Fracture/Dislocation

A fracture is a medical condition in which a bone is cracked or broken. It is a break in the continuity of the bone. “Fracture” and “Break” are the same thing. While many fractures are the result of high force impact or stress, some fractures can also occur as a result of certain medical conditions that weaken the bones, such as osteoporosis, or from repeated low impact forces resulting in stress fractures.

A dislocation is a medical condition in which a joint has come out of place. Again, these typically result from a significant force or impact. Occasionally, the joint will spontaneously pop back into place. At other times, the joint will require “reduction” by a health care provider.

Types of Fractures

The word “Fracture” implies to a broken bone. A bone may fracture completely or partially and it is caused commonly from trauma due to a fall, a motor vehicle accident, or sports. Thinning of the bone due to osteoporosis in the elderly can cause the bone to break easily. Repetitive stress can cause stress fractures in athletes.

Types of fractures include:

Stable fractures in which the fractured pieces of bone are well aligned and likely to remain well aligned.
Unstable fractures are those in which fragments of the broken bone are misaligned and displaced.
Comminuted fractures are those in which the bone is broken into several pieces. These are more likely to be unstable.
Open fractures are severe fractures in which the broken bones cut through the skin. This type of fracture is more prone to infection and requires immediate medical attention.
Greenstick fractures: This is a unique fracture in children that involves breaking of one side of the bone but only bending on the other side. These are also referred to as incomplete fractures.

Fracture Healing

Our body reacts to a fracture by protecting the injured area with a blood clot and callus or fibrous tissue. Bone cells begin forming on the either side of the fracture line. These cells grow towards each other and thus close the fracture.

Fracture Treatment

The objective of early fracture management is to control bleeding, prevent ischemic injury (bone death), remove sources of infection such as foreign bodies and dead tissues, and stabilize the bone.

Non-operative (closed) treatment consists of splinting or casting with or without manipulation (reduction) of the fracture. Initial splints are often made of plaster, which is forgiving, and allows for swelling. Subsequent splints or casts may be made of fiberglass, which is lighter and stronger than plaster. If a reduction was performed, repeat (sometimes serial) xrays will be performed to ensure the fracture remains stable. Fracture reduction may take place in the Emergency Department, in our office, or sometimes in the Operating room if general anesthesia is required.

Surgical Treatment

Open Reduction and Internal Fixation (ORIF)
This is a surgical procedure in which the fracture site is exposed through an incision, and reduction of fracture is performed with direct manipulation and visualization of the bone. Internal fixation is achieved with devices such as pins, plates and screws, and intramedullary nails.
Closed Reduction and Percutaneous Pinning (CRPP) This is a surgical procedure in which the fracture is reduced in a closed fashion (without an incision), and then held in place with pins that are inserted through the skin. This is performed in an operating room, and if closed reduction is unsuccessful, conversion to ORIF may be required.
External fixation
External fixation is a procedure in which the fracture is reduced and stabilization is done at a distance from the site of fracture with a frame held with pins inserted into the bone. It helps to maintain bone length and alignment without casting. This is sometimes performed in conjunction with ORIF or CRPP.

Rehabilitation

Fractures may take several weeks or months to heal completely. Compliance with treatment – immobilization or early mobilization, physical therapy, home exercises, etc is of utmost importance in returning your limb to function. Even if the bone heals perfectly, function can be compromised if post-operative instructions are not followed.