Bone fracture medical therapy: Difference between revisions
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==Medical Therapy== | |||
First aid for fractures includes stabilizing the break with a [[splint (medicine)|splint]] in order to prevent movement of the injured part, which could sever [[blood vessel]]s and cause further [[tissue (biology)|tissue]] damage. Waxed cardboard splints are inexpensive, lightweight, waterproof and strong. Compound fractures are treated as open wounds in addition to fractures. | |||
At the hospital, closed fractures are diagnosed by taking an [[X-ray]] photograph of the injury. | |||
Since [[bone healing]] is a natural process which will most often occur, fracture treatment aims to ensure the best possible ''function'' of the injured part after healing. Bone fractures are typically treated by restoring the fractured pieces of bone to their natural positions (if necessary), and maintaining those positions while the bone heals. To put them back into the natural positions, the doctor often "snaps" the bones back into place. This process is extremely painful without anesthesia, about as painful as breaking the bone itself. To this end, a fractured limb is usually immobilized with a plaster or fiberglass [[Cast (orthopedic)|cast]] which holds the bones in position and immobilizes the joints above and below the fracture. If being treated with surgery, surgical nails, screws, plates and wires are used to hold the fractured bone together more directly. Alternatively, fractured bones may be treated by the [[Ilizarov apparatus|Ilizarov method]] which is a form of external fixator. | |||
Occasionally smaller bones, such as [[toes]], may be treated without the cast, by [[buddy wrapping]] them, which serves a similar function to making a cast. By allowing only limited movement, fixation helps preserve anatomical alignment while enabling [[Fibrocartilage callus|callus]] formation, towards the target of achieving union. | |||
[[Surgery|Surgical]] methods of treating fractures have their own risks and benefits, but usually surgery is done only if conservative treatment has failed or is very likely to fail. With some fractures such as [[hip fracture]]s (usually caused by [[osteoporosis]] or [[Osteogenesis Imperfecta]]), surgery is offered routinely, because the complications of non-operative treatment include [[deep vein thrombosis]] (DVT) and [[pulmonary embolism]], which are more dangerous than surgery. When a joint surface is damaged by a fracture, surgery is also commonly recommended to make an accurate anatomical reduction and restore the smoothness of the joint. | |||
[[Infection]] is especially dangerous in bones, due to their limited blood flow. Bone tissue is predominantly [[extracellular matrix]], rather than living cells, and the few blood vessels needed to support this low metabolism are only able to bring a limited number of [[immune cell]]s to an injury to fight infection. For this reason, open fractures and osteotomies call for very careful [[antiseptic]] procedures and [[prophylactic]] antibiotics. | |||
Sometimes bones are reinforced with metal, but these fracture implants must be designed and installed with care. ''Stress shielding'' occurs when plates or screws carry too large of a portion of the bone's load, causing [[atrophy]]. This problem is reduced, but not eliminated, by the use of low-[[Young's modulus|modulus]] materials, including [[titanium]] and its alloys. The heat generated by the friction of installing hardware can easily accumulate and damage bone tissue, reducing the strength of the connections. If dissimilar metals are installed in contact with one another (i.e., a titanium plate with [[cobalt]]-[[chromium]] alloy or stainless steel screws), galvanic [[corrosion]] will result. The metal [[ion]]s produced can damage the bone locally and may cause systemic effects as well. | |||
===In Children=== | |||
In children, whose bones are still developing, there are risks of either a growth plate injury or a [[greenstick fracture]]. | |||
* A greenstick fracture occurs because the bone is not as brittle as it would be in an adult, and thus does not completely fracture, but rather exhibits bowing without complete disruption of the bone's [[Cortex (anatomy)|cortex]]. | |||
* Growth plate injuries, as in [[Salter-Harris fractures]], require careful treatment and accurate reduction to make sure that the bone continues to grow normally. | |||
* [[Plasticity (physics)|Plastic deformation]] of the bone, in which the bone permanently bends but does not break, is also possible in children. These injuries may require an [[osteotomy]] (bone cut) to realign the bone if it is fixed and cannot be realigned by closed methods. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Needs | [[Category:Needs overview]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:fractures]] | [[Category:fractures]] | ||
Revision as of 15:17, 6 February 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
First aid for fractures includes stabilizing the break with a splint in order to prevent movement of the injured part, which could sever blood vessels and cause further tissue damage. Waxed cardboard splints are inexpensive, lightweight, waterproof and strong. Compound fractures are treated as open wounds in addition to fractures.
At the hospital, closed fractures are diagnosed by taking an X-ray photograph of the injury.
Since bone healing is a natural process which will most often occur, fracture treatment aims to ensure the best possible function of the injured part after healing. Bone fractures are typically treated by restoring the fractured pieces of bone to their natural positions (if necessary), and maintaining those positions while the bone heals. To put them back into the natural positions, the doctor often "snaps" the bones back into place. This process is extremely painful without anesthesia, about as painful as breaking the bone itself. To this end, a fractured limb is usually immobilized with a plaster or fiberglass cast which holds the bones in position and immobilizes the joints above and below the fracture. If being treated with surgery, surgical nails, screws, plates and wires are used to hold the fractured bone together more directly. Alternatively, fractured bones may be treated by the Ilizarov method which is a form of external fixator.
Occasionally smaller bones, such as toes, may be treated without the cast, by buddy wrapping them, which serves a similar function to making a cast. By allowing only limited movement, fixation helps preserve anatomical alignment while enabling callus formation, towards the target of achieving union.
Surgical methods of treating fractures have their own risks and benefits, but usually surgery is done only if conservative treatment has failed or is very likely to fail. With some fractures such as hip fractures (usually caused by osteoporosis or Osteogenesis Imperfecta), surgery is offered routinely, because the complications of non-operative treatment include deep vein thrombosis (DVT) and pulmonary embolism, which are more dangerous than surgery. When a joint surface is damaged by a fracture, surgery is also commonly recommended to make an accurate anatomical reduction and restore the smoothness of the joint.
Infection is especially dangerous in bones, due to their limited blood flow. Bone tissue is predominantly extracellular matrix, rather than living cells, and the few blood vessels needed to support this low metabolism are only able to bring a limited number of immune cells to an injury to fight infection. For this reason, open fractures and osteotomies call for very careful antiseptic procedures and prophylactic antibiotics.
Sometimes bones are reinforced with metal, but these fracture implants must be designed and installed with care. Stress shielding occurs when plates or screws carry too large of a portion of the bone's load, causing atrophy. This problem is reduced, but not eliminated, by the use of low-modulus materials, including titanium and its alloys. The heat generated by the friction of installing hardware can easily accumulate and damage bone tissue, reducing the strength of the connections. If dissimilar metals are installed in contact with one another (i.e., a titanium plate with cobalt-chromium alloy or stainless steel screws), galvanic corrosion will result. The metal ions produced can damage the bone locally and may cause systemic effects as well.
In Children
In children, whose bones are still developing, there are risks of either a growth plate injury or a greenstick fracture.
- A greenstick fracture occurs because the bone is not as brittle as it would be in an adult, and thus does not completely fracture, but rather exhibits bowing without complete disruption of the bone's cortex.
- Growth plate injuries, as in Salter-Harris fractures, require careful treatment and accurate reduction to make sure that the bone continues to grow normally.
- Plastic deformation of the bone, in which the bone permanently bends but does not break, is also possible in children. These injuries may require an osteotomy (bone cut) to realign the bone if it is fixed and cannot be realigned by closed methods.