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Treatment of Fractures

When treating a fracture, it is important to remember you are treating not only the fracture but the patient as a whole.

Aims of Fracture Treatment

Before considering how to treat a fracture, it is important to understand what the aims of fracture treatment are:

  • Restore optimum function of the injured limb
  • Obtain and maintain reduction of the fracture
  • Encourage union (restoration of normal bone structure) of the fracture
  • Prevent complications 
  • Provide adequate pain relief
  • Rehabilitation of the patient.

How do Fractures Heal?

Bone healing occurs in four stages: 

  • Stage 1 - Haematoma formation.
    • After any fracture, bleeding occurs from the ends of the bone and from the surrounding tissues
    • The vessels that are torn at the time of fracture lead to the formation of a fracture haematoma.
  • Stage 2 - Cellular proliferation and vascular ingrowth
    • Within 8 hours of the fracture occurring, an acute inflammation reaction occurs, with proliferation of cells under the periosteum and within the breached medullary canal
    • The bone fragment ends are surrounded by cellular tissues that bridge the fracture
    • The haematoma is reabsorbed and fine new capillaries grow in the area.
  • Stage 3 - Callus formation
    • The proliferating cells are potentially chondrogenic and osteogenic in nature
    • Under the right circumstances, the cell population changes to osteoblasts and osteoclasts
    • The dead bone is mopped up and woven bone appears in the fracture callus.
  • Stage 4 - Consolidation and remodelling
    • The woven bone is replaced by lamellar bone and the fracture is solidly united
    • New bone is remodelled to resemble the original normal structure.

What affects Fracture Healing?

Numerous factors can affect fracture healing:

  • Patient - do they comply with the appropriate treatment?
  • Energy of the injury
  • Fracture site
    • Adequate compression?
    • Any movement?
  • Infection
  • Mode of treatment

Fracture Treatment

Treatment can only commence once a fracture has been diagnosed:

  • Clinical assessment
  • Radiological imaging

NB -

  • Always need radiographs in two views
  • Inorder for radiograph to be adequate, the joints above and below the injury should be included.

General Principles

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Describing a Fracture
Different types of Fractures
Fracture Complications
Fracture Principles
Open Fractures
Orthopaedic Devices
Pathological Fractures
Treatment of Fractures
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