Fracture Repair Health Article

Risks

Surgical risks of fracture repair are greater in persons over 60 years of age because the bones often require more time to properly heal. Obesity may place extra stress on the fracture site, affecting healing and possibly increasing the risk of re-fracturing the same bone. The healing process after fracture repair may also be slowed by smoking, as well as by poor nutrition, alcoholism, and chronic illness. Some medications may affect the fracture site, causing poor union; such medications include anti-hypertensives and such steroids as 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 (union) of the fracture. If there is a poor blood supply to the fractured site and one of the portions of broken bone is not adequately supplied with blood, the bony portion may die and healing of the fracture will not take place. This complication is called aseptic necrosis. Poor immobilization of the fracture from improper casting that permits motion between the bone parts may prevent healing and repair of the bone, and result in possible deformity. Infection can interfere with bone repair. This risk is greater in the case of a compound fracture (a bone fracture involving a portion of bone that breaks through the surface of skin). Compound fracture sites provide ideal conditions for severe infections by Streptococcus and Staphylococcus bacteria. 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 fracture site and rejoin the broken pieces. At first, this tissue (called a callus) is soft and easily injured. Later, the body deposits bone minerals (primarily compounds containing calcium) until the callus becomes a solid piece of bone. The fracture site is thus further strengthened with extra bone. It usually takes about six weeks for the pieces of a broken bone to knit (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 and frequently resulted in crippling deformities. With modern xray technology, physicians 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 more rapidly than do the bones of adults.

Morbidity and mortality rates

Morbidity associated with fracture repair includes damage to nerves or primary blood vessels that are adjacent to the fracture site. Improper alignment causing deformity is an abnormal outcome that is relatively rare due to presently available medical technology.

Mortality associated with fractures is also rare. It is usually associated with infections or contamination acquired during the fracture process.

Alternatives

There are no alternatives to proper fracture repair. Problems associated with allowing a fracture to heal without intervention include misalignment, deformity, loss of function, and pain.

Magnetic fields are occasionally used to stimulate healing when conventional techniques are not effective.

See also Bone grafting; Orthopedic surgery.

BOOKS

Browner, B., J. Jupiter, A. Levine, and P. Trafton. Skeletal Trauma: Fractures, Dislocations, Ligamentous Injuries, 3rd edition. Philadelphia: Saunders, 2002.

Canale, S. T. Campbell's Operative Orthopedics. St. Louis: Mosby, 2003.

Eiff, M. P., R. L. Hatch, W. L. Calmbach, and M. K. Higgins. Fracture Management for Primary Care, 2nd edition. Philadelphia: Saunders, 2002.

Staheli, L. T. Fundamentals of Pediatric Orthopedics, 3rd edition. Philadelphia: Lippincott, 2003.

PERIODICALS

Henry, B. J., et al. "The Effect of Local Hematoma Blocks on Early Fracture Healing." Orthopedics 25(11) 2002: 1259–1262.

Ong, C. T., D. S. Choon, N. P. Cabrera, and N. Maffulli. "The Treatment of Open Tibial Fractures and of Tibial Non-union with a Novel External Fixator." Injury 33(9) 2002: 829–834.

Sammarco, V. J., and L. Chang. "Modern Issues in Bone Graft Substitutes and Advances in Bone Tissue Technology." Foot and Ankle Clinics of North America 7(1) 2002: 19–41.

Szczesny, G. "Molecular Aspects of Bone Healing and Remodeling." Polish Journal of Pathology 53(3) 2002: 145–153.

ORGANIZATIONS

American Academy of Orthopaedic Surgeons. 6300 North River Road, Rosemont, IL 60018-4262. (847) 823-7186 or (800) 346-2267. <http://www.aaos.org/wordhtml/home2.htm>.

American College of Surgeons. 633 North Saint Claire Street, Chicago, IL 60611. (312) 202-5000. <http://www.facs.org/>.

American Society for Bone and Mineral Research. 2025 M Street, NW, Suite 800, Washington, DC 20036-3309. (202) 367-1161. <http://www.asbmr.org/>.

Orthopedic Trauma Association. 6300 N. River Road, Suite 727, Rosemont, IL 60018-4226. (847) 698-1631. <http://www.ota.org/links.htm>.