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, bone fracture can also occur because of certain medical conditions that weaken the bones, such as osteoporosis.

The word “Fracture” implies to broken bone. A bone may get fractured completely or partially and it is caused commonly from trauma due to fall, motor vehicle accident or sports. Weakening of the bone due to osteoporosis in the elderly can cause the bone to break easily. Overuse injuries can occur and are known as stress fractures.

Types of fractures include:

• Simple fractures 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: This is a unique fracture in children that involves bending of one side of the bone with or without a partial break in the bone.

Fracture Healing

Our body reacts to a fracture by protecting the injured area with a blood clot. This clot over time develops a healing clot called a callus. Bone cells begin working on either side of the fracture line. These cells grow towards each other and thus close the fracture. Stem cells come into the injury zone and assist the healing bone.

Medical Therapy

The objective of early fracture management is to control bleeding, prevent ischemic injury and to remove sources of infection such as foreign bodies and dead tissues. The next step in fracture management is the “reduction” (putting the pieces back together in the correct position) of the fracture and maintenance of the reduction. The aim of treatment is 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 a form of immobilization technique is needed. This can be achieved in some cases non-operative methods (casting or bracing) and on other occasions surgical treatment is needed.

Non-operative (closed) therapy comprises of casting, bracing or traction (skin or skeletal traction).

• Casting
  closed reduction is done for any fracture that is displaced, shortened, or angulated. Splints and casts made up of fiberglass, Plaster of Paris or Termoplastic materials are used to immobilize the injured limb.
• Traction
  Traction is used for the management of fractures and dislocations where shortening of the bones cannot be treated appropriately by casting. There are two methods of traction namely, skin traction and skeletal traction.

Skin traction involves 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. Traction may be used temporarily while preparing a patient for an operation or definitively. Traction is being used less frequently as a definitive treatment because it involves admission to hospital for the duration of the treatment, which can be as long as 6-9 months, and because it is associated with complications of prolonged immobilisation such as bed sores.

Surgical Therapy

• Open Reduction and Internal Fixation (ORIF)
  This is a surgical procedure in which the fracture site is adequately exposed and reduction of fracture is done. Internal fixation is done with devices such as Kirschner wires, plates and screws, and intramedullary nails.
• External fixation
  External fixation is a procedure in which the fracture stabilization 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

Some fractures are treated with joint replacements from the outset. Some hip and shoulder fractures are best treated this way.

Rehabilitation

Fractures may take several weeks to months to heal completely. You should limit your activities even after the removal of cast or brace so that the bone becomes solid enough to bear the stress. Your rehabilitation program involves exercises and gradual increase in activity levels until the process of healing is complete.