General overview on fractures-1

Fantastic facts about bone.Whenever it fractures it always wants to heals.When it heals the quality of the replacement tissue(which is the bone)is similar to the quality prior to fractures. Failure to unite is due to the extrinsic factors rather than from the bone itself.
There are two factors that affect the bone healing:
a)biological factors(either systemic or regional)
b)mechanical factors which deals with stability factor.
The treating doctor only tries to optimise these two factors.

What is the aim of treating patient with fracture?
The aim is to get back the patient to his original status as soon as possible.Note that the aim is not just to get bone unites.The aspect of rehabilitation is of paramount important.There is a situation where the bone unites but the patient cannot go to his work because of stiff joints or weak atrophied muscles.

We termed this condition as "fracture disease" where the bone union is achieved but during the course of treatment,the joint got stiff,muscle become atrophied and the bone become osteoporotic.
To overcome this the patient need to be able to do rehabilitation program as soon as possible by mobilising the joints and strengthening the muscles.
This required fracture to be stabilised and the joint is free to move.To achieve this situation patient need to do surgery, the fractures are reduced and stabilized with implants and the joints are free to move and to be involved in rehabilitation program.
So the main objective of open reduction and internal fixation is to get patient into early rehabilitation process.
However open reduction and internal fixation is not without problem.Most important is the risk of infection and delayed in union.Putting implants especially using plates jeopardise the blood supply to the bone.
To overcome this, new techniques of using:
a)close reduction and internal fixation usually intramedullary nailing is done
b)MIPO technique.MIPO=Minimal invasive percutaneous osteosynthesis.

Newer implants design also done to minimise vascular disruption such as LCP plates and interlocking nails.
Generally intramedullary nails are preferred implants compared to plates as they are less disruptive to blood supply to bone.

The stages of fracture management are as follows:

a)Treatment at the scene of injury /initial treatment :
Most important is splinting of fractures.The benefits of splinting:

• Reduces pain
• Minimises further injury

b)Reduction either close or open
c)Stabilization either POP or implants

where as for open fractures

a)wound debridement must be done should be within 6-8hours(golden time) otherwise risk of infection increases with delay.The said golden time is because this is a period where the body immune systems are fighting with organisms and without any debridement the organism always win and multiply exponentially after 6-8 hours.

b)stabilised either using POP or external fixator.With POP a window should be created to allow dressing of wound.The external fixator has dual function:

• stabilise the fracture
• allow wound management ie:dressing,redebridement,skin graft or flaps)