Principles of Fracture Management

Introduction

A fracture is a term used to describe a break or a crack in the structural continuity of the bone. Fractures may occur due to a sudden injury like falling down or getting hit on the bone, or due to overuse such as repetitive stress or strain in the bone. Fractures may also occur due to diseases that weaken the bones. Fractures vary in severity from a hairline crack to a complete break in the bone and can happen in any of the bones in the body. Common symptoms of a fracture include pain, swelling, bruising, and difficulty in moving the affected area.

What Are the Steps Involved in Managing a Fracture?

Management of fracture involves three phases:

• Emergency care.

• Definitive treatment.

• Rehabilitation.

What Are the Steps in Emergency Care (First-Aid) For a Fracture?

If a patient is suspected to have a fracture some emergency care has to be taken to prevent further damage to the affected bone and the patient should be helped to receive medical attention as quickly as possible. Some things that can be done as first-aid include the following:

• Immobilization of the affected area can be done by supporting or holding the affected area in a stable position.

• Ice can be applied to reduce pain and swelling.

• If there is any bleeding, direct pressure should be applied using a clean cloth or a bandage.

• Immediately seek medical help in a nearby hospital.

What Are the Principles of Fracture Management?

The three basic principles of fracture management include:

• Reduction

• Immobilization.

• Rehabilitation.

If the fracture is associated with severe trauma or high-energy injuries, first resuscitation is done and the patient is taken care of using the advanced trauma life support (ATLS) principles before any definitive treatment for the fracture is started. Management of fracture should be aimed at regaining normal alignment and function of the injured bone or joint in the shortest time possible.

What Is Reduction in Fracture Management?

• Reduction is the first principle in fracture management. It refers to the process of bringing the bone to its normal alignment. There are a variety of methods for fracture reduction and reduction methods vary for every fracture depending on its type and its severity. Reduction of a fracture facilitates the following:

  • Blockage of bleeding in the fracture site.

  • Reduces the pulling of the surrounding tissues.

  • Reduces swelling.

  • Reduces pressure in the surrounding blood vessels and nerves.

• Some common types of reduction methods are:

  • Closed Reduction: This method involves manipulating the broken bone into its normal position without surgery. This is usually done under anesthesia to minimize the pain. The doctor uses their hands or a device to apply pressure and realign the bone. A cast or a splint is applied to immobilize the fracture once the bone is in the correct position.

  • Open Reduction: Open reduction is necessary when the fracture cannot be reduced by closed reduction techniques. In this procedure, surgery is performed to expose the bone and then the fracture is reduced and fixed using screws, plates, or other devices.

  • Traction Reduction: involves the use of weights or pulleys to gradually and gently realign the bones. This is typically used for long bone fractures in the arms and legs.

What Is Immobilization in Fracture Management?

Immobilization of the fracture refers to the process of stabilizing the broken bone after it has been reduced. Immobilization helps in the healing and fusion of the bones in the ideal position. Common methods used for immobilization of the fracture include:

• Cast and Splints

  • Casts are hard plaster or fiberglass shells which are molded around the affected area. Casts are used for serious fractures that require a longer healing time. Splints are rigid or semi-rigid braces used to immobilize minor fractures. Splints can also be used for temporary immobilization.

• Continuous Mechanical Traction

  • In some cases, the fracture is so unstable that it cannot be immobilized using casts. In these cases, the bone is reduced and held in its place by continuous traction. Traction is applied in the limb distal to the fracture facilitating continuous pull along the long axis of the bone. This procedure is commonly used for femoral shaft fractures.

• Fixation

  • External fixation involves using pins or screws that are inserted into the bone on either side of the fracture. These pins or screws are then attached to an external frame or brace that holds the bone till it heals. External fixation is done in severe or complex fractures where there is significant damage to the surrounding soft tissues. It is done when other methods of fixation are not suitable.

  • Internal fixation involves the use of metal screws, plates, wires, or rods that are surgically implanted into the bone to immobilize the fracture. Internal fixation is done in simple and isolated fractures. The bone quality needs to be good for internal fixation to be done.

What Is Rehabilitation in Fracture Management?

Rehabilitation of fractures is an important part of the healing process. The goal of rehabilitation is to regain the strength, mobility, and function of the affected area. Rehabilitation also helps in preventing complications such as weakness and stiffness. The rehabilitation program depends on the needs of the individual and the type and location of the fracture. Physiotherapists examine the patients and come up with a rehabilitation program suitable for each patient. Rehabilitation using physiotherapy is done in four phases.

• Resting Phase: In this phase, the focus is to reduce pain and swelling. To prevent the affected area from further damage, resting is necessary. Physical therapy during this phase involves pain management techniques, gentle range of motion exercises, and the use of braces, slings, or crutches as supportive devices.

• Proprioceptive Training: It is done to recover the motion. Fracture immobilization may have affected the range of motion in the affected area. Gentle exercise, heat or cold therapy, or electrical stimulation is done in this phase to improve the range of motion.

• Strengthening Exercises: Weight-bearing exercises, balance training, and functional activities are done to gain back the lost strength in the affected area.

• Return to Activity Phase: This is the last phase of rehabilitation. This is done when the patient has regained sufficient strength, mobility, and function in the affected area. The focus is to prepare the patient to help them perform their preinjury activities including sports. Sports-specific exercises, injury prevention, and proper techniques are taught in this phase.

Conclusion

Fracture management involves a comprehensive approach that includes accurate diagnosis, proper immobilization or fixation, and appropriate rehabilitation. Treatment options vary depending on the location, severity, and type of fracture, as well as the individual needs and goals of the patient. With proper treatment and rehabilitation, most patients can expect to recover fully from their fracture and return to their normal activities.