The Essentials of Fractures

IMPORTANT THINGS TO KNOW ABOUT FRACTURES

To begin with here are a few things I have found that either confuse people or that patients want to know.

* There is no difference between a fracture and a break. They are synonymous terms.

* There is no truth in the belief that it is often better to break a bone than just have a soft tissue injury. Any broken bone is not positive. It is just 'an old wive's tale.'

*Different breaks take different amounts of time to heal because of a number of factors. Two major reasons for differences in healing times of different breaks are:

Structure of the particular bone in question. Some bones are made primarily with bone that has a honeycombed structure whilst other bones (generally the weight bearing bones of the lower limb) are composed of more dense bone. This more dense tissue takes longer to repair than it's counterpart.

Blood supply. Some parts of the body have a better blood supply than others. Generally the greater the blood supply, the faster the rate of healing can occur. This contributes to the difference in healing times between upper and lower limb injuries, with the upper limb tending to take less time.

*Breaks that occur near to or involving a joint tend to be more problematic than those occurring away from a joint. This is because damage caused to the surfaces and structures of the joint can make restoration of normal movement and pain free function difficult. In addition the blood and fluid leaked out from a fracture site can often settle and solidify in a joint thus seriously affecting it's movement.

*The range of fractures can be from miniscule micro cracks on the surface of a bone right through to total separations and crushing injuries. The commonest classifications are as follows:

Avulsion A small fragment of bone has been pulled or knocked off the surface of a bone. It often occurs at the site of attachment of a tendon and can be caused by extreme muscular contraction so strong that it pulls a piece of bone away from the main structure.

Horizontal The bone is fractures in a horizontal plane.

Oblique The bone is fractured in an oblique or diagonal plane.

Spiral The bone is fractured all the way round in a spiral shape.

Comminuted The bone is broken into many different pieces or fragments.

Compound The break has caused the bone to come through the skin.

Crush The bone is compressed or pressed down.

Wedge Part of the bone is crushed. this is common in compression injuries of the spine where part of a vertebra is crushed. The bone then looks like a wedge.

Open This is the where the skin has been broken so that the fracture is exposed.


Treatment of a Fracture

The treatment inevitably involves immobilising the injured site to enable healing of the broken bone to occur. Some of the most common ways this is achieved are:

SLINGS. Either triangular bandage or collar and cuff (covered lengths of foam tied with plastic fastenings)

CASTS. Either original or lightweight. Can be weight bearing or non weight bearing.

INTERNAL FIXATION. Screws, nails, pins, plates or wire can be used singularly or in any combination to achieve bony fixation and stability. The use of surgical techniques such as these often mean that rehabilitation of surrounding structures can begin that much earlier because the fracture site is held firmly. This aids recovery and helps avoid many associated complications.

EXTERNAL FIXATION. This group includes a variety of wires and supports sited outside the body that hold the broken bone together.

Complications

Non union This is when the fracture does not heal. It can be due to many factors. These may include such things as infection; poor bone quality or presence of a metabolic disease in the body amongst other things.

Delayed union. This is where the healing is slow. It can be due to similar factors to non union, described above.

Deep vein thrombosis (D.V.T.) A DVT is a blood clot or solid particle often of fat that can occur, commonly in the deep veins of the lower leg. Fractures can precipitate such situations because of the immobility they cause which can have the effect of slowing the circulation in the legs.

Fractures themselves can also cause particles of marrow to be released into the blood stream from the damaged site, which then become the problem. A DVT acts like a blockage in a pipe in the blood vesssel it is in resulting in swelling and pressure behind it.

The major danger though is the possibility of the particle or part of it moving from the deep veins of the leg and blocking a blood vessel connecting the heart and lungs. This is a critical and normally fatal situation.

Muscle wasting A painful, stiff, swollen and immobile body part often limits normal function. When the muscles are not used as a result they often decrease in size and strength. Hence one of the benefits of good rehabilitation begun at the right time.

Joint stiffness. A joint that is not moved through its full range of movement will slowly adapt to the lesser demands put on it. Component parts of the joint become less efficient and able to perform their role. This manifests itself as stiffness of inability to move a joint normally.

The process is markedly greater if the fracture directly impacts into the joint or blood and fluid released as a result of the trauma called inflammatory exudate leaks into the joint.

Infection An infection at the site of injury can seriously hamper the healing process. This can become a long term problem if the infection gets a 'foothold' in the bone. This is known as osteomyelitis and can require extensive antibiotic therapy as well as invasive surgery.

Fractures rarely occur without associated damage to other body tissues. It is not uncommon for there to be injury to blood vessels, nerves and other soft tissues. Situations of major trauma involving multiple fractures and soft tissue damage mean there are many factors to consider in the treatment and rehabilitation process.

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