Not all injuries require surgery, but there are times when the eventual outcome will be better after an operation. The main reasons for this are if a fracture involves (or is close to) a joint surface, or if the bony fracture ends are not well aligned. Ligament injuries are sometimes operated on to restore stability.
Other less common reasons for operating after a fracture include if the fracture is “open”, which means there is a break in the skin leading to a risk of infection, if there is a nerve, tendon or muscle injury that needs repair, or if there are some fractures that we know simply do badly if left alone. After diagnosing your injury, your treating surgeon will talk to you about the different options for treatment, including the possibility of surgery.
The aims of surgery for fractures are broadly to replace the bony fragments close to their original position, and then stabilise them with metal implants. Typical implants are plates and screws, or rods that fit on the inside of bones, but if the fracture involves a joint surface, then it is important to realign the pieces perfectly, as any steps in the joint surface can lead to arthritis in the joint later on. Although we typically aim for perfection, many fractures do not necessarily need to be perfectly aligned. There is generally a tolerance of a few mm or a few degrees, however the body will cope with these slight changes.