Fracture management

​

​

1. What is a fracture?

A fracture is a break or crack in a bone, usually caused by trauma or injury, but it can also result from osteoporosis or other underlying conditions that weaken the bone. Fractures can range from minor hairline fractures to severe breaks that completely separate the bone into two or more pieces.

 

2. What are the different types of fractures?
 

Fractures can be classified based on their location, severity, and the way the bone breaks. Common types include:

​

• Simple (closed) fracture: The bone breaks but does not pierce the skin.

• Compound (open) fracture: The bone breaks and pierces through the skin, often leading to a higher risk of infection.

• Comminuted fracture: The bone breaks into several pieces.

• Greenstick fracture: Common in children, where the bone cracks but doesn’t break all the way through.

• Transverse, oblique, and spiral fractures: Based on the direction of the break.

• Stress fracture: A small crack in the bone caused by repeated stress or overuse, commonly seen in athletes.

 

3. How are fractures diagnosed?

Fractures are typically diagnosed through a physical exam and imaging studies such as:

• X-rays: The most common diagnostic tool to visualise the fracture.

• CT scans: For more detailed images, especially with complex fractures.

• MRI: Used in cases where soft tissue damage is suspected or to assess stress fractures not visible on X-rays.

 

4. What are the different options for fracture management?
 

There are two main approaches to managing fractures: non-operative management and operative (surgical) management.

​

• Non-Operative Management:
  Involves conservative treatments that focus on immobilisation and pain control. This approach is typically used for stable fractures or when surgery is not necessary.

  • Casting or Splinting: For simple fractures, the bone is aligned and held in place by a cast or splint to allow natural healing.

  • Bracing: Used for fractures that need support but may not require complete immobilisation.

  • Traction: In rare cases, traction may be used to align the fracture and keep it in position, typically in fractures involving the spine or certain long bones.

​​

• Operative Management:
  Surgery may be necessary when fractures are:

  • Displaced (where the bone ends are not properly aligned).

  • Comminuted (broken into several pieces).

  • Open fractures (where the bone pierces the skin).

  • Associated with joint involvement or ligament damage.

​

Methods of surgical fixation include:

• Internal fixation: Involves the use of plates, screws, or nails/rods to stabilise the bone.

• External fixation: Uses external pins and rods to hold the bone in place when surgery is not possible or when the fracture is unstable.

• Joint replacement: In cases where the fracture affects the joint surface (e.g., hip or knee fractures), partial or total joint replacement may be necessary.

​

5. What factors determine whether a fracture is treated non-operatively or operatively?
 

The choice between non-operative and operative management depends on several factors:

​

• Type of fracture: Stable fractures may heal well with non-operative methods, while displaced or complex fractures often require surgery.

• Location: Fractures near joints or with ligament involvement often need surgical intervention to restore function.

• Age and activity level: Younger, more active individuals may benefit from surgical intervention to ensure a more precise and functional outcome.

• Bone health: In patients with weakened bones due to conditions like osteoporosis, fractures may need surgical stabilisation to ensure proper healing.

• Skin condition: In cases of open fractures, surgery is often necessary to clean the wound and stabilise the bone.

 

6. How long does it take for a fracture to heal?
 

The healing time for a fracture varies based on the type and location of the fracture, as well as the age and overall health of the individual.

​

• Simple fractures may take 6-8 weeks to heal.

• Comminuted or complex fractures may take longer, with some requiring up to 12 weeks or more.

• Fractures in children tend to heal faster due to their higher bone regeneration capacity.

 

Your surgeon will monitor your healing progress through regular follow-up appointments and imaging to ensure proper alignment and healing.

​

7. What are the common complications of fractures?
 

Fractures can lead to a range of complications, especially if not properly managed.

 

Some common issues include:

• Infection (particularly in open fractures).

• Nonunion or Malunion: When the bone fails to heal properly, or heals in an incorrect position.

• Nerve or Blood Vessel Damage: Caused by the fracture or the treatment method.

• Deep Vein Thrombosis (DVT): A blood clot that can form after surgery or during immobilisation.

• Arthritis: Particularly in fractures involving the joints.

 

Your surgeon will take steps to minimise these risks and advise on post-treatment care.

​

8. How are pain and swelling managed during fracture healing?
 

Pain and swelling are common after a fracture and can be managed through:

​

• Pain medications: Non steroidal anti-inflammatory drugs (NSAIDs), paracetamol, or stronger pain relievers in more severe cases.

• Ice and elevation: To reduce swelling and inflammation, especially in the first few days after the injury.

• Rest and activity modification: This can help prevent further stress on the injury.

• Compression: In some cases, compression wraps may be used to reduce swelling.

 

9. Will I need physical therapy after a fracture?
 

Yes, physical therapy is often necessary for rehabilitation after a fracture, especially after surgical intervention. A physical therapist will help you regain strength, mobility, and function in the affected area. Rehabilitation exercises can include:

​

• Range of motion exercises: To restore movement to the joint.

• Strengthening exercises: To rebuild muscle strength around the healing bone.

• Balance and coordination exercises: To prevent falls and improve function.

 

10. How can I prevent fractures?
 

While some fractures are unavoidable, especially those caused by trauma or accidents, there are steps you can take to reduce your risk:

​

• Bone health: Ensure adequate intake of calcium and vitamin D, and engage in weight-bearing exercises like walking, running, or resistance training.

• Fall prevention: In older adults, falls are a common cause of fractures. Ensure safe home environments by removing tripping hazards and using handrails.

• Protective gear: If you participate in high-risk activities like sports, wear appropriate protective gear to minimise injury.

 

11. What should I do if I think I have a fracture?
 

If you suspect you have a fracture, it’s essential to seek medical attention promptly. As a first point of call, please present to your GP or the emergency department. Immobilising the injured area and applying ice can help manage pain and swelling before you can see a doctor. 

​

12. Can fractures be treated without surgery?
 

Yes, many fractures can be treated without surgery, especially stable fractures where the bones remain aligned. Common non-operative treatments include:

​

• Casting or splinting: To immobilise the fracture and allow it to heal on its own.

• Bracing: For certain fractures, particularly those in the wrist, ankle, or collarbone, a brace may be used to provide support.

• Physical therapy: After the bone has healed, therapy will help restore strength and mobility.

 

13. What should I expect during the recovery process?
 

During recovery, you may experience discomfort, limited mobility, and need for follow-up visits to ensure proper healing. Most fractures require periodic X-rays to confirm the bone is healing correctly. The recovery process will also depend on the fracture's severity, with more complex fractures requiring longer periods of immobilisation and therapy.