Fractures

Any break or crack in a bone is called a fracture. With a simple, or closed, type, the skin remains intact. By contrast, in an open, or compound, fracture, the skin is broken, either from the injury that caused the fracture or by a piece of the bone itself. Compound fractures are especially dangerous, because they usually involve extensive tissue damage, heavy bleeding, and the possibility of infection. In a complex, or comminuted, fracture, the bone is broken into several pieces or part of it is shattered. It may be either closed or open. Greenstick fractures are cracks that do not go all the way through the bone. They occur mostly in young children, whose bones are still relatively pliable. Stress fractures are also bone cracks; they usually develop in the legs of runners, dancers, and other athletes who regularly do strenuous weight bearing exercise. Diagnostic Studies and Procedures Although a broken bone is often obvious, X-rays taken from different positions can confirm the exact nature of the fracture. In addition, a doctor may order a CT scan or MRI, especially if the injury involves the head or spine.

Medical Treatment

Treatment begins with setting the bone a process called fracture reduction, in which the broken pieces are restored to their normal position. If this can be done by simple manipulation, it is referred to as closed reduction. If an operation is necessary, the procedure is called open reduction. Such surgery requires anesthesia and an incision that allows the doctor access to the fracture. Surgery may also be necessary to mend tissues damaged by a broken bone. For example, a fractured rib that penetrates a lung can cause a collapsed lung, or pneumothorax, which may require surgical repair. When a dislocation accompanies the fracture, as it often does with a joint bone, the displaced bones must also be returned to their original position; otherwise, the joint cannot function normally. If a fracture extends into a joint, a plate, pin, or screw may be used to keep the parts in place. Such devices are especially common in the repair of a hip fracture. Dislocations involving the wrist, shoulder, and elbow are relatively easy to reposition and can usually be treated in the emergency room or doctor’s office using local anesthesia. Once a fractured bone has been set, immobilization, usually with a cast, is essential to promote healing. If the fracture is only a hairline break, a cast may not be necessary. For a hairline break in the shoulder, for example, a sling will support the arm and keep it raised, thus relieving the shoulder of stress during healing. For a hairline fracture of the hip in an older person, treatment may be limited to extended bed rest until the break has healed. When a rigid cast is necessary, the physician first covers the area to be immobilized with soft bandaging to protect the skin. He then saturates the wrapping with wet plaster, which hardens within minutes. The cast often extends beyond the area of the fracture. For example, a fractured wrist may need a plaster cast that extends from the knuckles to the elbow. A fractured ankle may require immobilization of the entire leg, so that the person must use crutches to move around. A cast should never be so tight that it impairs blood flow. This is why toes or fingers are left exposed when a limb is put in a cast; if they turn blue, it’s an indication that the cast must be removed and replaced with a looser one. A physician uses X-rays, taken every few weeks, to monitor the healing of a fracture. If healing is progressing properly, a plaster cast may at some point be replaced with a lighter, fiberglass type. Some fractures cannot be immobilized with a cast, so other methods are used to keep the broken bone in place while it heals. For example, a broken rib is usually taped. A broken thigh may be immobilized with the use of traction, which depends on a system of weights and pulleys to keep a limb elevated, while fractured neck bones generally require a rigid steel brace to hold them steady. A broken bone can be very painful, so codeine or another narcotic pain killer may be prescribed for a few days. After that, an over the counter pain reliever, such as aspirin or acetaminophen, is usually sufficient. Medications to reduce blood clotting and prevent any serious complications, such as a pulmonary embolism, may be prescribed, especially if a broken hip or leg necessitates bed rest. A compound fracture also requires taking antibiotics to prevent infection.

Alternative Therapies

Rehabilitation is an essential aspect of recovery from any fracture, and it often incorporates a combination of conventional and alternative therapies.

Exercise Therapy

Movement is essential to reduce the risk of a blood clot. A physical therapist or doctor will give specific instructions for exercises that preserve muscle tone without interfering with healing. Exercise is even more important as part of rehabilitation after the cast is removed, especially when a joint is involved. In this case, it is critical to the process of completely restoring a normal range of motion. After months in a cast, muscles will shrink and weaken; they need a graduated program of resistance and weight bearing exercises to regain strength and function. A physical therapist can prescribe home exercises to augment sessions at a rehabilitation center. Physical therapy for reestablishing hip function usually involves the transitional use of crutches, a walker, and perhaps a cane.   As hip function returns, such movement therapies as tai chi and dance therapy may help.

Hydrotherapy

Exercise in water may be easier than other forms of exercise, especially during the early stages of rehabilitation. Whirlpools and under water massage can alleviate the muscle spasms and soreness that often occur after a long period of disuse.

Massage

As soon as physical therapy for the restoration of muscle function begins, it may be combined with various types of massage to stimulate circulation and overcome muscle spasms.

Music Therapy. Therapists sometimes encourage patients to do their exercise to certain types of music to help improve coordination during rehabilitation. Music also reduces the perception of pain by stimulating an increase in the production of endorphins­brain chemicals that function as natural painkillers and mood elevators.

Nutrition Therapy

Healing of a broken bone generally demands extra calcium, vitamin D, and protein. A nutritionist may recommend supplements, as well as a diet rich in these nutrients.

Occupational Therapy

For a patient confined to a bed or wheelchair while recovering from a fracture, an occupational therapist can provide ingenious ways of managing daily self-care tasks, such as bathing, dressing, and eating.

Self Treatment

Be sure to keep weight off the broken bone until it is fully healed. Follow your prescribed exercise regimen, but avoid unnecessary risks; you don’t want to break the bone again. Bone tissue regenerates itself, so a healed bone is often stronger than it was before the fracture. Remember, however, that it takes a broken bone about a year to completely heal. Most people who have worn a cast describe infuriating itching underneath it. Resist the temptation to use a knitting needle or other such implement to scratch under a cast. If you break the skin, you may develop an infection. Instead, try placing an ice pack over the area cold often eases itchiness. If you must use crutches, be sure they are adjusted to fit your height and arms. Do not rest your weight on the underarm portion this can compress the nerves to your arm. Instead, use the hand rests to bear your weight.

Other Causes of Fractures

Most broken bones result from falls and accidents; however, osteoporosis (bone thinning that may occur with age) and other bone diseases sometimes cause spontaneous fractures, especially of the hip and back.

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