Fracture Treatments

Broken bones heal. Nature has ensured that this will happen, but it is the doctor's challenge to make broken bones heal in the correct position and ensure that there is minimal functional loss during this process.

Traditional treatment methods involve splinting the broken limb in the best possible position until fractures heal. These methods evolved with the use of an externally applied, moulded cast made of plaster of Paris (POP), which could be carefully shaped and held until it set. This remains the mainstay of fracture treatment in the world today. It is a cheap, safe, low risk and effective treatment for the majority of fracture patterns.

In some cases, the pattern of the fracture is such that the fragments are likely to displace and heal in the wrong position - even after the application of a suitable plaster cast. These fractures are called unstable and measures must be taken to ensure that the fragments heal correctly. Unstable fractures often require stabilisation with pins, screws or plates.

Similarly, fractures which involve the surface of a joint must be pieced back together so that a smooth surface remains. This will allow the joint the best chance to move normally and comfortably, as well as reducing the risk of early arthritis. These fragments must be stabilised (often with pins and screws) to allow healing in the optimum position.

A number of different methods of fracture fixation are available;

Kirschner wires
These small, thin, sharp pins can be inserted directly through the skin and then the bone fragments using a power drill. They are simple and quick to insert, cheap and associated with few complications. However, they are not suitable for all fracture configurations or injuries.

External fixation
Thicker metal pins can be screwed into normal bones on either side of the fracture area and then connected to an external rigid bar. This provides stability from a distance, but can prove difficult to control the fracture fragments.

Internal fixation
Some fractures cannot be controlled by external or inaccurate methods, and need direct handling of the fragments and assiduous fixation. Alternatively, some patients do not want to have to wear a plaster cast for weeks on end, and would choose an operation in order to avoid this. In these cases, open reduction and internal fixation (ORIF) can be offered. This involves opening the fracture through a surgical wound, piecing together the jigsaw of fragments, and holding them accurately with tiny screws and plates.
Screws are made as small as 1.0mm in diameter, which are suitable for even the tiniest of fragments. These devices and implants require experience and technical ability to insert. Special courses, organised by the Swiss charitable organisation, the AO Foundation, are held every year to teach surgeons how to and when to use these treatments. Surgeons offering these treatments should expect to be asked by their patients if they have received formal training in these methods.