Fracture Management Explained
Since the healing of a broken bone is a natural process, the treatment is aimed to ensure better functionality of the injured part after healing. However, the pattern of fractures and methods of treatment of fractures of bones varies differently for children, adults and the elderly.
Fractures In Children
Due to the presence of an active covering called (periosteum) that works as a rapid healing agent in children’s bones, it heals faster than adults. The bones of a child are more likely to bend than to break completely (greenstick fractures) because they are softer and the periosteum is stronger and thicker.
Fractures In Adults
Among younger patients, the main cause of a fracture is high-energy trauma and they can be classified into two types depending on soft tissue involvement. Closed fracture are those fractures in which the overlying skin is intact. Open/compound fractures involve wounds that are interlinked with the fracture and these fractures often require standard treatment modalities.
Fractures In Elderly
The bones of elderly patients become fragile due to osteoporosis and these brittle bones tend to break very easily. The most common osteoporotic fractures are that of the wrist, spine, shoulder and hip.
Treatment Of Fractures
The treatment of a fracture involves correct realignment and prevention from getting it displaced until the bone is healed. The specific treatment required depends on how severe the fracture is and if it is an open or closed type. The treatment also vanes for every bone involved in the fracture (for example, a hip fracture is treated differently from fracture in the ankle).
When fractured, the bones can be managed by both non-operative and operative techniques. Casting and traction are two parts of non-operative closed therapy. The casting is done after ensuring that the fractured fragments are in good alignment. It casting can be done either with fibre glass or with plaster of Pans (POP) bandages.
Treatment restores the bone to its natural position and maintains fragments in good alignment while the bone is healing. Often, aligning the bone (reduction) is done under X-ray control. Also, since this process may be extremely painful without anaesthesia, displaced fractures are often manipulated under general anaesthesia (MUA).
The traction treatment includes aligning the bone by a gentle, steady pulling action. This can either be achieved by pulling through skin tapes (skin traction) or by a metal pin inserted through a bone (skeletal traction).
Surgical treatments are applied if the orthopaedic surgeon is either unable to restore the broken bone to its original position or if he/she feels that it is not possible to achieve alignment (like in hip fractures). Surgical intervention strives for the bone fragments to be in their exact location.
This procedure involves opening up the fractured site or achieving the alignment by closed means and then fixing it with a metallic device (implant), so that the fragments can be held together. However, there are various ways of fixing the broken bones, either by an external means (external fixator) or by an internal device (Internal fixation).
This treatment uses pins or screws that are cautiously placed into the fractured site and supported by a metal bar attached outside the skin. It keeps the bone in its proper position and this makes healing easy.
There are various metallic devices available to fix fractured bones. These are made up of either stainless steel or titanium metal and are of various types:
Wires are commonly used for temporary and definitive treatment of fractures. It can be placed percutaneously or via a mini open mechanism.
Plates And Screws
Plates and screws are commonly used in the management of fractures in adults and elderly as they provide strength and stability to neutralize the forces on the injured limb for functional postoperative aftercare.
These nails are popularly used since World War II and are now considered as the preferred treatment for long bone fractures in adults. The nails act like an internal splint that shares the load with the bone. These can be flexible or rigid, locked or unlocked, and reamed or unreamed nails.
Now a days, locked intramedullary nails are preferable, as they provide relatively more stability to maintain bone alignment and length and to limit the rotation.
Joint Replacement Surgery
Hip fractures are very common amongst elderly people due to underlying osteoporosis and it is essential to treat these fractures with surgery either to fix the fractures (by screws, plates, or a nail) or to replace the ball of the hip by an artificial metallic implant (partial hip replacement or hemiarthroplasty) as these procedures allow the patients to gain mobility quickly and helps avoid the complications of being bed ridden.