Fractures

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Fractures

Introduction

Broken bones are common injuries. A broken bone is known as a fracture. Fractures usually occur as a result of injury. Commonly, injuries can be considered either high energy, such as in the case of a motor vehicular accident, or low energy, as in the case of a fall onto the ground from a standing position at ground level.

The energy level of the injury often determines the severity of the injury. Fractures are not only broken bones, but are also injuries to the muscle, nerves, blood vessels and skin around the broken bone. A higher energy injury would mean a higher risk of damage to these soft tissues.

Because of this, it is important that any person who suspects that they might have a broken bone, should seek help from a doctor as soon as possible. This minimizes the risk of damage to the soft tissues surrounding the bone, and can prevent complications.

broken wrist treatment
Illustrated Anatomy of a Foot Fracture [1]

What are the symptoms of a fracture?

A patient who has a fracture usually has severe pain at the site of the injury. There is usually also a lot of swelling and bruising seen, and you are usually not able to move that part of the body due to pain. The affected body part may also be floppy, with the injured portion appearing out of shape as compared to the other uninjured side.

Occasionally, as in the case of high energy injuries, fractures can have broken skin overlying the fracture site, a condition known as an open fracture. In this scenario, there is direct access of the broken bone with the external environment, this places the patient at a very high risk of infection. Patients with broken skin and features suggestive of a fracture should therefore seek medical attention immediately.

High energy fractures may also cause damage to the nerves and blood vessels of the affected area. If there is any numbness in the area, or if the area appears very pale and cold, medical attention should similarly be sought immediately. 

How are fractures diagnosed?

When you first see a doctor, a medical interview will be conducted. Based on the information gained during this interview, the doctor will perform a focused examination on the injured broken part and its associated areas. This will include feeling the bone for breaks, checking the skin, blood vessels and nerves, and looking for other injured areas in the body.

Usually, X-rays of the affected area will then be taken, which will confirm the diagnosis of a fracture. Occasionally, X-rays do not provide sufficient information about a fracture, and the doctor may ask that you undergo a computerized tomography (CT) scan. This will allow visualization of the fracture in 3 dimensions, which is especially important in joint fractures.

What can be done to treat a fracture?

In the early phase of fracture treatment, your doctor will usually recommend that you immobilize the fracture. This is conducted by application of a temporary half-cast known as a backslab. This cast supports the broken bone, and prevents injury to the surrounding soft tissues. As it is a half cast, it allows for further swelling to occur. Occasionally, the fracture may have to be reduced (put back together) before the temporary cast is applied.

Depending on the area of fracture, the type of fracture and the severity of the fracture as well as the severity of the damage to the surrounding soft tissues, the fracture may either be treated with operative or non-operative methods.

For patients who are suitable for non-operative management, the cast is changed to a full cast about a week after the injury. The fracture is then monitored for healing, with most upper limb fractures requiring 4-6 weeks in cast, and most lower-limb fractures requiring 6-8 weeks in a cast.

Should operative treatment be recommended, surgery will then be undertaken. Broken bones are usually put in place surgically (open reduction) and fixed with metal implants (internal fixation). These implants are usually left in place until the fracture heals. There is usually no need to remove the implants unless they irritate surrounding tissues. The implants are biologically inert and do not pose any health risks.

In some cases, rather than fixing the broken bone, the broken bone will sometimes be removed and replaced with a metal replacement (prosthesis). This is more common in hip bone fractures, and related to the lower rates of healing in these types of fractures.

References:
[1] Patient, R. (n.d.). Ankle fracture: Rehab my patient. Retrieved January 27, 2022, from https://www.rehabmypatient.com/ankle/ankle-fracture

 

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