Fractures

Fractures, or broken bones, generally occur after some type of trauma. There are some special fractures called stress fractures that may be associated with very minimal trauma.

Pain
Fracture pain is really not like any other type of pain. Most people have a very deep aching feeling that just does not let up. Most patients who have fractures are treated with a combination of narcotics and Tylenol for pain relief.

Activity
Most fractures are treated nonweightbearing, and you will use crutches, a walker or a wheelchair. Simple fractures in the toes and the metatarsals are often treated with protected weight-bearing. That means that you may walk on the fracture wearing a “boot” brace or “fracture shoe” if it feels okay.

Swelling
It is normal after having had a fracture for the area to Swell significantly. That is why patients are not put into casts immediately.

Splints or Casts
Splints are used to provide protection and support, but they will allow for swelling to occur without restriction. The swelling may be uncomfortable, and significant swelling may prolong the healing. Therefore, it is usually best to try to position the area that is broken so that it is elevated rather than dangling down.

Bruising
When a bone fractures bleeding will come from the broken ends. That is why you will often see bruising in the skin over an area of fracture. As some days pass that bruising may spread to areas that are remote from the actual fracture site. It is not unusual for ankle or heel fractures to cause bruising in the toes after a few days.

Fracture Healing
From the moment a bone breaks, a Complex Process is started that will eventually heal the bone back together.

NonUnion
There are some fractures that have a better chance than others to heal properly. If the bone does not heal together, it is a Nonunion.

Treatment
In the evaluation of each fracture a determination will be made about the position of the bone ends or pieces, and the bone alignment. If these are deemed to be satisfactory, then the treatment will be to support the bones in that position with a cast until the bone healing progresses to stability. That time may take 6 – 10 weeks.

If the position is not satisfactory, then the bones will have to be adjusted, or Reduced, to the proper position. In some simple cases that can be done closed, with manipulation of the limb and no cutting through the skin. Closed Reduction may occasionally be done with you awake, using local anesthesia. In most cases, however, it will require a general anesthetic.

The reduction of more complex fractures requires that the skin be cut, and the fracture opened with an operation. This is called Open Reduction, and does require an anesthetic and an operating room.

Most fractures that need Open Reduction will then need to have the bone pieces held together to maintain the proper position. That is usually done with some combination of metal wires, plates, pins or screws depending on the particular injury. That is called using Internal Fixation.  The entire process is called Open Reduction and Internal Fixation, and is customarily shortened to "ORIF" when Orthopaedic Surgeons discuss it.