Table of Contents
Introduction
A spiral fracture occurs when a significant twisting force is exerted on a long bone, usually causing it to split along its length. These fractures commonly happen in the arm or leg. They pose serious risks because the jagged ends of the bone are challenging to realign due to their uneven surfaces. Spiral fractures primarily affect the body's long bones, which are common in the arms and legs. Activities involving regular use of these limbs, such as gripping and walking, heighten the susceptibility to spiral fractures due to twisting injuries. Examples of long bones prone to spiral fractures include:
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Radius or ulna (forearm).
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Femur (thigh).
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Tibia or fibula (lower leg).
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Humerus (upper arm).
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Metatarsals or phalanges (feet and toes).
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Metacarpals or phalanges (hand and fingers).
How Do Spiral Fractures Occur?
Spiral fractures usually occur due to high-energy impacts and rotational forces applied to the bone, commonly encountered during sports, workplace injuries, motor vehicle accidents, or traumatic falls. These fractures frequently occur when one end of the bone is immobilized while the other undergoes movement, creating a twisting force on the bone. In the lower extremities, most spiral fractures occur when the foot is anchored, but the body will continue to rotate. Young children may sustain accidental spiral fractures in the lower leg after falling while their leg is extended. Unfortunately, spiral fractures in children are not usually accidental. If a physician identifies a spiral fracture on an X-ray, they will investigate for additional signs of abuse. Spiral fractures can occur due to the following in the majority of cases:
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Skiing or snowboarding accidents.
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Wrestling incidents.
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Motor vehicle collisions.
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Cases of child abuse involve aggressive jerking of a child’s leg or arm.
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Football-related injuries.
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Injuries involving machinery.
What Are the Symptoms of Spiral Fractures?
Spiral fractures usually result in intense pain, accompanied by several common symptoms that include:
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Inability to bear weight on the affected bone.
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Inability to move affected parts of the body.
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Bruising or discoloration.
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Loss of consciousness.
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Inflammation, redness, and swelling in the affected area.
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Tenting of the bone indicates the fractured bone is poised to penetrate the skin.
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Occasionally, a loss of pulse in the ankle or wrist.
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An unusual deformity or bump in the affected part.
How to Diagnose Spiral Fractures?
As a first line of diagnosis, medical professionals usually rely on imaging techniques such as MRI (magnetic resonance imaging) scans, X-rays, and blood tests as the first line of management for diagnosing and assessing spiral fractures. It is worth noting that spiral fractures can infrequently be mistaken for oblique fractures due to their similar appearance in imaging studies. X-rays are the main diagnostic tools to identify fractures, including spiral fractures. These fractures appear as breaks encircling the bone on X-ray images, resembling their appearance stripes on a candy cane. In some cases, physicians may use CT (computed tomography) scans to obtain cross-sectional images of the fracture. This aids in distinguishing spiral fractures from other types of fractures.
What Are the Treatment Strategies for Spiral Fractures?
Due to the nature of how spiral fractures occur, resulting in jagged ends and potentially detached fragments, the treatment approach is tailored to the stability and severity of the break. For stable spiral fractures, commonly seen in children, treatment typically involves immobilizing the bone with a cast for about four to six weeks.
In contrast, displaced spiral fractures usually require surgery due to the complex nature of the injury. An open reduction surgery is a procedure carried out that involves setting the bone fragments in place under general anesthesia. During the operation, the surgeon estimates and addresses any damage to surrounding tissues, such as blood vessels or muscles. The broken bone is then realigned and secured using pins, rods, or screws that may be temporary or permanent.
Following are the procedures carried out for spiral fractures:
1. Immobilization: Mild, nondisplaced spiral fractures may only need a cast or splint. Splinting usually lasts for three to five weeks, while casting may be required for six to eight weeks. Follow-up X-rays are generally essential to closely watch the healing progress.
2. Closed Reduction: More severe fractures will require a procedure known as closed reduction, a non-surgical procedure where the bones are manually aligned by the treating physician. Pain management options during the procedure may include sedatives and general or local anesthesia. After the procedure, the affected limb is typically immobilized with a cast or splint.
3. Spiral Fracture Surgery: Severe fractures may necessitate surgery involving external or internal fixation methods:
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Internal Fixation - This involves realignment of the bones and securing them with metal implants such as plates, screws, rods, or pins. These implants can hold the bone fragments in place during healing. Follow-up surgeries are required to remove the implants if needed.
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External Fixation - In certain cases, temporary stabilization using screws or pins connected to an external brace or bracket may be done before internal fixation.
4. Bone Grafting: In instances of severe displacement or poor healing, bone grafting will be the next resort. Additional bone tissue is inserted to facilitate bone regeneration. This is usually followed by internal fixation to stabilize the bone fragments.
How Long Does It Take to Recover From Spiral Fractures?
Surgical procedures for spiral fractures are typically outpatient procedures, and the patient can return home the same day or stay in the hospital for a day or two, especially for larger bone fractures that involve the femur or tibia. After surgery, the affected limb is immobilized with a splint, brace, or cast until sufficient healing occurs, thereby allowing for weight-bearing and resumption of normal activities. The recovery process can be painful at times, and medications like Acetaminophen are prescribed to manage pain and discomfort, as nonsteroidal anti-inflammatory drugs (NSAIDs) can slow the healing process. Physical therapy is often added to the recovery regimen to regain strength and range of motion in the affected limb, compensating for any loss during the period of immobilization.
Conclusion
Bone healing may be a slow process, and spiral fractures typically require about four to six months to fully heal. Prompt medical attention is important for optimal healing outcomes. If one suspects a spiral fracture, immediate medical intervention must be sought without delay. Early diagnosis and treatment can help in ensuring proper alignment of the bones and facilitate healing.
