Bone fracture therapy

The right therapy for a broken bone depends primarily on the fracture’s type, severity and location. Still, individual factors such as age or concomitant diseases also play a role. There are different forms of treatment, which are divided into conservative and surgical. The doctor treating you decides which form is correct in each case. We will introduce you to the standard methods of treating a broken bone.

How is a broken bone treated?

For the broken bone to heal, both ends must be rejoined so that they are in the correct anatomical position (reposition). Otherwise, a restricted movement or an axial kink will result. It is also essential that there is a manageable gap between them; otherwise, no new bone tissue will be built up.

Bone healing takes some time, and the bone must be immobilized (retention and fixation). Simple fractures are usually done with a rigid bandage made of Paris plaster or similar materials.

The third important part of the treatment is rehabilitation, in which specific exercises are used to avoid or restore function loss.

A fracture should be treated as soon as possible after the accident because once swelling has formed around the fracture, an operation, for example, is more challenging.

 

Treatment is not always required.

However, not every broken bone needs to be treated. For example, an uncomplicated rib fracture or a broken nose without bone displacement will heal without treatment. In such cases, therapy is usually limited to relieving the pain, for example, through cooling and the administration of painkillers.

Conservative treatment of a broken bone

In the conservative treatment of a broken bone, it is immobilized in the correct position (possibly after repositioning) until it has healed. Examples of possible tools are:

• plaster cast or splint
• orthosis or splint
• special dressing techniques
• Extension treatment (traction bandage)

Conservative treatment is usually possible if the fracture is not dislocated. Surgery is generally required for complicated or open fractures.

 

Surgery for complicated fractures

Complicated fractures are often operated on, for example, to reassemble the individual parts of the bone or to compensate for an axial misalignment. The broken bones are joined together with special wires, nails, screws and plates to restore the exact anatomical shape (this is called osteosynthesis). The interior of the bone is often used to anchor, particularly thick screws.

These metallic aids mean that the bone is subsequently stabilized to such an extent that it can be subjected to limited loads. This rapid mobilization is often a lifesaver, especially for older patients with a femoral neck fracture – in the past, many older patients died as a result of being confined to bed for a long time (e.g. pneumonia ) following a femoral neck fracture.

The metal parts are usually removed again after six months to two years. However, in some cases (mainly in older people), they are left in the body permanently. There are also cases in which, for example, wires can be removed again after just a few days.

External fixator – the “external tensioner”

Another surgical treatment option is a so-called external fixator. The bone is stabilized from the outside by fixing a steel rod outside the body through undamaged bone parts using long screws.

This method is mainly used when the bone is broken into many small pieces, the tissue at the site is badly damaged, or the wound is (probably) infected. The advantage of the procedure is that there is no pressure on the soft tissue or the damaged bone. However, healing usually takes longer.

Rehabilitation as part of treatment

As already described, rehabilitation often begins when the pain subsides, and movement is permitted. Targeted physiotherapeutic exercises and as regular use as possible are intended to prevent affected muscles and joints from being damaged due to the lack of movement. As the healing progresses, the affected area of ​​the body can be subjected to increasing stress.

In other cases, however, it may be advisable to completely rest and relieve the affected body part until it has completely healed. The doctor treating you decides which measures are appropriate in each case.

 

What complications are there?

If the broken bone is not adequately immobilized, the bone ends are not in firm contact with each other, or if they shift again, the body cannot build new bone tissue in the fracture site. It makes inferior tissue enter the bone gap, slowly converting it to stable bone tissue.

This secondary bone healing can take up to two years. Failure to do so will result in pseudarthrosis, i.e. an unstable bone area that leads to pain and restricted movement.

Especially with open fractures, there is also the risk of bone inflammation  ( osteitis, osteomyelitis), which requires lengthy treatment and can lead to the bone not growing together.

Also, a broken bone can always be accompanied by other injuries, such as muscle, nerves or tendons, or severe blood loss. Infections caused by bacteria, particularly the tetanus pathogen Clostridium tetani, are just as conceivable consequences as thrombosis from lying down for a long time with complicated fractures.

However, most broken bones heal without complications or long-term consequences.