Fractures And Dislocations

Bone Fractures

An Individual’s vulnerability to a bone fracture varies over the course of their life. Men are most vulnerable until the age of 45, and women after that as a result of hormonal changes and the onset of osteoporosis. Bones consist of bone cells, proteins and minerals such as calcium.

Sudden pressure that pulls a bone out of its “socket” at the joint results in a dislocation. A fracture occurs when the bone actually breaks. The severity of a broken bone can vary and should always be assessed by a physician. Breaks are generally classified as either “closed” or “simple” – meaning that the skin is not broken, or “opened” or “compound,” when the skin is pierced and an open wound is susceptible to infection. Fractures, which leave the bone in many broken fragments, as well as those involving a joint, are sometimes called “complex” fractures. They may be closed or open. When they involve the joint, they are referred to as intra-articular fractures. These fractures require precise repair, usually with plates and screws.

Bones heal much faster in children than in adults. The slowest healing takes place among the elderly. Though, some bones heal faster than others regardless of age. A fracture of the upper arm or humerus may heal uneventfully in several weeks, while a fracture in the forearm takes much longer. The femur, or thighbone, is the longest and strongest bone in the body and difficult to break without major trauma. The lower part of the radius, making up the upper part of the wrist joint, is the most frequently fractured, because it is often used to support or break a sudden fall.

Change in Bone Fracture Treatment

Treatment of bone fractures has changed dramatically over the years and today yields much better results than those previously accepted. The once common practice of placing casts on the entire limb and immobilizing for long periods of time was found to cause permanent weakness and stiffness of the joints, both above and below the affected area. Today, removable braces are placed briefly on the affected area only when a bone is broken and only until it adequately repairs itself. This method isolates the fracture yet allows patients to continue full movement of the limb, which keeps joints strong and eliminates the risk of stiffness. Many fractures do not require casting or other stabilizing device at all, as many bones repair themselves much more quickly – particularly when the limb continues to move freely and maintain its strength. Young children with long bone fractures are rarely able to cooperate with doctor’s orders for limited activity and may be placed in plaster or fiberglass casts. Unlike adults, they do not regularly develop disabling joint stiffness if immobilized, and their joints and muscles remain much more supple and flexible.

Often times a simple fracture can be treated with ice, elevation, bracing and medication for pain. Many of these simple fractures can become worse if put in a cast and immobilized.

Unless a severe break in an adult requires surgery for stabilization with plates and screws or rods, little more than a functional brace is recommended. Fractures of the shaft of the thighbone are best treated with rods. Fractures that involve joints regularly require screws – with or without plates. Fractures of the arm can often be treated with functional bracing. Fractures of the elbow, if serious, require plates and screws. Fractures of the forearm in adults require plates and screws. After an adult has surgery on a fractured bone or joint, immediate functional treatment, including range of motion exercises, are mandatory.

Sometimes fractures do not heal on a regular schedule. When this occurs, the fracture is described as delayed union or nonunion. Generally, surgical treatment is necessary for these fractures. Range of motion and functional rehabilitation follows immediately thereafter. Casting only contributes to the disuse atrophy and stiffness.

When a bone heals crooked, there is often both a cosmetic and functional disability. This condition is called a malunion. Malunions are treated by cutting the bone and repairing it in its anatomical position. This procedure is called an osteotomy. After cutting the bone, it is stabilized with orthopaedic hardware. Immediate functional treatment will follow just as with nonunions.

This understanding about the affects of prolonged and unnecessary immobilization of joints and surrounding muscle groups around a fracture supports the cornerstone of the treatment philosophy at the Sanders Clinic – the body must keep moving. Dr. Sanders applies the same principals used in treating sports and occupational injuries to bone fractures. A rapid return to activity requires proper treatment, exercise, diet, and nutrition. Nutrition is extremely important in fracture cases. If a patient is not in positive nitrogen and caloric territory – required energy and basic amino acids (essential for protein synthesis), the body cannot mount the appropriate response for fracture healing.

Mobility is essential in order to maintain the strength of surrounding joints, tendons, and muscles – ensuring normal motion and function of the injured limb.

Healthy Living Key to Healing

Patients are instructed on the nutritional requirements bones need to heal, including adequate caloric intake for sufficient energy and proper vitamins for bone and joint strengthening. Tobacco use is strongly discouraged because it lowers the amount of much needed oxygen in the blood. Adequate oxygen is essential for the proper healing of broken bones.

Patients are not encouraged to “stay off the limb” for any period of time, though careful guidelines are given to ensure proper healing of the bone while maintaining strength in the limb. And an individualized exercise program is developed for the patient and considered ongoing until the limb is completely recovered.