Surgery for fractures and soft tissue injuries

All fracture surgeries involve getting the broken ends of the bone back into position and then holding them in place until the fracture heals. This can be done in a number of ways.

• More straightforward injuries (such as wrist fractures) may only need a manipulation when you are asleep with general anaesthetic to get the fracture ends back into position and then wires or a plaster cast to hold them in place. If wires are used they are usually left outside the skin so they can be removed easily in the fracture clinic.
• Other surgical methods involve internal fixation where metal plates and screws are placed on the outside of the bone or metal rods are inserted down through the centre of the bone.
• In rarer cases, external fixation is needed where wires are inserted into the bone and connected to metal bars and rods outside the skin. This may be temporary and need further surgery, or external fixation may be the main treatment needed.
• Soft tissue injuries, such as knee injuries with ligament tears, can sometimes be managed with keyhole surgery.

Whatever surgery and management your injury needs, your surgeon will discuss this in detail with you on the day of the surgery and answer any questions you may have.

When will I find out about my surgery?

We try to give you as much notice as possible, but planning operations for patients that have suffered trauma means that sometimes you may only get 12 hours notice before an operation.

If you know you are on the waiting list for surgery, please be prepared to come in at short notice. It’s a good idea to plan things such as:

• How you’ll get to and from hospital
• Having a bag packed
• Who will look after children, anyone else you care for, or pets

What time do I need to come in for my operation?

Depending on your operation, you’ll need to come in at either 7.30am or 11.30am.

If you’re not sure what time you need to come in please call our trauma admin co-ordinator on 01872 253281, 7 days a week between 8am and 4pm.

More information about coming in for an operation

Find out more about preparing for your operation, including information about having an anaesthetic, in these videos.

You can find out about preparing to leave hospital on our going home page.

You can also find out about what to expect after your discharge from hospital in this video.

Stitches

After you’ve had stitches, you should be given some aftercare advice. If you’re worried or have any questions please contact the Fracture Clinic. You can also call your GP for advice, or NHS 111 if it’s out of hours.

How should I care for my stitches?

If you have stitches, take care to:

• keep them clean and dry
• watch out for any increase in redness, swelling or pain

This will reduce your risk of developing an infection, or catch it early.

Protect your stitches

It’s important not to scratch your stitches; even though they’re strong, scratching may damage them.

You should avoid contact sports, such as football or hockey, to give your wound the best possible chance to heal.

You should not go swimming until your wound has healed and your stitches have been removed.

If your child has stitches, do not let them play with water, mud, sand and paint. These could cause the wound area to get dirty or sore, or cause an infection.

Children may also be advised to avoid PE at school until their wound has healed.

Signs of infection

Watch out for any signs of infection near or around the stitches, such as:

• swelling
• increased redness around the wound
• pus or bleeding from the wound
• the wound feeling warm
• an unpleasant smell from the wound
• increasing pain
• a high temperature
• swollen glands

If you have any of these symptoms, call the fracture clinic on 01872 253091, speak to your GP or call NHS 111 for advice.

Removing stitches

You’ll need to return to the fracture clinic to have your stitches removed. We’ll tell you when, but these are the usual time periods:

• For stitches over joints, such as your knees or elbows after 10 to 14 days
• For stitches on other parts of your body after 7 to 10 days

If you haven’t got an appointment booked in, please call the Fracture Clinic on 01872 253091 to book one as soon as possible.

If I have dissolvable stitches, how long will my stitches (sutures) take to dissolve?

Some stitches are designed to dissolve gradually and will disappear on their own.

The time it takes for dissolvable or absorbable stitches to disappear can vary. Most types should start to dissolve or fall out within a week or two, although it may be a few weeks before they disappear completely. Some may last for several months. Ask your doctor about the type of stitches you have been given and how long they should take to dissolve.

There is a small risk that some people can get a mild inflammatory reaction to dissolvable sutures. If this happens please call the Fracture Clinic on 01872 253091.

If your wound has healed and your dissolvable stitches are bothering you, consider making an appointment with a GP or practice nurse, who may be able to remove them, rather than waiting for them to dissolve completely.

Having a bath or shower

A doctor or nurse will tell you when you can get your stitches wet or if they need to be kept dry. This will depend on what kind of wound and dressing you have.

When can I have a bath or shower after surgery?

After 48 hours, surgical wounds can get wet without increasing the risk of infection.

After this time, you can get your stitches wet briefly with a light spray (such as in the shower), but they should not be soaked (for example, in the bath).

Make sure you pat the area dry afterwards.

Dressings over your stitches

If you have a dressing over your stitches, avoid getting it wet.

Some dressings are waterproof, so you could wet your dressing lightly – for example, with the spray from a shower. However, you should not submerge your dressing underwater. If you’re not sure whether your dressing is waterproof, avoid getting it wet.

Do not remove the dressing unless you’re told to do so by a healthcare professional.

Keeping stitches dry

If you have been advised to keep your stitches dry, you could:

• cover your stitches when you have a shower, with a waterproof dressing – you may be able to use a rubber glove or plastic bag if they will cover your wound
• have a wash standing in a bathtub, using a cloth to clean yourself and avoiding your stitches

Dab your stitches dry with a clean towel after washing, even if the wound area did not get wet, to make sure the area is completely dry.

If your stitches get wet accidentally, dry the area immediately with a clean towel and make sure all the moisture around the stitches is soaked up.

Scars are a natural part of the healing process. Most will fade and become paler over time, although they never completely disappear.

How do scars normally form?

Scarring is part of the body’s natural healing process after tissue is damaged.

When the skin is wounded, the tissues break, which causes a protein called collagen to be released. Collagen builds up where the tissue is damaged, helping to heal and strengthen the wound.

New collagen continues forming for several months and the blood supply increases, causing the scar to become red, raised and lumpy.

In time, some collagen breaks down at the site of the wound and the blood supply reduces. The scar gradually becomes smoother, softer and paler.

Although scars are permanent, they can fade over a period of up to two years. It’s unlikely they’ll fade any more after this time.

Normal fine-line scars

A minor wound like a cut will usually heal to leave a red, raised line, which will gradually get paler and flatter over time.

This process can take up to two years. The scar won’t disappear completely and you’ll be left with a visible mark or line.

Fine-line scars are common following a wound or after surgery. They aren’t usually painful, but they may be itchy for a few months.

On darker skin types, the scar tissue may fade to leave a brown or white mark. A pale scar may be more obvious on tanned skin because scar tissue doesn’t tan.

For more information on scars, head to the NHS website page on scars.