TRAUMA & FRACTURES

The word “Fracture” implies to broken bone. It is caused commonly from injury due to fall, motor vehicle accident or sports. Softening of the bone due to osteoporosis in the elderly can cause the bone to break easily.

Types of fractures include:

• Stable and 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 fractures in which the broken bones cut through the skin.
  • - These injuries are more prone to infection and requires immediate medical attention.
• Greenstick fractures are unique fractures in children that involves bending of one side of the bone without break in the bone.

Fracture Healing

Our body reacts to a fracture by protecting the injured area with a blood clot and scar tissue. Bone cells begin forming on the either side of the fracture line and these cells grow towards each other to close the fracture gap.

Fracture management

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 fracture heals. Fracture reduction with immobilization technique is done by either non-operative or surgical method.

Non-operative / Medical Therapy

Non-operative (closed) therapy comprises of casting and traction (skin and skeletal traction).

• Casting

After reduction is done for any fracture that is displaced, shortened, or angulated, Splints and casts made up of plaster of Paris material or fiberglass are used to immobilize the limb.

• Traction

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 attachment of traction tapes to the skin of the limb segment below the fracture.
• Skeletal traction involves a pin is inserted through the bone distal to the fracture.
• Weights will be applied and the patient is placed in an apparatus that facilitates traction.

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 wires, plates and screws, and nails.

• External fixation

External fixation is a procedure in which the fracture is stabilized using wires, pins and frame outside the skin.

Rehabilitation

Fractures can 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 become solid enough to bear the stress. Rehabilitation program involves exercises and gradual increase in activity levels until the process of healing is complete.

Stress Fracture

Stress fracture is a tiny crack in the bone or severe bruising within a bone. Stress fractures are caused by repetitive activity or from overuse.

They commonly occur when people change their activities – such as by trying a new exercise, suddenly increasing the intensity of their workouts, or changing the workout surface (jogging on a treadmill vs. jogging outdoors). In addition, if osteoporosis or other disease has weakened the bones, just doing everyday activities may result in a stress fracture.

The weight-bearing bones of the foot and lower leg are more prone to stress fractures because of the repetitive forces they must absorb during activities like walking, running, and jumping.

Stress fractures occur most often in the second and third metatarsals in the foot, which are thinner (and often longer) than the adjacent first metatarsal. This is the area of greatest impact on your foot as you push off when you walk or run.

Stress fractures are also common in the calcaneus (heel); fibula (the outer bone of the lower leg); talus (ankle bone); and the navicular (the bone on the top of the midfoot).

Refraining from high impact activities for an adequate period of time is the key to recovering from a stress fracture in the foot or ankle. Returning to activity too quickly can not only delay the healing process but also increase the risk for a complete fracture. Should a complete fracture occur, it will take far longer to recover and return to activities.