A man’s limb, heavily casted and suspended overhead from elaborate contraptions and ropes tied to these casts pulling down gymnasium weights in a cramped hospital orthopaedic ward, is the picture which comes to mind when we think of visiting a friend who has unfortunately met with a recent accident involving a few broken bones. Along with this image which is so well engraved in our minds, is also the fact that for at least a couple of months this person will have to drag his cast with him to his bed, the dinner table and the washroom.
More than patients with broken bones, bone specialists feel relieved to affirm that such orthodox methods of bone healing have been replaced by less cumbersome modalities.
What is a cracked/broken bone or fracture?
They all refer to the same condition. A fracture results from the application of excessive force through injuries, such as a fall or a hard blow on any bone of the body resulting in its discontinuity. A broken bone presents itself as severe pain, massive swelling, gruesome deformity and a significant loss of movement, which invariably arouses apprehension making a person seek prompt medical attention.
Patients are aware that the traditional method of treatment of a broken bone when arriving at an emergency medical service is the application of a Plaster of Paris cast on the limb, immobilizing it for weeks, resulting in a forced absence from work.
A physical exam by a specialist and X-rays are venerable methods of diagnosis and have remained unchanged, but the modalities of treatment have galloped ahead by leaps and bounds.
Emerging trends in fracture treatment
By the turn of the 21st century early reports of surgical treatment for broken bones started coming in from around the globe. More and more surgeons have chosen to ‘fix’ a fracture by surgery rather than letting nature take its own course in cast treatment.
Like any tissue belonging to the body, the bone has a great capacity to heal. Your bones are natural healers. At the location of the fracture, your bones will produce lots of new cells and tiny blood vessels that rebuild the bone. These cells cover both ends of the broken part of the bone and close up the break until it is as good as new.
Hence in the early days the cast treatment gained popularity on the principle that if broken bones are kept in one position for a few weeks they heal. They do in most cases, but with several disadvantages:
* Prolonged cast wear lasting up to three months
* A loss of man-hours due to immobility
* Joint stiffness.
* Deformity of the healed limb due to a lack of direct control over the broken ends of the bone.
* Complications of cast wear like skin sores, tightening of casts and nerve compression, to name a few
* Add-on weight of the cast on a limb
Principles of fracture fixation
Surgical fixation of broken bones consists primarily of two main steps. Firstly, the fracture is surgically exposed so the bone ends can be directly seen. These ends of the broken bones are like pieces of a jigsaw which when brought together fit like a lock and key.
The second step is the key to the success of this technique wherein the fracture which is now reduced is ‘fixed’ and held together rigidly by means of an implant which is left buried in the body. This implant is most commonly made up of an alloy of inert metal. This can either be in the form of pins, plate and screws or a nail.
Screws and nails for living bone?
The use of these terms being applied to one’s body does raise eyebrows. They have their own detractors and myths, like, metal implants rust in the body; they cause pain during rainy and cold weather; they become loose and migrate to other parts; or most commonly, that they need to be removed.
Not only do they not rust and have no relation to changes in the weather but also they need not be removed and may remain in the body for as long as desired.
The following is a comparison between cast treatment and surgical fixation:
On a concluding note
There are arguments about the method of fracture treatment depending on the type and location of the fracture, the seriousness of the injury, the condition and needs of the patient, and the judgment of the orthopaedist. No single method of fracture treatment may be assigned to the general population and it varies with each individual.
Also, not all fractures need surgical intervention. Most fractures in children as well as undisplaced fractures in adults are best treated by non-invasive techniques, but for most of the remaining patients, surgical procedures accelerate rehabilitation and early recovery of functions directly contributing to gainful employment.
Because of these encouraging results, techniques in surgical reduction and fixation of broken bones when appropriate are being adopted by surgeons worldwide.
