Treatment of Broken Bones

Immobilization

The most common type of fracture management is with immobilization. There are different types of immobilization including splint, braces, casts, slings, and others.

Cast immobilization is the most common method where a material (typically plaster or fiberglass) is wrapped around an injured extremity and allowed to harden. Casts come in an endless number of shapes and sizes and require proper cast care.

Fractures treated with immobilization must be adequately aligned to allow for healing with good results. If the alignment of the fracture is not sufficient, further treatment may be needed.

Reducing (Resetting) the Broken Bone

A procedure called a fracture reduction, or reducing a fracture, is an intervention to better align the broken bones. A fracture reduction can either be done as a closed reduction (nonsurgical) or an open reduction (surgery).

A typical closed reduction is performed either by providing local anesthetic to the broken bone or a general anesthesia, followed by a specific maneuver to attempt to realign the broken bone. After a closed reduction, a splint or cast would be applied to hold the bones in the improved alignment while they heal.

Traction

Traction is an older form of fracture management that is used much less commonly today. However, there are certain situations where traction can be a very useful treatment option.

Traction involves gentle pulling of the extremity to align the bones. Often a metal pin is placed in the bone away from the fracture, this is called skeletal traction. Ropes and weights are attached to the pin to gently pull and hold the bone fragments into alignment.

Skin traction is a similar concept, but instead of a pin being inserted into the bone, the traction is placed by pulling externally on the extremity. Skin traction cannot pull with as much force as skeletal traction, so if traction is being used for more than a short time, usually skeletal traction is favored.

Pins

Pins can be used to stabilize bones when a closed reduction is used to improve alignment, but a cast is insufficient to hold the bones in place.

Pins are typically placed through the skin in a procedure called a closed reduction with percutaneous pinning (CRPP). The pins are placed in the operating room, but can typically be removed in your healthcare provider's office and there is little discomfort in most pin removal procedures. If there is discomfort, the removal can be performed in the operating room.

External Fixation

External fixation also uses pins that enter the skin but are held together outside the body with a frame to maintain alignment. External fixation can be an excellent option in cases of trauma as they can be applied quickly, they can be adjusted as needed, and they allow access to the skin and soft-tissue wounds. External fixation is often used with open fractures (vs. closed fractures).

External fixation can also be helpful when there is significant swelling that could make surgery too risky. By temporarily immobilizing the fracture, the swelling can improve, and internal fixation can be considered at a later time.

Open Reduction With Internal Fixation

Open reduction with internal fixation (ORIF) means to surgically open the site of the fracture, align the bone fragments, and then hold them in place. The most common type of internal fixation are metal plates and screws, although there are many devices that can be used to stabilize different types of fractures.

(ORIF) is the preferred treatment for a number of different types of fractures:

• Fractures that tend to displace despite immobilization
• Fractures that are poorly aligned
• Fractures around the joints that are poorly aligned

Determining when a fracture should have surgery is a complex decision that must take into account many variables including the type, location, and severity of the fractures, as well as the expectations of the patient. In some situations, metal implants may have to be removed at a later date.

Intramedullary Rodding

Intramedullary (IM) rodding is a surgical procedure to stabilize a broken bone by inserting a metal rod in the hollow medullary canal of the bone. This part of the bone (where the bone marrow is) can be used to hold the rod and allow for early movement and weight-bearing in some cases

IM rodding can be utilized for fractures of the lower extremity long bones that are not close to the joints (bone ends). While this treatment can often allow for early movement, how soon one can resume walking after surgery often depends on the fracture type.