Fractures & Corrections
A fracture, or broken bone, often results from an injury or accident and can cause significant disability to a patient. Fractures range from a small non-displaced cracks to severely broken bones with multiple pieces. Fractures can be ‘closed’ (skin is intact) or ‘open’ (compound, the skin over the fracture is damaged). Open fractures have a high risk for infection and need to be treated with surgery.
Some closed fractures are treated with a cast, where others need surgical repair or fixation also known as an ORIF (Open Reduction and Internal Fixation). There are different methods to fix fractures, including pins, screws, plates, nails (=rods) and external frames. Sometimes fractures don’t heal properly or heal in the wrong position. In those situations, deformities may occur needing further treatment including ‘re-breaking’ of the bone. This is called an osteotomy.
Specific fractures
Every fracture is different and therefore the treatments of all fractures are different. Below is a list of the most common fractures with a general outline of the treatment plan and follow-up.
Lower limb fractures
Ankle fracture
One of the most common fractures is the broken ankle. This is when one or more of the bones that make up the ankle joint are broken from an injury. Some ankle fractures may be treated in a moonboot or cast, while others will require surgical treatment (ORIF). After fixation, most ankle fractures are suitable for weight bearing in a moonboot. Often you will be instructed to rest and elevate the first 2 weeks. After this a moonboot or aircast can be fitted and gradual weight bearing can commence in most situations. You should have a follow-up appointment approximately 6 weeks after surgery
Tibial plateau fracture
This is a fracture through the part of thee knee that bears your weight and also contains the cartilage of the knee. Any displaced fracture through the tibia plateau needs an ORIF. After fixation, the fracture still needs to heal and therefore you are instructed to keep you weight of the leg (toe touch weight bearing is often allowed). Depending on the severity of the fracture and quality of the repair, early range of motion (ROM) of the knee is allowed to prevent stiffness. Most often a ROM brace is used in the first six to 12 weeks.
Upper limb fractures
Clavicle fracture
Clavicle (collar bone) fractures often result from a direct blow or fall onto the shoulder. If the fracture is displaced it might be beneficial to have it fixed with surgery. Not all clavicle fractures need ORIF though. Especially in non-displaced fractures and in low-demand patients these fractures can be left alone.
Wrist fracture
A wrist fracture (distal radius) is also quite common. It results from a fall onto an outstretched hand. These fractures often need to be manipulated in the emergency department and are placed into a back-slab. After the manipulation a decision has to be made whether the fracture is likely to heal in the correct position or whether it needs surgical stabilisation.