Fracture & Trauma

Introduction

A fracture is a break in the continuity of a bone, which can be caused by trauma, overuse, or diseases that weaken bones.

Types of Fractures

1. Hairline (Fissure) Fracture: A thin crack in the bone, often difficult to detect.
2. Comminuted Fracture: The bone is shattered into multiple pieces.
3. Incomplete Fracture: The bone is cracked but not broken all the way through.
4. Complete Fracture: The bone is broken into two or more pieces.
5. Stress Fracture: A small crack in the bone caused by repetitive force or overuse
   

Causes

The most common causes of fractures are:

1. Trauma: A fall, a motor vehicle accident, or a tackle during a football game can all result in fractures.
2. Osteoporosis: This disorder weakens bones and makes them more likely to break.
3. Overuse: Repetitive motion can tire muscles and place more force on bone. This can result in stress fractures. Stress fractures are more common in athletes.

Symptoms

Most common:

• Pain
• Swelling
• Bruising
• Deformity
• Inability to use the affected limb.

Less common:

• Audible snap
• Grinding noise

Diagnosis

Your doctor will do a careful examination to assess your overall condition, as well as the extent of the injury. He or she will talk with you about how the injury occurred, your symptoms, and medical history.

The most common way to evaluate a fracture is with x-rays, which provide clear images of bone. Your doctor will likely use an x-ray to verify the diagnosis. X-rays can show whether a bone is intact or broken. They can also show the type of fracture and exactly where it is located within the bone.

Treatment

All forms of treatment of broken bones follow one basic rule: the broken pieces must be put back into position and prevented from moving out of place until they are healed. In many cases, the doctor will restore parts of a broken bone back to the original position. The technical term for this process is “reduction.”

Broken bone ends heal by “knitting” back together with new bone being formed around the edge of the broken parts.

Surgery is sometimes required to treat a fracture. The type of treatment required depends on the severity of the break, whether it is “open” or “closed,” and the specific bone involved. For example, a broken bone in the spine (vertebra) is treated differently from a broken leg bone or a broken hip.

Non-Surgical Options:

1. Functional Cast or Brace: The cast or brace allows limited or “controlled” movement of nearby joints. This treatment is desirable for some, but not all, fractures.
2. Traction: Traction is usually used to align a bone or bones by a gentle, steady pulling action.
3. Cast Immobilization: A plaster or fiberglass cast is the most common type of fracture treatment, because most broken bones can heal successfully once they have been repositioned and a cast has been applied to keep the broken ends in proper position while they heal.

Surgical Options:

1. External Fixation

• • Description: Stabilization of the fracture using a frame outside the body connected to the bone with pins or wires.
  • Indications: Used for severe fractures with extensive soft tissue damage, open fractures, or when internal fixation is not possible.

2. Closed Reduction and Internal Fixation (CRIF)

• • Description: Non-surgical alignment of the fracture followed by internal fixation with devices like screws or rods.
  • Indications: Used when a closed reduction is sufficient to align the fracture but requires internal fixation for stability.

3. Intramedullary Nailing (IM Nailing)

• • Description: A metal rod is inserted into the marrow canal of the bone to keep the fractured bone in proper position.
  • Indications: Commonly used for fractures of long bones such as the femur, tibia, and humerus.

4. Percutaneous Pinning/K-wiring

• • Description: Minimally invasive procedure where pins or wires are inserted through the skin to hold the bone fragments in place.
  • Indications: Often used for fractures in children, simple fractures, or fractures of small bones like those in the hand or wrist.

5. Open Reduction and Internal Fixation (ORIF)

• • Description: Surgical procedure where the fracture is first reduced (aligned) and then stabilized using internal fixation devices such as plates, screws, or rods.
  • Indications: Used for fractures that cannot be aligned properly with non-surgical methods, complex fractures, or fractures involving joints.

First Aid for Bone Fractures

• Immobilize the affected area using a splint or sling.
• Apply ice to reduce swelling.
• Elevate the injured limb if possible.
• Seek medical attention immediately, especially for compound fractures.

Recovery

Fractures take several weeks to several months to heal, depending on the extent of the injury and how well you follow your doctor’s advice. Pain usually stops long before the fracture is solid enough to handle the stresses of normal activity.

Even after your cast or brace is removed, you may need to continue limiting your movement until the bone is solid enough for normal activity.

During your recovery you will likely lose muscle strength in the injured area. Specific exercises will help you restore normal muscle strength, joint motion, and flexibility.

Prevention

To prevent fractures, maintain good bone health through a diet rich in calcium and vitamin D, engage in regular weight-bearing exercises, use protective gear during sports, and avoid high-risk activities that could lead to falls or trauma.