What is fracture repair?

Indications and Procedures

A fracture is a break in a bone, either partial or complete, resulting from an applied force that is greater than the bone’s internal strength. The most common causes of fractures are accidents and trauma.

Fractures are usually treated by reduction and immobilization. Reduction, which may be either closed or open, refers to the process of returning the fractured bones to their normal position. Closed reduction is accomplished without surgery by manipulating the broken bone through overlying skin and muscles. Open reduction requires surgical intervention. The broken pieces are exposed and returned to their normal positions. Orthopedic appliances may be used to hold the bones in the proper position (internal fixation); the most common appliances are stainless-steel pins and screws, but metal plates and wires may also be employed. These devices can be left in the body indefinitely or may be surgically removed after healing is complete. Local anesthesia is usually used with closed reductions; open reductions are performed in an operating room under sterile conditions, using general anesthesia.

After reduction, the broken bone and accompanying body part must be placed in an anatomically neutral position. Immobilization is generally accomplished by the use of a cast. Casts are usually made of plaster, but they may be constructed of inflatable plastic.

Individual ends of a single fractured bone are sometimes held in position by external pins and screws (external fixation). Holes are drilled through the bone, and pins are inserted as described above. The pins on opposite sides of the fracture site are then attached to each other with threaded rods and locked in position by nuts. This process allows a fractured bone to be immobilized without using a cast.

Traction, the external application of force to overcome muscular resistance and hold bones in a desired position, may also be used to immobilize a fracture. Commonly, holes are drilled through bones and pins are inserted; the ends of these pins extend through the surface of the skin. Part of the body is fixed in position through the use of a strap or weights. Wires are attached to the pins in the body part to be stretched. Force is applied to the wires via weights or tension until the broken bone parts are in the desired position. Traction is maintained until complete healing has occurred.

Uses and Complications

All broken bones must be held in position until healing takes place. The complications associated with repairing fractures include infection, which is rare, and loss of function. The potential for loss of function is minimized by placing the limb in an anatomically neutral position prior to the application of a cast.

The techniques of fracture repair have not changed radically in decades. New methods, however, are being tried. For example, electromagnetic fields are used with fractures that do not heal spontaneously. Such fields induce the growth of osteoblasts, which are bone-forming cells.

Bibliography

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