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Bone fractures - treatment options

Afractureisabreakinthebone.Itcanbeeithercompleteorincomplete.Followingdiagnosisof thefracture,thetreatmentistorealigntheboneendsandimmobilisethefracturebyexternal splintsorinternalfixingofthebone.Theaimoftreatmentistoassistthebonetorecoverfullyin strength,movementandsensitivity.Somecomplicatedfracturesmayneedsurgeryorsurgical traction(orboth)forbestresults. Causesoffracturesofhealthybonesincludeincidentssuchassportinginjuries,vehicleaccidents andfalls.Aswegetolder,ourbonesusuallybecomemorebrittle.Osteoporosisandsometypesof cancercanalsocausethebonestofracturemoreeasily.

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Problems associated with bone fractures

Someoftheproblemsassociatedwithfracturesinclude: Bloodloss Injurytoorgans,tissuesorsurroundingstructures(suchasbloodvessels) Stuntedgrowthofthebone,ifachildslongbonebreaksclosetothejoint.

Medical issues to consider

Treatmenttosetabrokenbonedependsonthelocationandseverityoftheinjury.Someofthe differenttypesoffractureinclude: Closed (simple) fracturetheskinremainsintactandthereislittledamageto surroundingtissue. Open (compound) fracturethebrokenboneprotrudesthroughtheskinorthereisa woundthatleadstothefracturesite. Complicated fractureinadditiontothefracture,thereisinjurytothesurrounding structures.Theremaybedamagetotheveins,arteriesornervesandtheremayalsobe injurytotheliningofthebone(theperiosteum).

First Aid principles with fractures

Goodfirstaidcareoffracturesisalwaysimportant.Abnormalmovementofthebrokenbonescan increasepainandbleedingandcausedamageofthetissuesaroundtheinjury.Thiscanleadto complicationsintherepairandhealingoftheinjurylateron. Firstaidforfracturesisallaboutimmobilising(limitingmovement)theinjury.Splintscanbe purposemadeormakeshiftbutwillbeeffectiveiftheinjuryisimmobilisedaboveandbelowthe breaktostopmovement.Anyexternalbleedingshouldbecontrolled.Complicatedbreakswherea limbisverydeformedmayneedtoberealignedbeforesplintingandthisisbestdoneonlyby paramedicsormedicalstaff. Otherfracturesofthebodysuchasskull,ribsandthepelvisareallseriousandshouldbemanaged byparamedics.

Operation procedure
PlasterofParisisoneofthemostcommonmethodsusedtoimmobilisealimb.Thiscastismade fromapreparationofgypsumthatsetshardwhenwaterisadded.Operationproceduresdepend onthelocationandseverityofthefracture,forexample:

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Closed or simple fractures-thetwoendsofthebrokenbonearelinedupandheldin place.Thelimbisthoroughlybandagedthenthewetplasterisapplied.Sometimes,once theplasterisdry,thecastissplitintotwoandthetwohalvesarethenre-bandagedonthe outside.Thisallowsforanyswellingthatmayoccur. Open or compound fracturesthesehavetobethoroughlycleansedintheoperating roomtoremovedebrispriortobeingsetbecauseabrokenboneexposedtotheopenairis atincreasedriskofinfection. Long bones longbones,liketheboneofthethigh(femur),aredifficulttokeepaligned and,inadults,aregenerallytreatedbyinternalnailing.Childrenmayneedtractionfora coupleofdayspriortosettinginacast.Oncethetwoendsofbonestarttoshowsignsof healing,thelegandhipjointareimmobilisedinplasterofParis.Inothercases,pinsare insertedaboveandbelowthefractureandsecuredtoanexternalframeorfixatorundera generalanaesthetic.

Immediately after the operation

Yourdoctorchecksthatyouhavefullfeelinginthelimb.Forexample,ifyouhaveabrokenarmin plaster,youareaskedtowiggleyourfingers.Yourlimbisalsocheckedfortingling,palloror coolness.Theinjuredpartisimmobilisedasmuchaspossibleinthefirstfewdays(withtheaidsof splints,ifnecessary)inordertoreducepainanddisplacementofthefracture. Thenursingstaffwillofferyouadequatepainreliefmedication.Theywilldeterminethedifference betweenthepainofyourfractureandanypainthatcouldbecausedbythesplint,traction,plaster cast,pooralignmentofthelimborswellingofthelimbfollowingthefracture.

Possible complications
Someofthepossiblecomplicationsmayinclude: Pooralignmentofthelimb Infection Incorrectlyfittedplastercast(forexample,tootightortooloose).

Taking care of yourself at home

Beguidedbyyourdoctorbutgeneralsuggestionsinclude: Untilthecasthasproperlyset,avoiddirectheatsuchashotwaterbottles. Restthelimbasmuchaspossibletopromotehealing. Usethetechniquesshowntoyoubynursingstafftowalkormanageday-to-dayactivities. Forexample,youriskfurtherinjuryifyouusecrutchesincorrectly. Avoidanyliftingordrivinguntilthefracturehashealed. Ifyouexperienceanitch,dontpokeanythingbetweenthecastandyourlimb(suchasa coathangerorpencil).Instead,useahairdryertoblowcoolairintothecast. Avoidgettingyourcastwet,aswetplasterbecomessoftanddoesnotprovidethe necessarysupport.Wetplastercanalsocauseskinirritation.Whenshowering,wrapthe castinaplasticbagandtapeitdirectlytotheskin,keepingtheareawater-tight. Seeyourdoctorimmediatelyifyouexperienceswelling,bluenessorlossofmovementof thefingersortoes,pinsandneedles,numbnessorincreasedpain.

Long-term outlook
Inmostcases,thecastcanberemovedafterafewweeksbutthelimbmustbehandledwithcare foratleastthenextmonthorso.Legfractureswilltakeseveralmonthstoheal.Thetemporary bone(callus)isstillbeingreplacedbyrealboneandissusceptibletoinjury.Atrophied(wastedor decreasedinsize)musclesmayneedrehabilitationincludingstrengtheningexercisestorecover fromtheirimmobilisation.

Other forms of treatment

Somebones,suchasthecollarboneorbonesofthetoes,areimmobilisedwithaslingorsplint (insteadofplastered)andrestedforabouttwomonths.

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Where to get help

Yourdoctor.

Things to remember

Afractureisabreakinthebone. Somecomplicatedfracturesmayneedsurgeryandsurgicaltractionforbestresults. Inmostcases,thecastcanberemovedafterafewweeksbutthelimbmustbehandled withcareforatleastthenextmonthorso.

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AmbulanceVictoria
Contentonthiswebsiteisprovidedforeducationandinformationpurposesonly.Information aboutatherapy,service,productortreatmentdoesnotimplyendorsementandisnotintendedto replaceadvicefromyourdoctororotherregisteredhealthprofessional.Contenthasbeen preparedforVictorianresidentsandwiderAustralianaudiences,andwasaccurateatthetimeof publication.Readersshouldnotethat,overtime,currencyandcompletenessoftheinformation maychange.Allusersareurgedtoalwaysseekadvicefromaregisteredhealthcareprofessional fordiagnosisandanswerstotheirmedicalquestions. Forthelatestupdatesandmoreinformation,visitwww.betterhealth.vic.gov.au Copyight 1999/2012StateofVictoria.ReproducedfromtheBetterHealthChannel (www.betterhealth.vic.gov.au)atnocostwithpermissionoftheVictorianMinisterforHealth. Unauthorisedreproductionandotherusescomprisedinthecopyrightareprohibitedwithout permission.

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