not rapidly controlled with IV
antibiotic, the implants should be replaced
with external fixation.
 Non-union
- Cause : Excessive stripping of soft tissues,
unnecessary damage to blood supply and rigid
fixation with a gap between the fragments.
Implant failure
- Metal is subject to fatigue and undue stresses
should be avoided until fractures has united.
- Pt with femoral or tibial fractures should still
use crutches until fracture is healing (at least
6 weeks)
- Pain at the fracture site is a danger signal!
Re-fracture
- Important not to remove metal implant too
soon
- A year is minimum and 18-24 months safer.
- For several weeks after implant removal, the bone
is weak so weight bearing should be avoided.
 REFERENCES
Apley and Solomons Concise System
of Orthopedics and Trauma 4th
Edition. CRC Press
THANK
YOU..