An internal fixation is a treatment for a fracture where an orthopedic surgeon implants devices inside or next to the bone and then closes the surgical site, providing support for healing bones inside the body instead of with the use of external fixation like a cast. This treatment began to be available in the middle of the 19th century and can improve patient outcomes by reducing healing time, making patients more comfortable, and providing direct reinforcement of broken bones so they are more likely to heal properly. If this is an option in a patient's case, a surgeon often will recommend it.
Numerous devices can be used in internal fixation, including screws, nails, rods, plates, pins, and wires. The surgeon will use medical imaging studies like X-rays to understand the nature of the fracture and develop a plan for treating it effectively and appropriately. This can include readying internal fixation devices so they will be ready to go in surgery. The patient is taken into an operating room and put under general anesthesia so the surgeon can access the site, install the devices, and then close the wound.
This is often part of a surgical procedure known as open reduction, internal fixation (ORIF). The “open reduction” refers to opening up the patient to get a clear view of the fracture and then put the bones back in place, as opposed to closed reduction, where orthopedic physicians leave the skin intact and pull the fracture into position by manipulating the bones in the area. Surgical correction of fractures is more invasive, but can also be more accurate.
Patients can usually be active sooner after internal fixation. While they should not strain the fracture site with heavy physical activity and may need slings or crutches, the lack of a cast makes it much easier to care for the fracture. Patients can usually shower in comfort within a few days after surgery and will also find it easier to dress and perform other basic functions. They may be able to start physical therapy to improve muscle health in the area before the bone is fully healed, if a surgeon approves this.
A common risk of internal fixation is infection at the surgical site, including colonization of the fixation devices with bacteria or mold. Anesthesia also carries risks, especially in the case of patients who have experienced severe trauma like a car accident and may be less stable. There is also a chance that the bones will not heal properly, requiring another surgery to correct the problem. Patients may opt to leave the devices in, in which case they may encounter problems at security checkpoints; they also may remove them once the bone is completely healed and stable.