Fractures and Trauma
A bone fracture is a medical condition in which a bone is cracked or broken. It is a break in the continuity of the bone. While many fractures are the result of high force impact or stress, a bone fracture can also occur as a result of certain medical conditions that weaken the bones, such as osteoporosis.
A bone may get fractured completely or partially and it is caused commonly from trauma due to a fall, motor vehicle accident or sports. Thinning of the bone due to osteoporosis in the elderly can cause the bone to break easily. Overuse injuries are a common cause of stress fractures in athletes.
Types of fractures include:
- Simple fractures are those in which the fractured pieces of bone are well aligned and stable.
- Unstable fractures are those in which fragments of the broken bone are misaligned and displaced.
- Open (compound) fractures are severe fractures in which the broken bones cut through the skin. This type of fracture is more prone to infection and requires immediate medical attention.
- Greenstick fractures are an unique fracture in children that involves bending of one side of the bone without any break.
Our body reacts to a fracture by protecting the injured area with a blood clot and callus or fibrous tissue. Bone cells begin forming on the either side of the fracture line. These cells grow towards each other and thus close the fracture.
The objective of early fracture management is to control bleeding, prevent ischemic injury (bone death) and remove sources of infection such as foreign bodies and dead tissues. The next step in fracture management is the reduction of the fracture and its maintenance. It is important to ensure that the involved part of the body returns to its function after the fracture heals. To achieve this, maintenance of fracture reduction with immobilisation techniques is performed by either a nonoperative or surgical method.
Nonoperative (closed) treatment
This comprises of casting and traction (skin and skeletal traction).
Closed reduction is performed for any fracture that is displaced, shortened or angulated. Splints and casts made up of fibreglass or plaster of Paris material are used to immobilise the limb.
The traction method is used for the management of fractures and dislocations that cannot be treated by casting. There are two methods of traction namely, skin traction and skeletal traction.
Skin traction involves the attachment of traction tapes to the skin of the limb segment below the fracture. In skeletal traction, a pin is inserted through the bone distal to the fracture. Weights will be applied to this pin, and the patient is placed in an apparatus that facilitates traction. This method is most commonly used for fractures of the thighbone.
Open reduction and internal fixation (ORIF)
This is a surgical procedure in which the fracture site is adequately exposed and the fracture is reduced. Internal fixation is done with devices such as Kirschner wires, plates and screws, and intramedullary nails.
External fixation is a procedure in which the fracture stabilisation is done at a distance from the site of fracture. It helps to maintain bone length and alignment without casting.
External fixation is performed in the following conditions:
- Open fractures with soft tissue involvement
- Burns and soft tissue injuries
- Pelvic fractures
- Comminuted and unstable fractures
- Fractures having bony deficits
- Limb-lengthening procedures
- Fractures with infection or non-union
Fractures may take several weeks to months to heal completely. You should limit your activities even after the removal of the cast or brace so that the bone become solid enough to bear the stress. Rehabilitation programs involve exercises and gradual increase in activity levels until the process of healing is complete.