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Trauma Fracture Care 

Sudden and traumatic injuries to the bone cover a wide spectrum and are perhaps the most complex to handle because not only is an immediate solution required, but one that ensures there will be no complications or residual problems during the healing process. A completely healed, fully-aligned bone that functions well is always the goal.

Sudden and traumatic injuries to the bone cover a wide spectrum and are perhaps the most complex to handle because not only is an immediate solution required, but one that ensures there will be no complications or residual problems during the healing process. A completely healed, fully-aligned bone that functions well is always the goal.

There are two basic types of injuries but many different types of fractures that can occur. First, a fracture and a break are essentially the same thing – the bone is broken. The degree and severity may vary and whether the bone has broken through the skin – the first type of injury (compound fracture) or whether the skin remains intact (simple fracture) . An injury where the bone has broken through the skin poses more problems inasmuch as it leaves the area open to infection of both surrounding tissue and bone and is considered an extreme emergency.

The severity of a fracture usually depends on the force that caused the fracture. If the bone’s breaking point has been exceeded only slightly, then the bone may crack rather than breaking all the way through. If the force is extreme, such as in an automobile collision or a gunshot, the bone may shatter. Usually the pain is so severe it makes movement impossible, but sometimes it is still possible to use the injured leg or arm and not be aware that there is a break – just because you can move doesn’t necessarily mean it is not broken. In order to prevent further damage to surrounding blood vessels and the bone, always seek medical help.

One basic rule governs all forms of treatment – the broken pieces must be put back into position and prevented from moving out of place until they are healed. Broken bone ends heal by “knitting” back together with new bone being formed around the edge of the broken parts. The following are some types of treatment.

Cast
A plaster or fiberglass cast is the most common type used to immobilize the injured area and to promote bone alignment and healing as well as protect the injured area from motion or use.

Functional Cast Or Brace
The cast or brace allows limited or “controlled” movement of nearby joints, but is only used for some types of less severe fractures.

Traction
Traction is usually used to align a bone or bones by a gentle, steady pulling action. The pulling force may be transmitted to the bone through skin tapes or a metal pin through a bone. Traction may be used as a preliminary treatment, before other forms of treatment.

Fracture Fixation
In this type of treatment, surgery to the bone must be performed. The bone fragments are first repositioned into their normal alignment, and then held together with special screws or by metal plates. The fragments may also be held together by inserting rods down through the marrow space in the center of the bone. These methods of treatment can reposition the fracture fragments very exactly. Because of the risks of surgery, however, and possible complications, such as infection, they are used only when the such treatment is the most likely to restore the broken bone to normal function. Minimally invasive surgical techniques can also be used to treat fractures and we will always try to use these before moving on to more serious or complex methods.

External Fixation
Pins or screws are placed into the broken bone above and below the fracture site. Then the bone fragments are repositioned . The pins or screws are connected to a metal bar or bars outside the skin. This device is a stabilizing frame that holds the bones in the proper position so they can heal. After the bone has healed, the external fixation device is removed.

Finally, following our instructions for healing – which may include not only cumbersome casts and braces but a certain amount of exercise to ensure proper muscle strength, joint motion and flexibility is imperative for a full recovery. Nonunions, malunions, infections, post-traumatic arthritis and leg length discrepancies are just some of the deformities we see when trauma is not treated correctly.