eA long bone is a bone that is longer than it is wide. It makes up most of the length of the limbs in humans. Some examples of long bones are the Femur (thigh bone), the Tibia (shin bone), and the Humerus (bone of the upper arm).
Long Bone Fractures are soft tissue injuries that include a partial or complete break in the continuity of the long bones in question.
Long Bone Fractures usually occur from direct or indirect injuries to the long bone. An example of a direct injury is a gunshot wound through the femur bone. Indirect injuries refer to injuries sustained when the force exerted is away from the site of the fracture. An example would be a fracture sustained from a twisting injury to the thigh bone, such as is common during sport. In some patients with low bone density, minor injuries such as slips or falls from a low height can also cause the long bones to fracture.
A. Clinical Evaluation
Based on the reported mechanism of injury, and the symptoms reported by the patient, a doctor will conduct a focused examination of the injured limb. This would include an assessment of the skin at the site of the injury, the status of the nerves, muscles, and blood vessels of the affected limb, as well as the continuity of the bone in question.
B. Radiological Examinations
Plain X-rays use electromagnetic waves to generate an image of the bone being surveyed. In most cases, it will allow the diagnosis of any long bone fractures. In some cases, CT scans may be necessary, especially if the injury is severe.
Long bone fractures can cause complications such as damage to the skin, blood vessels, and nerves. If any of the following applies to you, it is recommended to seek medical attention:
If not treated appropriately, long bone fractures will result in loss of function in the affected limb. This can lead to loss of upper or lower limb mobility and can hamper a person’s way of life. In some cases, this can lead to other complications, such as skin ulcers, and infections of the urinary tract or the respiratory tract, which may even lead to death.
Treatment for long bone fractures depends on the site and severity of the injury. In general, upper limb injuries with minimal displacement may not require surgery. Lower limb injuries however typically require surgery unless the fracture is incomplete. This is due to the fact that lower limb fractures have a propensity to undergo subsequent shifting of the fracture ends.
Casting is an option for minimally displaced upper limb fractures and some lower limb long bone fractures. Depending on the area of injury, your doctor may recommend a period of casting which may last between 3 to 6 weeks depending on location. Occasionally, the doctor will also recommend that you undergo anaesthesia to allow resetting of the broken bone before casting is performed.
A. Intramedullary Fixation
Intramedullary fixation involves the use of a long intramedullary rod, which is an internal splint inserted inside the bone and permanently fixed to the fractured bones using large screws, to manage and keep the fractured bones in place. Additional large screws are also inserted at the lower end of the rod to prevent rotation of the fractured bones around the rod. This is the most common form of treatment for long bone fractures in the lower limb.
Open reduction involves the use of a long plate, which serves as a splint and is permanently fixed to the side of the bone using small screws, to manage and keep the fractured bones in place.
Open reduction is a procedure that is very similar to intramedullary fixation in that they both make use of internal splints which are put into the body during open surgery.
However, open reduction makes use of a plate with screws attached, while intramedullary fixation makes use of a long intramedullary rod.
This procedure is mainly carried out in the upper limbs, though it remains a good option in the selected cases involving the lower limbs.
In general, most long bone fractures treated with surgery will require a period of rehabilitation. Most fractures heal within 3 months for upper limb injuries and 6 months for lower limb injuries.
Most patients will find themselves able to move their limbs immediately after surgery, though their ability to walk or carry heavy objects may be affected during the period of recovery.
Patients will be required to undergo a course of physical therapy which will help with muscle conditioning and joint suppleness, and allow a faster return to their original lifestyle.
For assessment of your condition, please book an appointment with Dr. Yong Ren.