Fracture repair is the process of rejoining and realigning the ends of broken bones. This procedure is usually performed by an orthopedist, general surgeon, or family doctor. In cases of an emergency, first aid measures should be evoked for temporary realignment and immobilization until proper medical help is available.
Purpose
Fracture repair is required when there is a need for restoration of the normal position and function of the broken bone. Throughout the stages of fracture healing, the bones must be held firmly in the correct position. In the event the fracture is not properly repaired, malalignment of the bone may occur, resulting in possible physical dys-function of the bone or joint of that region of the body.
Precautions
Precautions for fracture repair are anything found to be significant with patients' medical diagnosis and history. This would include an individual's tolerance to anesthesia and the presence of bleeding disorders that may be present to complicate surgery.
Description
Fracture repair is applied by means of traction, surgery, and/or by immobilization of the bones. The bone fragments are aligned as close as possible to the normal position without injuring the skin. Metal wires or screws may be needed to align smaller bone fragments. Once the broken ends of the bone are set, the affected area is immobilized for several weeks and kept rigid with a sling, plaster cast, brace or splint. With the use of traction, muscle pull on the fracture site is overcome by weights attached to a series of ropes running over pulleys. Strategically implanted electrical stimulation devices have proven beneficial in healing a fracture site, especially when the fracture is healing poorly and repair by other means is difficult.
Preparation
Emergency splinting may be required to immobilize the body part or parts involved. When fracture repair is necessary, the procedure is often performed in a hospital but can also be successfully done in an outpatient surgical facility, doctor's office or emergency room. Before any surgery for fracture repair, blood and urine studies may be taken from the patient. X rays may follow this if not previously acquired. It has been noted however, that not all fractures are immediately apparent on an initial x-ray examination. In this case, where a fracture is definitely suspected the extent of the fracture can be properly diagnosed by repeating the x rays 10–14 days later. Depending upon the situation, local or general anesthesia may be used for fracture repair.
Aftercare
After surgery, x rays may be again taken through the cast or splint to evaluate if rejoined pieces remain in good position for healing. This is usually performed either before the application of the splint or at least before the patient is awakened from the general anesthesia. The patient needs to be cautious not to place excess pressure on any part of the cast until it is completely dry. The patient also should avoid excess pressure on the operative site until complete healing has taken place and the injury has been re-examined by the physician. If the cast becomes exposed to moisture it may soften and require repair. The patient should also be instructed to keep the injured region propped up whenever possible to reduce the possibility of swelling.
Risks
Surgical risks of fracture repair are greater in patients over 60 years of age because the bones often taking longer to heal properly. Obesity may place extra stress on the healing site, affecting healing and possibly risking reinjury. Smoking may slow the healing process after fracture repair, as well as poor nutrition, alcoholism, and chronic illness. Some medications may affect the fracture site, causing poor union. Such medications include anti-hypertensives and cortisone.
Possible complications following fracture repair include excessive bleeding, improper fit of joined bone ends, pressure on nearby nerves, delayed healing, and a permanent incomplete healing of the fracture. If there is a poor blood supply to the fractured site with one of the portions of broken bone not properly supplied by the blood, the bony portion will die and healing of the fracture will not take place. This is called aseptic necrosis. Poor immobilization of the fracture from improper casting which permits motion between the bone parts may prevent healing and repair of the bone with possible deformity. Infection can interfere with bone repair. This risk is greater in the case of a compound fracture (a bone fracture causing an open wound) where ideal conditions are present for severe streptococcal and staphylococcal infections. Occasionally, fractured bones in the elderly may possibly never heal properly. The risk is increased when nutrition is poor.
Normal results
Once the procedure for fracture repair is completed, the body begins to produce new tissue to bridge the broken pieces. At first, this tissue (called a callus) is soft and easily injured. Later, the body deposits bone minerals until the callus becomes a solid piece of bone. The fracture site is thus strengthened further with extra bone. It usually takes about six weeks for a broken bone to heal together. The exact time required for healing depends on the type of fracture and the extent of damage. Before the use of x rays, fracture repair was not always accurate, resulting in crippling deformities. With modern x-ray technology, the physician can view the extent of the fracture, check the setting following the repair, and be certain after the procedure that the bones have not moved from their intended alignment. Children's bones usually heal relatively rapidly.
Abnormal results
Abnormal results of fracture repair include damage to nearby nerves or primary blood vessels. Improper alignment causing deformity is also an abnormal outcome, however, with today's medical technology it is relatively rare.
BOOKS
Arnheim, Daniel D. Modern Principals of Athletic Training. St. Louis: Times Mirror/Mosby College Publishing Co., 1989.
Magee, David J. Orthopedic Physical Assessment. Philidelphia: W. B. Saunders Co., 1992.
Scully, Rosemary M., and Marylou R. Barnes. Physical Therapy. Philadelphia: J. B. Lippincott Co., 1989.
PERIODICALS
Gorden, Everett J. "Fractures and Dislocations: An Overview." Trauma 37, no. 5 (Feb. 1996): 5-36.
OTHER
Griffith, H. Winter. "Fracture Repair." ThriveOnline. 1998. 3 Mar. 1998 <http://thriveonline.oxygen.com>.
Jeffrey P. Larson, RPT
KEY TERMS
Compound fracture—A fracture in which the broken end or ends of the bone have torn through the skin. Compound fractures are also known as open fractures
Staphylococcal infection—An infection caused by any of several pathogenic species of staphylococcus, commonly characterized by the formation of abscesses of the skin or other organs.
Streptococcal infection—An infection caused by a pathogenic bacteria of one of several species of the genus streptococcus or their toxins. Almost any organ in the body may be involved.
