A bone fracture occurs when a force exerted against it is stronger than the bone can structurally withstand. Fractures can range from a hairline crack to the bone shattering into multiple pieces. While a broken bone often brings to mind the need for surgery, this is not always the case. The appropriate treatment depends on many factors, including the specific type of break and its location.
Non-Surgical Approaches to Healing
Many broken bones can heal effectively without surgical intervention. The primary goal of non-surgical treatment is to realign the bone fragments if necessary and then immobilize the bone, allowing healing. Immobilization prevents movement at the fracture site, which is crucial for bone union.
Common methods of non-surgical immobilization include casting, splinting, and bracing. A cast provides rigid support to hold the bone in a fixed position. Splints offer less rigid support and can be adjusted more easily, while braces provide external support and protection.
For fractures where bone pieces are misaligned, a “closed reduction” may be performed. This involves manually manipulating the bone from the outside to realign fragments without an incision. Pain management is also an important part of non-surgical care, and physical therapy often begins to restore strength and mobility once the bone is stable.
Fractures that heal well without surgery include stable fractures, where the broken ends remain aligned, and non-displaced fractures, where the bone fragments are not significantly out of alignment. Greenstick fractures, which are incomplete breaks common in children due to their more flexible bones, also respond well to non-surgical treatment. Simple, closed fractures, where the skin is not broken, heal quickly.
When Surgery Becomes Necessary
Surgery becomes necessary for broken bones when non-surgical methods cannot adequately realign or stabilize the fragments, or when there is a risk of complications. One common indication for surgery is a displaced fracture, where the bone pieces are significantly out of alignment or have a gap between them. Realigning these fractures is crucial for proper healing and function.
Open, or compound, fractures also require surgery. These fractures involve the bone piercing the skin or a wound exposing the bone, increasing infection risk. Surgery for open fractures aims to prevent infection and restore limb function. Fractures extending into a joint, known as intra-articular fractures, often necessitate surgery to restore the smooth joint surface and prevent long-term stiffness or arthritis.
Highly fragmented fractures, called comminuted fractures, where the bone shatters into three or more pieces, often require surgical stabilization. Surgery may also be needed if a fracture damages surrounding soft tissues, nerves, or blood vessels. Fractures that fail to heal properly over time, known as non-unions, can also be addressed surgically to stimulate healing.
Common Surgical Techniques
Several techniques are available to stabilize the fracture and promote healing when surgery is needed. A common procedure is Open Reduction and Internal Fixation (ORIF). “Open reduction” means the surgeon makes an incision to directly visualize and realign the bone fragments. “Internal fixation” involves placing metal implants inside the body to hold the bone pieces securely in place while they heal.
These internal fixation devices include plates, screws, rods, and pins. Plates are metal devices screwed onto the outer surface of the bone to hold fragments together. Screws can be used alone or with plates to provide compression or stabilize fragments. Rods, also called intramedullary nails, are inserted into the hollow center of long bones to provide internal support. Pins and wires are typically used for smaller bone fragments or in conjunction with other hardware.
Another surgical technique is external fixation. This involves inserting pins or screws into the bone through small skin incisions, connecting them to a rigid metal frame outside the body. External fixation is often used for severe or complex fractures, especially those with significant soft tissue damage or a high risk of infection, as it allows for easier wound care and can be a temporary measure before internal fixation.
Factors Guiding Treatment Decisions
The decision between surgical and non-surgical treatment for a broken bone is a complex process, guided by multiple factors. The type and location of the fracture are primary considerations; for instance, a non-displaced wrist fracture might be treated non-surgically, while a highly fragmented hip fracture almost always requires surgery. The severity of the fracture, including the degree of bone displacement and whether it is an open or closed injury, also plays a significant role.
A patient’s age and overall health, including any existing medical conditions (comorbidities) such as osteoporosis or diabetes, influence the decision. Younger patients with good bone quality may heal differently than older patients with weaker bones. The patient’s activity level and functional goals are also considered, as an active individual may benefit from surgery to achieve faster or more complete recovery of function.
The presence of other injuries alongside the fracture can impact the treatment plan. Medical professionals also weigh the potential risks and benefits of each approach, including the risks of surgery like infection or complications from anesthesia, versus the risks of non-surgical treatment such as malunion (healing in an improper position) or delayed healing. The decision-making process involves a comprehensive assessment by the medical team, often in discussion with the patient, to determine the most appropriate treatment.