Ever wondered how a fracture is set and fixed by orthopedic surgeons? Well, here's an overview of how its done.
What is a fracture?
A break in bone is called a fracture. A broken bone can remain in its place (hairline fracture) or get displaced. It can even break in two or more fragments (like in a comminuted fracture).
Investigation
Before attempting to fix a fracture, orthopedic surgeons usually gather as much information as possible about the fracture by doing an X Ray/CT scan/MRI scan. This helps them plan and make a well informed decision about how to manage a particular fracture.
Reduction:
The first step in fracture treatment is to reduce the fractured bone to its normal shape. To do this, the force which caused the bone to break is reversed. Traction (pulling), controlled twisting, gentle straightening of the bone or a combination of these maneuvers are done to achieve reduction. As the reduction maneuvers are painful, they are done under anesthesia.
Fig 2: A broken forearm bone in a plaster cast.
Maintaining the reduced fracture position:
Once the normal shape and length of the bone is achieved, the next step would be to maintain that position till the fracture heals and the bone becomes normal again. This is done by applying a plaster of paris cast to the limb (Fig 2) or in some cases by fixing an implant to the bone by surgery.
Fig 3: A plate
Fig 4: A nail (rod)
What is an implant?
It is a metal device fixed to the bone to maintain its shape and alignment and prevent re-displacement of the fracture. When put on the side of the bone it is called a plate (Fig 3) and when put inside the bone it is called a nail (or a rod)(Fig 4).
Why aren't all fractures treated without surgery?
There are various types of fracture in which surgery is the only option like:
When the fracture cannot be reduced (those occurring inside a joint)
When the reduced position cannot be maintained in a plaster (unstable fractures)
When the fracture doesn't heal in a plaster (scaphoid bone fractures, etc.)
When the fracture takes unacceptably long time to heal in the plaster (tibia fractures)
When a plaster can't be applied (shoulder or hip fractures)
When there is a big wound over the fracture
Once properly reduced and fixed, the fracture heals on its own without any further intervention.
