Skip to content
Bone plate fixation surgery is a common method for treating fractures. However, various complications may occur after the operation, affecting the recovery of patients. The following introduces its preventive measures from aspects such as infection, neurovascular injury, nonunion and delayed healing of bones, and complications related to internal fixators:
Infection prevention
Strict aseptic operation: During the surgical procedure, medical staff must strictly adhere to the aseptic principle. The operating room should be thoroughly cleaned and disinfected in advance, including air purification and wiping of object surfaces. Surgical instruments must undergo strict sterilization treatment to ensure a sterile state. Personnel involved in the operation should wear sterile surgical gowns, gloves, masks and hats correctly to avoid bacterial contamination of the surgical area. For example, when laying the towel, make sure that the sterile towel completely covers the surgical site and the edge is firmly fixed to prevent it from slipping during the operation.
Rational use of antibiotics: Antibiotics should be used rationally before and during the operation based on the specific condition of the patient and the surgical site. Generally speaking, antibiotics can be intravenously infused 30 minutes to 1 hour before the operation to achieve an effective drug concentration at the surgical site when incision is made. For surgeries with a higher risk of contamination, such as open fractures, the duration of antibiotic use can be appropriately extended. However, it is necessary to follow the norms for antibiotic use to avoid the abuse that leads to the emergence of drug-resistant bacteria.
Wound care: After the operation, closely monitor the condition of the wound and keep it clean and dry. Change the dressing regularly. During the dressing change, strictly follow the aseptic operation procedures and observe whether there are any signs of infection such as redness, swelling, exudation or odor in the wound. If early signs of infection are found in the wound, timely treatment should be carried out, such as strengthening dressing changes and adjusting antibiotics.
Prevention of neurovascular injury
Familiarity with anatomical structures: Surgeons need to have a deep understanding of the neurovascular anatomical structures of the surgical site, and be familiar with their course and distribution. Before the operation, the locations of nerves and blood vessels can be further clarified through imaging data (such as CT and MRI) to accurately avoid them during the operation. For example, when performing bone plate fixation surgery for humeral fractures, special attention should be paid to the position of the radial nerve to avoid damaging it when the periosteum is removed or drilling.
Gentle operation: During the surgical procedure, movements should be gentle and meticulous, avoiding rough handling. Be cautious when using instruments, especially in areas close to nerves and blood vessels. For instance, when using an electric drill to drill holes, it is necessary to control the force and direction well to prevent the drill bit from slipping and damaging the surrounding nerves and blood vessels.
Intraoperative monitoring: For some important nerves and blood vessels, corresponding monitoring methods can be adopted during the operation. If neuroelectrophysiological monitoring technology is used, the functional status of nerves can be monitored in real time. Once abnormal nerve function is detected, the surgical operation can be adjusted promptly. For larger blood vessels, monitoring can be carried out by observing the local blood circulation or using equipment such as ultrasound Doppler.
Prevention of nonunion of bones and delayed healing
Good fracture reduction and fixation: During the operation, it is necessary to ensure that the fracture ends achieve good reduction and restore the normal anatomical structure of the bone. Select appropriate bone plates and screws for fixation to ensure the stability of the fixation. Stable fixation can provide a favorable mechanical environment for fracture healing and promote the formation and growth of callus. For example, for long shaft fractures, compression bone plates should be used for fixation to make the fracture ends closely contact, which is conducive to fracture healing.
Measures to promote bone healing: Some measures to promote bone healing can be taken after the operation. If patients are given foods rich in nutrients such as calcium, phosphorus and vitamin D, it can promote the repair of bone tissue. For some patients with difficult fracture healing, drugs that promote bone healing, such as bone peptides and calcium supplements, can be used. In addition, physical therapy methods such as infrared irradiation and ultrasound therapy can also be adopted to improve local blood circulation and promote fracture healing.
Avoid premature weight-bearing: During the process of fracture healing, patients should be guided to avoid premature weight-bearing. Premature weight-bearing may lead to loosening and fracture of the bone plates, affecting fracture healing. A reasonable rehabilitation plan should be formulated based on the location of the fracture and the healing condition, gradually increasing the patient’s activity level and weight-bearing capacity. Generally speaking, patients with lower limb fractures need to use crutches or walkers to assist them in walking after surgery. Once the fracture has healed to a certain strength, they can gradually abandon crutches and walk.
Prevention of complications related to internal fixators
Correct selection of internal fixators: Based on the type, location of the fracture and the patient’s physical condition, choose the appropriate bone plates and screws. The material, length, width and shape of the bone plate should match the fracture site, and the diameter and length of the screws should also be selected appropriately to ensure the stability and effectiveness of the fixation. For instance, for patients with osteoporosis, screws with good holding force, such as locking screws, should be selected.
Avoid loosening or breaking of the internal fixation: During the surgical operation, ensure that the tightening force of the screws is moderate, avoiding being too loose or too tight. Too loose may lead to the loosening of the internal fixator, while too tight may cause the screw to break or the bone cortex to rupture. After the operation, it is necessary to guide the patient to carry out correct rehabilitation exercises, avoid excessive activity and vigorous exercise, and prevent the internal fixation device from loosening or breaking due to excessive stress.
The timing of removing the internal fixation device: For patients who need to have the internal fixation device removed, an appropriate timing for removal should be selected. Generally speaking, the internal fixator should be removed after the fracture has completely healed. Before removing the internal fixator, the healing of the fracture should be evaluated through imaging examinations to ensure that the fracture site has reached sufficient strength. After the internal fixation device is removed, the patient should be guided to carry out appropriate rehabilitation exercises to promote the recovery of local tissues.