Diagnosis and Treatment

Medical intervention focuses on supporting the bone as it heals naturally.

A doctor will carry out a physical examination, identify signs and symptoms, and make a diagnosis.

The patient will be interviewed - or friends, relatives, and witnesses if the patient cannot communicate properly - and asked about circumstances that caused the injury or may have caused it.

Doctors often order an X-ray OR AN MRI/CT in rare cases.

Bone healing is a NATURAL process which, in most cases, will occur automatically. Fracture treatment is usually aimed at making sure there is the best possible function of the injured part after healing.

Treatment also focuses on providing the injured bone with the best circumstances for optimum healing (immobilization).

For the natural healing process to begin, the ends of the broken bone need to be lined up - this is known as reducing the fracture.

The patient is usually asleep under a general anesthetic when fracture reduction is done. Fracture reduction may be done by manipulation, closed reduction (pulling the bone fragments), or surgery.

• Immobilization - as soon as the bones are aligned they must stay aligned while they heal. This may include:·         
• Plaster casts or plastic functional braces - these hold the bone in position until it has healed.
•  Metal plates and screws - current procedures may use minimally invasive techniques.
• Intra-medullary nails - internal metal rods are placed down the centre of long bones. Flexible wires may be used in children.
• External fixators - these may be made of metal or carbon fibre; they have steel pins that go into the bone directly through the skin. They are a type of scaffolding outside the body.

Usually, the fractured bone area is immobilized for 2-8 weeks. The duration depends on which bone is affected and whether there are any complications, such as a blood supply problem or an infection.

Healing - if a broken bone has been aligned properly and kept immobile, the healing process is usually straightforward.

Osteoclasts (bone cells) absorb old and damaged bone while osteoblasts (other bone cells) are used to create new bone.

Callus is new bone that forms around a fracture. It forms on either side of the fracture and grows toward each end until the fracture gap is filled. Eventually, the excess bone smooths off and the bone is as it was before.

The patient's age, which bone is affected, the type of fracture, as well as the patient's general health are all factors which influence how rapidly the bone heals. If the patient smokes regularly, the healing process will be delayed.

Physio therapy - after the bone has healed, it may be necessary to restore muscle strength as well as mobility to the affected area. If the fracture occurred near or through a joint, there is a risk of permanent stiffness or Arthritis - the individual may not be able to bend that joint as well as before.

Surgery - if there was damage to the skin and soft tissue around the affected bone or joint, plastic surgery may be required.

Delayed unions and non-unions

Non-unions are fractures that fail to heal, while delayed unions are those that take longer to heal.

• Ultrasound therapy - low-intensity UST is applied to the affected area daily. This has been found to help the fracture heal. Studies in this area are still ongoing.
• Bone graft - if the fracture does not heal, a natural or synthetic bone is transplanted to stimulate the broken bone.

COMPLICATIONS-

Heals in the wrong position - this is known as a malunion; either the fracture heals in the wrong position or it shifts (the fracture itself shifts).

Disruption of bone growth - if a childhood bone fracture affects the growth plate, there is a risk that the normal development of that bone may be affected, raising the risk of a subsequent deformity.

Persistent bone or bone marrow infection - if there is a break in the skin, as may happen with a compound fracture, bacteria can get in and infect the bone or bone marrow, which can become a persistent infection.

Patients may need to be hospitalized and treated with Antibiotics. Sometimes, surgical drainage and curettage is required.

Bone death (avascular necrosis) - if the bone loses its essential supply of blood it may die.

PREVENTION

Nutrition and sunlight - the human body needs adequate supplies of Calcium for healthy bones. Milk, cheese, yoghurt, and dark green leafy vegetables are good sources of calcium.

Our body needs Vitamin D to absorb calcium - exposure to sunlight, as well as eating eggs and oily fish are good ways of getting Vitamin D.

Physical activity - the more weight-bearing exercises you do, the stronger and denser your bones will be.

Examples include skipping, walking, running, and dancing - any exercise where the body pulls on the skeleton.

Older age not only results in weaker bones, but often in less physical activity, which further increases the risk of even weaker bones. It is important for people of all ages to stay physically active.

Menopause- Oestrogen which regulates a woman's calcium levels, drops during Menopause making calcium regulation much more difficult. Consequently, women need to be especially careful about the density and strength of their bones during and after the menopause.

The following steps may help reduce post-menopausal osteoporosis risk:

•      Do several short weight-bearing exercise sessions each week.
• ·      Do not smoke.
• ·      Consume only moderate quantities of alcohol, or don't drink it.
• ·      Get adequate exposure to daylight.

Make sure your diet has plenty of calcium-rich foods. For those who find this difficult, a doctor may recommend calcium supplements.