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