While the patient is pain-free (general or local anesthesia), an incision is made over the fractured bone. The bone is placed in proper position and screws, pins, or plates are attached to or in the bone temporarily or permanently. Any disrupted blood vessels are tied off or burned (cauterized). If examination of the fracture shows that a quantity of bone has been lost as a result of the fracture, especially if there is a gap between the broken bone ends, the surgeon may decide that a bone graft is essential to avoid delayed healing.
If bone grafting is not necessary, the fracture can be repaired by the following methods:
a) one or more screws inserted across the break to hold it.
b) a steel plate held by screws drilled into the bone.
c) a long fluted metal pin with holes in it, is driven down the shaft of the bone from one end, with screws then passed through the bone and through a hole in the pin.
In some cases, after this stabilization, the microsurgical repair of blood vessels and nerves is necessary. The skin incision is then closed in the usual fashion.