What is Fracture?
Bones are living tissues with nerves, blood supply and marrow inside. When the bone is broken (called fracture), there is a lot of pain, bleeding from the bone and loss of function. Fractures of different bones have to be managed differently. Also the type of fractures influences the management of fractures.
Types of Fractures:
Closed Fractures: Closed fractures are those when the bone is broken but there are no cuts on the skin through which the bone can come out.
Open fractures are those broken bone is in contact with the external atmosphere. Open fractures have to be managed as an emergency because of the contamination occurring to the bone when in contact with al the bacteria in the air, ground etc., Most open fractures of the limbs need to be operated upon immediately after cleaning with antiseptics and clean solutions. As emphasized earlier, open fractures are emergencies and need to be operated soon to prevent infection. Infection of bones is persistent and sometimes can recur again & again.
The main aim of fracture management is to get near normal anatomy and return to previous level of activity as soon as possible. These goals are possible today with advanced equipments, better materials and highly qualified orthopedic surgeons.
Plaster of Paris:
Some fractures may be treated without surgery with only a plaster of Paris cast. This may be possible in some fractures of the wrist, shoulder, collar bone & foot fractures. But in all these the broken ends must be approximated, in line in all planes and stay in position after plaster is applied. If these criteria are not satisfied then surgery is mandatory.
In orthopedic surgery, for fractures the broken bones are held together and in proper alignment with the help of metallic plates, screws, rods, wires & nails. These are made of special grade stainless steel or titanium metal, which are compatible to the body and cause no reactions. These metallic implants can be removed after the bone has healed by minor surgeries. Some of the implants may be left in place. Newer implants called “bio degradable” implants have the capacity to dissolve inside the body one the fracture heals.
Recently more and more biological techniques have been introduced to allow the bones to heal naturally by themselves with minimal surgical trauma at the fracture site. This is possible in long bones of the lower limbs where rods are introduced inside the bone from the top of the bone or bottom with the help of special techniques and not to open the fracture site. This helps the bone to heal naturally and faster allowing movements of the adjacent joints. So the patient is up & about with crutches by second day. Also the cuts made on the skin are minimized.