Why Two Surgeries for a Closed Fracture? the Process - Orthopedics

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When dealing with closed fractures, especially in elderly patients, the decision to perform two separate surgeries—initially external fixation followed by internal fixation—can be influenced by several factors. In your grandmother's case, the approach taken by the medical team is quite common and is based on the principles of fracture management, particularly in the context of soft tissue injury and swelling.


Why Two Surgeries?
1. Swelling Management: After a fracture, it is typical for the surrounding soft tissues to swell. This swelling can complicate surgical procedures, making it difficult to accurately align and stabilize the fracture. By initially using external fixation, the surgeon can stabilize the fracture while allowing time for the swelling to decrease. This approach minimizes the risk of complications during the internal fixation surgery, such as excessive bleeding or further injury to the soft tissues.

2. Timing of Surgery: In your grandmother's case, the external fixation serves as a temporary measure. The delay until the swelling subsides (in this case, until around September 16 or 17) is crucial. If surgery is performed too soon, the risk of complications increases, and the surgeon may not be able to achieve optimal alignment of the fractured bone.
3. Bone Healing Considerations: While it is true that bone healing begins immediately after a fracture, the initial healing phase involves the formation of a hematoma and subsequent soft callus. This process can take several days to weeks. During this time, the fracture may not be fully stable, but it is also not likely to heal in a way that would prevent realignment during the internal fixation surgery. The surgeon will monitor the fracture closely, often using imaging techniques like X-rays, to ensure that the fracture has not shifted significantly during the waiting period.


Health Insurance and Coverage
Regarding your question about health insurance coverage for two surgeries, in many healthcare systems, including those in the U.S., insurance policies typically cover necessary medical procedures, including both external and internal fixation for fractures. However, the specifics can vary based on the insurance plan. It is advisable to check with the insurance provider to confirm coverage details for multiple procedures related to the same injury.


Concerns About Delays
Your concern about the delay in surgery is valid, especially for an elderly patient. However, the medical team is likely taking a cautious approach to ensure the best possible outcome. The risk of the bone starting to heal improperly is present, but the external fixation is designed to prevent significant movement at the fracture site, thereby allowing for proper alignment when the internal fixation is eventually performed.


Conclusion
In summary, the two-step surgical approach for your grandmother's closed fracture is a well-considered strategy aimed at optimizing healing and minimizing complications. The initial external fixation provides stability while allowing time for swelling to decrease, which is critical for the success of the subsequent internal fixation. While waiting for surgery can be concerning, it is often necessary to ensure the best possible alignment and healing of the fracture. Always feel free to discuss any concerns with the treating physician, as they can provide specific insights based on your grandmother's condition and progress.