Orthopedics focuses on the musculoskeletal system. Learn about the diagnosis, treatment, and rehabilitation of bone, joint, ligament, and muscle conditions.
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Once a fracture is diagnosed, the goal shifts to treatment. The principles are simple: get the bone pieces back in the right place (reduction), hold them there (immobilization), and let the body heal. However, the method used to achieve this varies wildly depending on the bone involved and the severity of the break. Treatment ranges from a simple Velcro boot to complex surgery with metal hardware.
This section covers the journey from the emergency room to the recovery room. We will explain the difference between casts and splints, when surgery is absolutely necessary, and what “internal fixation” actually means. We will also discuss the biology of healing—how the body knits bone back together—and the factors that can speed up or slow down this wonderful process. Knowing what to expect helps patients manage the inconvenience of a broken bone with patience and compliance.
For many fractures, especially those that are non-displaced (lined up correctly), the treatment is external immobilization. This usually means a cast or a splint. A splint, or “half-cast,” is often used first because fresh fractures swell. A rigid cast applied too early could become too tight like a tourniquet, cutting off circulation. Once swelling goes down after a few days, a full fiberglass cast can be applied.
Casts hold the bone still so the healing bridge (callus) can form without being disturbed. They also protect the injury from bumps. Waterproof casts are an option for some, allowing for showers and swimming. For foot or ankle fractures, a removable walking boot (CAM boot) is popular because it can be taken off to sleep and wash, improving hygiene and comfort.
If the bone pieces are displaced (out of alignment), the doctor must put them back before applying a cast. This is called a closed reduction. “Closed” means no incision is made.
The patient is given medication to relax the muscles and block pain. The doctor then manually pulls and manipulates the limb to realign the bones. This task This type of procedure is often done with X-ray guidance (fluoroscopy) to ensure the position is perfect. Once aligned, a cast is applied immediately to hold it.
When a fracture is too unstable, shattered, or involves a joint surface, a cast isn’t enough. Surgery is needed. This procedure is called Open Reduction and Internal Fixation (ORIF). “Open” means an incision is made to see the bone. “Internal fixation” means hardware is put inside to hold it.
This ensures perfect alignment, which is critical for preserving joint function and preventing arthritis.
Metal plates are screwed onto the surface of the bone to bridge the fracture. They act like an internal splint, holding the pieces rigidly together.
This allows for very stable healing and often permits the patient to move the joints sooner than with a cast, preventing stiffness.
For long bones like the femur (thigh) or tibia (shin), a metal rod (intramedullary nail) is often inserted down the hollow center of the bone.
This rod acts like an internal spine for the bone, sharing the load. It is minimally invasive and allows patients to walk on the leg much sooner than with plates.
Occasionally, the skin and muscles are too damaged to allow for an internal plate immediately. In severe open fractures with serious wounds, an external fixator is used.
Metal pins are inserted into the bone above and below the break. These pins stick out of the skin and attach to a carbon-fiber frame or bar on the outside of the limb. This holds the bone stable while allowing the doctors to access and treat the skin wounds. Once the soft tissue heals, the frame might be removed and replaced with internal plates or a cast.
Bone healing is a biological miracle that happens in stages. First is the inflammatory phase (days): a blood clot forms, and immune cells clean up the damage. Second is the reparative phase (weeks): a soft callus of cartilage forms, bridging the gap. This rigid process is why the bone feels rubbery but stable.
Third is the rigid callus phase (months): the body mineralizes the cartilage, turning it into hard bone. Finally, the remodeling phase (years): the body sculpts the bone, removing the extra bulge of the callus and restoring the original shape and strength.
Healing isn’t guaranteed. Several factors influence how fast and how well a bone heals. Nutrition is key; the body needs calcium, vitamin D, and protein to build bone. Blood supply is vital; bones with poor circulation (like the scaphoid in the wrist) heal slowly.
Smoking affects bone healing. Nicotine constricts blood vessels, starving the new bone of oxygen. Smokers have a significantly higher risk of nonunion (the bone failing to heal). Diabetes and age also slow down the process. Mechanical stability matters too—too much movement prevents the bridge from forming, while too little movement (for too long) can weaken the bone.
Most fractures heal well, but complications can occur. Compartment syndrome is a dangerous swelling within the muscles that cuts off blood flow; it requires emergency surgery to slice open the fascia and relieve pressure.
Infection is a risk, especially with open fractures or surgery. Malunion happens when the bone heals in a crooked position. Nonunion is when the bone fails to heal at all, often requiring a second surgery with bone grafts to stimulate growth.
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It depends on the amount of metal and the sensitivity of the scanner. Large hip or knee implants often do, but small plates might not. You don’t usually need a card; just tell the agent.
Usually, no. The hardware is designed to stay in forever. It is only removed if it causes pain, irritation, or breaks. Removing it requires another surgery and leaves screw holes that weaken the bone temporarily.
Dead skin cells and sweat accumulate under the cast. Never stick a hanger or pencil inside to scratch, as you can break the skin and cause an infection. Use a hair dryer on a cool setting to blow air inside.
If you have a waterproof cast, you can shower. If you have a standard fiberglass or plaster cast, it must stay dry. Use a cast cover or a plastic bag sealed with tape.
If your fingers or toes become swollen, blue, numb, or cold, or if pain increases despite medication, the cast may be too tight. Elevate the limb. If it doesn’t improve quickly, go to the ER or call your doctor immediately.
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