Fracture Fixation

Fracture fixation is the mechanical stabilization of a broken bone so that healing can proceed. Three broad approaches exist. Casting and splinting immobilize from outside the skin and suit stable fractures in acceptable alignment. External fixation uses pins driven into bone and joined by a frame outside the body, favored when soft tissue is too swollen or contaminated to close over hardware. Internal fixation places plates, screws, intramedullary nails or wires against or inside the bone through a surgical exposure.

Two descriptors drive the choice. A comminuted fracture is broken into three or more fragments, so there is no single clean interface to compress and the surgeon may bridge the zone rather than piece it together. An intra-articular fracture crosses a joint surface. Cartilage does not remodel the way bone does, and a step left in the surface concentrates load and accelerates post-traumatic arthritis, so these demand anatomic reduction — millimeter accuracy — where a shaft fracture tolerates far more.

What hardware does is hold position and share load while Bone Remodeling proceeds; it does not itself repair anything. A construct that is too flexible permits motion and risks Fracture Nonunion; one that is rigid across a fragment robbed of perfusion cannot compensate for the biology described in Watershed Blood Supply. Radiographs confirm alignment and hardware position but are a lagging proxy rather than Ground Truth for union.

Fixation also changes the pain course: an incision adds its own Nociception on top of the fracture, which is why a Regional Nerve Block is often placed for the operation and the hours after it.