Osteosynthesis is a surgical procedure used to stabilise and fixate bone fractures using implants such as plates, screws or nails. This method enables the precise repositioning of the bone fragments and promotes natural healing.

Overview of osteosynthesis

Osteosynthesis refers to the joining of bones and is a surgical procedure for treating bone fractures. The fragments are fixed using screws, plates, nails or wires so that the bone can grow together in the correct position. However, not every bone fracture requires surgical treatment – in some cases, immobilisation with a cast is sufficient. Osteosynthesis is mainly used for complicated or poorly healing fractures and is particularly suitable for:

  • Open fractures
  • Multi-fragment fractures
  • Comminuted fractures
  • Leg fractures (fractures of the long bones)
  • Simultaneous damage to bones and joints
  • Bone fractures in patients with osteoporosis

Treatment goal

The main goal of osteosynthesis is to restore bone stability and functionality with the shortest possible healing time.

The osteosynthesis procedure

Depending on the fracture’s location and type, various methods such as screw, plate, intramedullary rod or tension band osteosynthesis, Kirschner wire fixation, external fixation or dynamic hip screws can be used.

Depending on the location of the bone fracture and the general condition of the patient, the intervention is performed under general anaesthesia, spinal cord anaesthesia or local anaesthesia.

Screw osteosynthesis

Screw osteosynthesis involves the fixation of bone fragments using screws. To do this, a hole is first drilled in one of the bone fragments. Depending on the technique, either a thread is cut into the opposite fragment (lag screw) or a screw with an integrated thread is used at the end (cancellous bone screw). In both methods, the bone fragments are firmly pressed together by tightening the screw so that the healing process is best supported.

Plate osteosynthesis

In plate osteosynthesis, the bone fragments are fixated using a plate. The surgeon exposes the broken bone and screws a suitable plate over the fracture line. They fasten it to all of the fragments by means of screws in the bone in order to securely bring them together.

Intramedullary rod osteosynthesis

In intramedullary rod osteosynthesis, the medullary cavity of the broken bone is opened. The surgeon creates a canal in the medullary cavity into which he can insert a long rod. This rod connects the fragments of the bone as an internal splint.  If necessary, the intramedullary rod is stabilised with a cross bolt so that it cannot move. The correct positioning of the rod is checked with X-rays.

Tension band osteosynthesis

Tension band osteosynthesis is a procedure in which bone fragments are pressed together.  In this rather complex procedure, the fragments are fitted with transfixion wires and joined together with a tension band.

Kirschner wire fixation

Kirschner wires are elastic steel wires that are used to fixate fractures on small bones such as fingers or the collarbone. When the wires are placed into the bone, the upper end remains outside the bone. Once the fracture has finished healing, the wires can be pulled out again. Usually a splint or plaster cast is also used, as the wires alone do not sufficiently stabilise the fracture.

External fixation

With external fixation, the fracture is fixed with an external metal frame. To do this, the operating doctor makes small skin incisions over the bone fragments, through which they drill holes in the bones. Metal rods, which protrude from the body, are anchored into the holes. The rods are externally connected to a metal frame and the bone fracture is thus externally stabilised.

Dynamic hip screw

The dynamic hip screw is a method for treating femoral neck fractures (thigh fractures near the hip joint). A screw is driven into the femoral head, and then a plate with a tube is screwed to the outside of the femur, which the free end of the hip screw can slide into. The patient’s body weight is then diverted via the hip screw in such a way that the fracture is compressed.

Preparation and precautions

Before the surgery, the bone fracture is examined using imaging techniques such as X-ray or MRI. These images allow a detailed assessment of the fracture, including its location, shape and possible concomitant injuries. Based on these results, the appropriate treatment method is selected.

In addition, the standard preoperative clarifications are performed, including a blood test, blood pressure measurement and an ECG. If the patient takes blood-thinning medications, they must be discontinued in good time in consultation with the attending doctor. It is also important that the patient arrives for treatment on an empty stomach, which means that they must not eat solid food for at least six hours before the surgery. Clear fluids such as water or unsweetened tea are generally allowed up to two hours before the intervention.

Aftercare and recovery

After the surgery, the anaesthesia recovery phase takes place under monitoring. Physiotherapy exercises begin at an early stage to prevent joint stiffening and to keep muscle atrophy as low as possible. When the bone can be fully loaded again depends on both the osteosynthesis method chosen and the individual healing process. The healing time after a bone fracture is usually at least six weeks, but can take several months depending on the severity of the fracture and individual factors. In most cases, partial loads and limited mobilisation with walking aids or supports are possible earlier.

The various osteosynthesis procedures serve to stabilise broken bones until they have fully grown together. Whether the material used is removed after healing depends on several factors. As osteosynthesis material such as titanium is generally well tolerated, and can typically remain in the body permanently. Unless medically necessary, screws and plates are usually no longer removed nowadays.

Potential complications

Osteosynthesis is a proven standard procedure for the stabilisation of bone fractures and in most cases proceeds without complications. As with any surgery, however, occasional infections, nerve injuries, post-bleeding or blood clots may occur. In rare cases, joint stiffening, the death of bone tissue or tendon injuries can occur. Occasionally, compartment syndrome can also occur, in which an increase in pressure in the tissue disrupts blood circulation. In such cases, rapid medical treatment is required.

Centres 13