A fracture or broken bone is one of the most common injuries seen by an orthopaedic surgeon that results from a traumatic event, overuse, or from bone weakening associated with osteoporosis or a tumor.
There are many different ways to describe a fracture. An open fracture is a serious injury in which either a piece of the broken bone penetrates the skin or an open wound surrounds the fracture. This is what used to be called a “compound fracture”. These type of injuries require surgery and complications may be occur. A closed fracture is more common. No puncture wound is present with a closed fracture. Fractures can also be classified based on the pattern of the “crack” identified, the degree of angulation, and how many pieces the bone has broken into.
Some fractures cannot be treated in a splint or cast due to displacement or angulation. These may require surgery to fix. Regardless of whether the patient is immobilized in a cast or surgery is performed, the overall goal is to reduce (realign) the fracture back to its original position.
Open reduction of a fracture refers to a surgical procedure to bring the ends of the broken bone back together. The surgeon will manipulate the bones into a better position. In some cases, fluoroscopy (live x-ray) is used to help. Once the bones are realigned in an acceptable position, internal fixation is then used to keep the bones in this position. Internal fixation can amount to the use of pins, screws, plates, rods and other orthopaedic hardware. Fractures tend to heal at a better rate when the broken bony edges are brought together and compressed with a fixation device.
For certain fractures, modern advancements with technology allow internal fixation devices to be placed using less invasive techniques. This can cause less soft tissue disruption, minimize the risk of blood loss, and allow for a faster recovery. The technique to fix the fracture is determined by the surgeon after evaluating the injury and reviewing x-rays or other diagnostic studies. Some fractures are complex and require a more invasive approach to fix.
In many cases, a fracture can take several months to heal. Certain medical conditions such as diabetes and osteoporosis can delay bone healing. Smoking can also prevent or severely delay healing.