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Osteosynthesis – Surgical Bone Fracture Fixation

Osteosynthesis is a surgical procedure used to stabilize bone fractures using implants such as screws, plates, or intramedullary nails to restore proper bone alignment.

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Things worth knowing about "Osteosynthesis"

Osteosynthesis is a surgical procedure used to stabilize bone fractures using implants such as screws, plates, or intramedullary nails to restore proper bone alignment.

What is Osteosynthesis?

Osteosynthesis is a surgical technique used in trauma surgery and orthopedics to fix and stabilize broken bones using specially designed implants. The goal is to hold fractured bone fragments in their anatomically correct position so they can heal properly. The term is derived from the Greek words "osteon" (bone) and "synthesis" (joining together).

Types of Osteosynthesis

Depending on the fracture type, affected body region, and the condition of the patient, different implants and techniques are used:

Plate Osteosynthesis

In plate osteosynthesis, a metal plate is attached directly to the surface of the bone and secured with screws. This method is particularly suitable for fractures of long bones and fractures near joints.

Intramedullary Nail Osteosynthesis

An intramedullary nail is a solid metal rod inserted into the medullary canal (the hollow center) of the bone. This technique is commonly used for fractures of the femur (thigh bone) or tibia (shin bone).

Screw Osteosynthesis

For simple fractures, screws alone may be sufficient to stabilize the bone fragments. This is often the case for certain fractures of the ankle or wrist.

External Fixator

An external fixator is an external stabilization system in which pins or wires are inserted through the skin into the bone and connected to an external frame. It is frequently used for open fractures or heavily contaminated wounds.

Kirschner Wire Osteosynthesis

Kirschner wires (K-wires) are thin metal wires used primarily for small bones such as those in the hands or feet, as well as in pediatric fractures.

When is Osteosynthesis Performed?

Osteosynthesis is indicated when:

Conservative measures (e.g., casting) are insufficient to stabilize the fracture
The fracture is significantly displaced and precise repositioning is necessary
Periarticular or intra-articular fractures are present
Early mobilization of the patient is required (e.g., elderly patients with a femoral neck fracture)
Open fractures or multi-fragment fractures are present

Surgical Procedure

Before surgery, imaging techniques such as X-ray or CT scan are used to assess the fracture in detail. The procedure is performed under general or regional anesthesia. Depending on the technique, the bone may be surgically exposed (open osteosynthesis) or the implant inserted minimally invasively (closed osteosynthesis). Correct implant placement is typically confirmed intraoperatively using X-ray imaging.

Aftercare and Rehabilitation

Careful follow-up care is essential for a successful recovery after osteosynthesis:

Regular X-ray check-ups to monitor fracture healing
Physiotherapy to restore mobility and muscle strength
Weight-bearing restrictions depending on the implant type and fracture location
Implant removal after complete bone healing (not always necessary)

Risks and Complications

As with any surgical procedure, osteosynthesis carries certain risks:

Infection at the surgical site
Implant failure (e.g., screw breakage or loosening)
Non-union (pseudarthrosis): impaired or absent bone healing
Injury to nerves or blood vessels
Thrombosis or embolism (blood clots)

Materials and Implants

Modern osteosynthesis implants are typically made of titanium or surgical stainless steel, as these materials are biocompatible, durable, and MRI-compatible. In certain cases, bioresorbable (self-dissolving) implants are used, which do not require surgical removal at a later stage.

References

Rüedi, T.P., Buckley, R.E., Moran, C.G. (eds.) - AO Principles of Fracture Management. Thieme Publishers, 3rd edition (2018).
Orthopaedic Trauma Association (OTA) - Clinical Practice Guidelines on Fracture Fixation. www.ota.org (accessed 2024).
Müller, M.E., Allgöwer, M., Schneider, R., Willenegger, H. - Manual of Internal Fixation. Springer Verlag, Berlin (1991).

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