Fracture Repair Health Article

Definition

Fracture repair is the process of rejoining and realigning the ends of broken bones, usually performed by an orthopedist, general surgeon, or family doctor. In cases of an emergency, first aid measures should be used to provide temporary realignment and immobilization until proper medical help is available.

Purpose

Fracture repair is required when there is a need to restore the normal alignment and function of a broken bone. Throughout the stages of fracture healing, the bones must be held firmly in the correct position. In the event that a fracture is not properly repaired, misalignment of the bone may occur, resulting in possible physical dysfunction of the bone, adjacent joint, or region of the body.

Demographics

The incidence of fractures that occur in the United States can only be estimated because fractures are not always reported. The average person sustains two to three fractured bones during the course of a lifetime. A reasonable estimate is approximately nine million fractures per year.

Fractures are slightly more common in children and adolescents than in young adults due to the levels and kinds of activities in which they engage. Fractures become more common in adults as they age, however, due to changes in bone structure and generally diminished levels of physical activity.

Description

Fracture repair is accomplished by means of applied traction, surgery, and immobilizing affected bones. The bone fragments are aligned as closely as possible to their 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, muscles pulling on the fracture site are neutralized 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.

Diagnosis/Preparation

Fractures are commonly diagnosed on the basis of history of trauma or the presence of pain. An x ray is usually taken to confirm the diagnosis.

Precautions for fracture repair include any relevant factors in an individual's medical condition and history. These include allergic reactions to anesthesia and the presence of bleeding disorders that may complicate surgery.

Preparation often begins with emergency splinting 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 performed. X rays may be obtained. It must be noted, however, that not all fractures are immediately apparent on an initial x-ray examination. In such a case, when a fracture is highly 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 during fracture repair.

Aftercare

Immediately following surgical repair of a fracture, x rays may be again taken through the cast or splint to evaluate whether the rejoined pieces are in good position for healing. The x ray can be performed either before the application of the splint or at least before an individual is awakened from the general anesthesia. Persons need to exercise caution and not place excess pressure on any part of the cast until it is completely dry. Excess pressure on the operative site should also be avoided until complete healing has taken place and the injury has been reexamined by the physician or surgeon. If the cast becomes exposed to moisture, it may soften and require repair. For this reason, plastic has largely replaced plaster as the casting material of choice. The injured region should be elevated or propped up whenever possible to reduce the possibility of swelling.