Fracture repair
Fracture repair involves the medical treatment of broken bones, which can occur from trauma or accidents. The primary approach includes two main procedures: reduction and immobilization. Reduction is the repositioning of fractured bones, which can be performed either through closed methods, without surgery, or open methods, requiring surgical intervention. After the bones are aligned, they are stabilized using orthopedic devices such as pins, screws, or plates, which may remain in the body or be removed later.
Immobilization is typically achieved with casts or, in certain circumstances, through external fixation devices that hold the bone in place without traditional casting. Traction may also be employed, applying external force to align the fractured elements. Complications can arise, including the risk of infection and loss of function, making the correct positioning and stabilization essential for optimal healing. New techniques, such as using electromagnetic fields to promote bone healing, are being explored, along with surgical options for addressing non-unions that may require bone grafts from the patient’s body. Understanding these processes is important for anyone looking to learn about how fractures are managed in a clinical setting.
Fracture repair
Anatomy or system affected: Arms, bones, hips, legs, musculoskeletal system, teeth
Definition: The placement and fixation of broken portions of bones in their correct positions until they have grown together
Indications and Procedures
A fracture is a break in a bone, either partial or complete, resulting from an applied force greater than the bone’s internal strength. The most common causes of fractures are accidents and trauma.
Fractures are usually treated by reduction and immobilization. Reduction, which may be either closed or open, refers to the process of returning the fractured bones to their normal position. Closed reduction is accomplished without surgery by manipulating the broken bone through overlying skin and muscles. Open reduction requires surgical intervention. The broken pieces are exposed and returned to their normal positions. Orthopedic appliances may be used to hold the bones in the proper position (internal fixation); the most common appliances are stainless-steel pins and screws, but metal plates and wires may also be employed. These devices can be left in the body indefinitely or may be surgically removed after healing is complete. Local anesthesia is usually used with closed reductions; open reductions are performed in an operating room under sterile conditions, using general anesthesia.
After reduction, the broken bone and accompanying body part must be placed in an anatomically neutral position. Immobilization is generally accomplished by the use of a cast. Casts are usually made of plaster, but they may be constructed of inflatable plastic.
Individual ends of a single fractured bone are sometimes held in position by external pins and screws (external fixation). Holes are drilled through the bone, and pins are inserted as described above. The pins on opposite sides of the fracture site are then attached to each other with threaded rods and locked in position by nuts. This process allows a fractured bone to be immobilized without using a cast.
Traction, the external application of force to overcome muscular resistance and hold bones in a desired position, may also be used to immobilize a fracture. Commonly, holes are drilled through bones and pins are inserted; the ends of these pins extend through the surface of the skin. Part of the body is fixed in position through the use of a strap or weights. Wires are attached to the pins in the body part to be stretched. Force is applied to the wires via weights or tension until the broken bone parts are in the desired position. Traction is maintained until complete healing has occurred.
Uses and Complications
All broken bones must be held in position until healing takes place. The complications associated with repairing fractures include infection, which is rare, and loss of function. The potential for loss of function is minimized by placing the limb in an anatomically neutral position before applying a cast. Complications arise when, after treatment, fractures do not begin to form new unions. This may result in the need for several surgical procedures, which prolongs the period of healing. A non-union will result from things such as insufficient stabilization and perhaps followed by excessive movement. An insufficient blood supply to the affected area can also have negative impacts. These three factors, stabilization, mechanical strain from movement, and blood flow vascularity, are often called “the Diamond Concept.”
The techniques of fracture repair have not changed radically in decades. New methods, however, are being tried. For example, electromagnetic fields are used with fractures that do not heal spontaneously. Such fields induce the growth of osteoblasts, which are bone-forming cells. Another method is a surgical procedure to increase blood flow to the impacted area. In the case of non-union, parts of the bone connection may have atrophied, which requires their replacement, in some case by a bone graft. In these cases the preferred method is to extract an alternative bone segment from the patient. This is referred to as an “autologous” bone graft.
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