Fracture: treatment

Carola Felchner is a freelance writer in the medical department and a certified training and nutrition advisor. She worked for various specialist magazines and online portals before becoming a freelance journalist in 2015. Before starting her internship, she studied translation and interpreting in Kempten and Munich.

More about the experts All content is checked by medical journalists.

The right first aid and the right medical treatment go a long way towards ensuring that a broken bone can heal well. The fracture treatment depends on various factors such as the location, type and extent of the fracture and any accompanying injuries. In principle, a broken bone can be treated conservatively (e.g. with a plaster of paris) and surgically. You can find out more about this and first aid in the case of broken bones here!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. S62S22S32T79S82S92S42S72S52

Brief overview

• What to do in the event of a broken bone Calm the injured person, lie down, stabilize the affected part of the body and, if possible, elevate them, cover open fractures with sterile covers, cool closed fractures, call emergency services
• Treatment options for a fracture: conservative (e.g. with a plaster cast) or surgical (e.g. osteosynthesis, external fixation, etc.)
• Bone fracture risks: i.a. Ligament injuries, soft tissue damage, blood loss, compartment syndrome, pseudoarthrosis

Caution!

• Never try to set up the break and move the injured part of the body as little as possible!
• You must always have a doctor treat a broken bone. Otherwise there is a risk that the ends of the fracture will not grow together properly and permanent movement restrictions or misalignments will result!
• When it comes to fractures, a distinction is made between complex and simple fractures. In the former, the bone splinters into several pieces. This makes medical treatment more difficult.
• Crack fractures are common in children. The bone breaks like a young branch, which is why such breaks are also called greenwood fractures. The bone does not break through completely and the periosteum on both sides remains intact, so that the bone is still anatomically correct even after the break.

Fraktur: what to do

Broken bones hurt and often look unsettling, especially if they are open. It is therefore important that you as the first aider remain calm and try to take away the fear of the injured person as well. This is especially important with children. Talk to him calmly and explain what you are going to do before each of the first aid steps listed below:

• Lying down: Lay the injured person flat on the floor (unless spinal injuries are suspected - then do not move the patient if possible!). In this way you can stabilize the fracture more effectively, and the person concerned cannot fall over and injure himself even more if he passes out due to shock.
• Immobilize and stabilize: You pad a broken arm or a broken leg with a rolled up blanket or a rolled up piece of clothing. In the case of broken ribs, you can put the affected person's arm on the injured side in a sling (e.g. a triangular shawl) and fix it with a second cloth or bandage wrapped around the upper body.
• Elevate: Elevate the injured body part if possible. This can help reduce the swelling that often occurs when a bone breaks.
• Cooling the closed hernia: If the hernia is closed, carefully cool the area with an ice pack or ice pack wrapped in a cloth.
• Cover open fractures with sterile cover: Cover open fractures with a sterile wound pad. Make sure it isn't too tight.
• Emergency call: Call the emergency doctor and stay with the injured person until he or she arrives.

The goal of fracture treatment

The goal of fracture treatment is to restore the broken bone to normal function as soon as possible. The individual steps are:

• anatomical alignment of the bone
• Immobilization and fixation for rapid fracture healing
• early functional follow-up treatment

In the case of a displaced (dislocated) fracture, the anatomical alignment and fixation of the bone usually requires a surgical procedure: The fragments are brought back to their original position and stabilized / fixed. In the case of simple, non-displaced fractures, on the other hand, conservative fracture treatment is usually sufficient.

Conservative fracture treatment

In conservative bone fracture treatment, the doctor first aligns the ends of the fracture correctly and immobilizes them with a plaster splint or orthosis.

The following types of fractures are generally treated conservatively:

• Shaft fracture of the arm in growing age
• Fracture in the shaft area of ​​the upper arm
• little dislocated fracture of the humerus
• Broken rib
• stable fracture on the pelvic ring
• stable vertebral body fracture without a narrowed spinal canal
• break of collarbone
• Fracture of the shoulder blade without joint involvement
• distal radius fracture (wrist fracture)

Conservative-functional treatment

Conservative bone fracture treatment is based on the bones stabilizing themselves and the muscles acting as a splint. Once the pain subsides, the patient can slowly begin to exercise.

The doctor stabilizes the fracture using special bandaging techniques. These put pressure on the muscles surrounding the bone, which also prevents the broken ends from shortening. Special splints immobilize the fracture and enable quick healing. Depending on the progress of the healing process, the patient can put increasing strain on the extremity.

In the event of a fracture in the area of ​​the shoulder girdle, this is immobilized, for example, with a so-called rucksack bandage, a bandage crossed in the back.

Conservative immobilizing treatment

If the fracture is displaced or shortened, it can in some cases be held in place with stretch or plaster casts. This prevents a new misalignment.

With the stretch bandage, the doctor drives in a so-called Steinmann nail under local anesthesia, which he connects to a bracket and on which a different weight hangs via a pulley. This stretch bandage prevents shortening and aligns the bones along the longitudinal axis.

A plaster cast is applied so that it encloses both adjacent joints. It must be well padded so that there is no tissue damage from too much pressure. In the case of a fresh fracture of the arm or leg, the doctor must not apply a circular cast that encompasses the entire circumference of the extremity due to swelling. Otherwise there is too much pressure on the tissue, which affects the blood circulation. This in turn can lead to blood clots (thrombosis) forming. A plaster splint is best. If a circular cast cannot be avoided, the doctor should split it down to the last thread in order to protect the patient's blood flow, nerves and skin.

For thrombosis prophylaxis, for example with a leg cast, low molecular weight heparin can be injected daily. In addition, those affected should always raise their legs and cool them with an ice pack.

If the pain increases despite the plaster cast, this is an alarm sign. A dangerous compartment syndrome (see below) or a Volkmann contracture (irreversible flexion deformity) may have formed.

Surgical fracture treatment

An operation comes into question if the bone fragments do not have sufficient contact or displaced fractures can no longer be correctly positioned. The doctor will also operate if, after conservative treatment, a misalignment occurs again or the affected extremity can no longer be immobilized. This is the case, for example, in elderly patients because of the risk of thrombosis.

Surgical fracture treatment is more likely to stabilize an injured extremity and put weight on it again earlier than with conservative treatment.

During the surgical treatment, the doctor positions the fragments anatomically exactly and fixes them with plates and lag screws (osteosynthesis). This allows the bone to grow directly into the opposite bony cortex. Scar tissue (callus) does not form, which is why it is referred to as direct fracture healing.

With screw osteosynthesis, the doctor fixes the bone fragments with screws. Depending on the place of use, there are different threads for the cancellous bone (the inside of a bone) and the bony cortex. A further distinction is made between compression and lag screws.

In some cases, screws alone are not enough to hold a fracture in place. Then an additional plate fixation can help: An inserted metal plate serves as a splint to absorb pressure, bending and torsional forces. The plates are differentiated based on their function: They can neutralize, compress, support, bridge and anchor at a stable angle.

In the case of a fracture of the long bones (such as the thigh or shin bone), intramedullary nail osteosynthesis is recommended: The doctor inserts a nail into the medullary canal of the bone. This splintes the bone from the inside, making the fracture relatively stable and quickly resilient. However, this procedure is not recommended for patients with multiple injuries (multiple trauma), as particles of the bone marrow get into the lungs with the blood and can block a vessel there (fat embolism).

The tension belt osteosynthesis works with a wire loop in the shape of a figure eight. It is used for avulsion fractures (e.g. on the kneecap). An avulsion fracture tears off a piece of bone by pulling excessively on a tendon that is anchored to the bone.

With the external fixator, the bone is stabilized from the outside. The doctor uses small incisions (skin incisions) to insert long screws into the bone, which are externally stabilized by means of rods. This means that there is no pressure on either the soft tissue or the bones in the area of ​​the fracture. This method is particularly useful for open or infected fractures. The disadvantage, however, is that the fracture can often not be brought into an ideal normal position (repositioned), and healing is therefore usually delayed.

Dynamic screw systems are another option for surgical fracture treatment. The dynamic hip screw (DHS) is used for fractures of the femoral neck. The doctor splints the fracture from the inside, and the splint compresses under load. The femoral nail (PFN) of the thigh bone, also known as the gamma nail, works in a similar way.

In composite osteosynthesis, bone cement is added to the screws or plates. This method is always used when the screws cannot get hold of a bad bone substance. This often affects elderly patients with osteoporosis or those with tumors that have destroyed the bone.

Fracture: complications

A fracture often brings complications with it, as the surrounding structures are often also damaged. In the following, more about such accompanying injuries and other important complications of a fracture:

Joint fractures are often associated with ligament injuries. In many cases, the surrounding ligaments are also injured in fractures close to the joint.

In the case of dislocation fractures (fracture near the joint with dislocation of the joint), soft tissues can be squeezed. The doctor should therefore realign such a fracture as quickly as possible. He should only operate if there is no swelling. To see if this is the case, the doctor can use their fingers to fold the skin in the area. If this does not succeed, there is swelling.

Vascular and nerve injuries can also accompany a fracture. In the case of a broken bone, blood vessels in the bone, in the periosteum or in the neighboring muscles can tear and lead to a fracture hematoma (bruise). In extreme cases, the high blood loss can lead to shock.

In the case of the compartment syndrome, swelling and bruises result in excessive pressure in a so-called muscle box (= group of muscles that is surrounded by a barely stretchable fascia). This increase in pressure can squeeze blood vessels and nerves, which, if left untreated, can lead to the death of muscle tissue. Such a compartment syndrome can in principle develop with any fracture. An indication of this are violent, boring pains that have been treated in vain.

The so-called tibialis anterior lodge in the lower leg is most frequently affected by a compartment syndrome. The main symptom is passive stretch pain in the affected region. In addition, sensitivity disorders can occur in the first space between the toes of the foot. Additional signs include bulging swelling of the region and tension bubbles. The risk of a compartment syndrome is particularly high in patients in shock, since the regions remote from the body are then less well supplied with blood.

At the slightest suspicion of a compartment syndrome, the doctor should immediately surgically split the muscle box.

Doctors speak of pseudoarthrosis if the broken bone has not healed even after six months, but is still connected in a flexible manner (similar to a joint). The patient is in pain, the affected part of the body is abnormally mobile, and function and resilience are limited. Surgery is usually necessary in such a case.

Broken bone: treatment affects prognosis

Early, adequate fracture treatment has a positive effect on fracture healing. If you suspect a fracture, you should therefore go to the doctor as soon as possible!

Tags:  organ systems sports fitness teenager