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Fractures

(Also known as “Broken Bones”)

A fracture is also known as a broken bone. A bone can be fractured “broken” in any many different manners.

Types of Fractures
Bones are generally rigid, and are able to bend when an outside force is applied. However, if the force is too strong, the bones will break, just as a tree branch breaks when it is bent too far.

The fracture’s severity will depend on the force that caused the break. If the bone’s breaking point has only barely been breached, then the bone may crack rather completely break. If the force is overwhelming, such as in a motor vehicle crash or a gunshot, the bone may shatter.

If the bone breaks in such a way that bone fragments pierce out through the skin, or a wound penetrates down to the broken bone, the fracture is called an “open” fracture or is sometimes referred to as a “compound” fracture. This type of fracture is particularly serious because once the skin is broken, infection in both the wound and the bone can occur.

The most common types of fractures include:
• Stable fracture. The broken ends of the bone are in close alignment.
• Open fracture. The skin may be pierced by the bone or by a blow that breaks the skin at the time of the fracture. The bone may or may not be visible outside of the wound.
• Transverse fracture. This type of fracture has a horizontal fracture line.
• Oblique fracture. This type of fracture has an angled pattern.
• Comminuted fracture. In this type of fracture, the bone shatters into at least three pieces.

Cause
The most common causes of fractures are:
• Trauma. A fall, a motor vehicle crash, or a work related injury can all result in fractures.
• Osteoporosis. This disorder weakens bones and makes them more likely to break.
• Overuse. Repetitive motion can tire muscles and place more force on bone. This can result in stress fractures. Stress fractures are more common in athletes.

Symptoms
Many fractures are painful and may prevent you from moving the injured area. Other common symptoms include:

• Swelling and tenderness around the injury
• Bruising
• Deformity — a limb may look deformed or a part of the bone may puncture through the skin

Doctor Examination
Dr. Ortega will do a careful examination to assess your overall condition, as well as the extent of the injury. He may examine you in the emergency room, hospital, and/or in his office. He will talk with you about how the injury occurred, your symptoms, and medical history.

The most common way to evaluate a fracture is with x-rays, which provide radiographic images of bone. Dr. Ortega will likely use an x-ray to verify the diagnosis. X-rays can show whether a bone is intact or broken. They can also show the type of fracture and exactly where it is located within the bone. In some types of injuries, Dr. Ortega may also order and examine other radiographic studies such as a CAT (CT) scan and/or a MRI.

Treatment
The bone’s broken pieces must be put back into position and prevented from moving out of place until they are healed. In many cases, Dr. Ortrega will restore parts of a broken bone back to the original position. The medical term for this process is “reduction.”
Surgery is sometimes required to treat a fracture. The type of treatment required depends on the severity of the break, whether it is “open” or “closed,” and the specific bone involved. For example, a broken bone in the arm is treated differently from a broken leg bone or a broken hip.
Depending on your type of fracture, Dr. Ortega uses a variety of treatments to treat fractures:

Cast Immobilization
A plaster or fiberglass cast is the most common type of fracture treatment, because most broken bones can heal successfully once they have been repositioned and a cast has been applied to keep the broken ends in proper position while they heal. Cast treatment is a common treatment for young kids who have broken bones or some adults with broken wrists.

Functional Cast or Brace
The cast or brace allows limited or “controlled” movement of nearby joints. This treatment is desirable for some, but not all, fractures. Fracture brace treatment is a common treatment for young kids who have broken bones or some adults with broken wrists or arm bones.

External Fixation
In this type of operation, metal pins are placed into the broken bone above and below the fracture site. The pins or screws are connected to a metal bar outside the skin. This device is a stabilizing frame that holds the bones in the proper position while they heal.
In cases where the skin and other soft tissues around the fracture are badly damaged, an external fixator may be applied until surgery can be tolerated.

Open Reduction and Internal Fixation
During this operation, Dr. Ortega realigns the bone fragments (reduced) in their normal alignment, and then held together with special screws or by attaching metal plates to the outer surface of the bone. The fragments may also be held together by inserting intramedullary nails (rods) down through the marrow space in the center of the bone.

A specially designed metal rod, called an intramedullary nail, provides strong fixation for this thighbone fracture.

Recovery
Fractures take several weeks to several months to heal, depending on the extent of the injury and how well you follow your Dr. Ortega’s advice. Pain usually stops long before the fracture is solid enough to handle the stresses of normal activity.
Even after your cast or brace is removed, you may need to continue limiting your movement until the bone is solid enough for normal activity.
During your recovery you will likely lose muscle strength in the injured area. Specific exercises will help you restore normal muscle strength, joint motion, and flexibility. In most cases, Dr. Ortega will discuss therapeutic exercises to help assist your full recovery.

Prevention
Proper diet and exercise may help in preventing some fractures. A diet rich in calcium and Vitamin D will promote bone strength. Weight bearing exercise also helps keep bones strong. Dr. Ortega will also review with you the importance of bone health and avoiding things that may hinder your recovery and/or harm your health such as smoking.