Fracture Treatment & Hand Injuries

Fracture Treatment :: Hand Injuries

Fracture Treatment

The word "Fracture" implies to broken bone. A bone may get fractured completely or partially and it is caused commonly from trauma due to fall, motor vehicle accident or sports. Thinning of the bone due to osteoporosis in the elderly can cause the bone to break easily. Overuse injuries are common cause of stress fractures in athletes.

Fracture Healing

Our body reacts to a fracture by protecting the injured area with a blood clot and callus or fibrous tissue. Bone cells begin forming on the either side of the fracture line. These cells grow towards each other and thus close the fracture.

Medical Therapy

The objective of early fracture management is to control bleeding, prevent ischemic injury (bone death) and to remove sources of infection such as foreign bodies and dead tissues. The next step in fracture management is the reduction of the fracture and its maintenance. It is important to ensure that the involved part of the body returns to its function after fracture heals. To achieve this, maintenance of fracture reduction with immobilization technique is done by either non-operative or surgical method.

Non-operative (closed) therapy comprises of casting and traction (skin and skeletal traction).

• Casting
  

Closed reduction is done for any fracture that is displaced, shortened, or angulated. Splints and casts made up of fiberglass or plaster of Paris material are used to immobilize the limb.

• Traction
  

Traction method is used for the management of fractures and dislocations that cannot be treated by casting. There are two methods of traction namely, skin traction and skeletal traction.

Skin traction involves attachment of traction tapes to the skin of the limb segment below the fracture. In skeletal traction, a pin is inserted through the bone distal to the fracture. Weights will be applied to this pin, and the patient is placed in an apparatus that facilitates traction. This method is most commonly used for fractures of the thighbone.

Surgical Therapy

• Open Reduction and Internal Fixation (ORIF)

This is a surgical procedure in which the fracture site is adequately exposed and reduction of fracture is done. Internal fixation is done with devices such as Kirschner wires, plates and screws, and intramedullary nails.

• External fixation

External fixation is a procedure in which the fracture stabilization is done at a distance from the site of fracture. It helps to maintain bone length and alignment without casting.

External fixation is performed in the following conditions:

• Open fractures with soft-tissue involvement
• Burns and soft tissue injuries
• Pelvic fractures
• Comminuted and unstable fractures
• Fractures having bony deficits
• Limb-lengthening procedures
• Fractures with infection or nonunion

Rehabilitation

Fractures may take several weeks to months to heal completely. You should limit your activities even after the removal of cast or brace so that the bone become solid enough to bear the stress. Rehabilitation program involves exercises and gradual increase in activity levels until the process of healing is complete.

Hand and Wrist Injuries

The hand and wrist are more prone to injuries and the problems may include sprains and strains as well as fractures can occur with lifting and carrying heavy objects, hand injury while operating machinery, bracing against a fall, or sports-related injuries.

Some of the common hand and wrist injuries include:

Sprains and Strains: Sprains and strains are the two most common types of injuries affecting the hand and wrist. A sprain refers to an injury to a ligament and a strain refers to a muscle injury. Sprains and strains occur due to excessive force applied during a stretching, twisting, or thrusting action. Most sprains and strains will repair themselves with adequate rest, ice application, compression, and elevation. Surgery is occasionally required to repair the damage.

Ligamentous Injuries: Ligaments are tissues that connect bones to other bones. They are made up of several fibers and one or all of the fibers may be involved. Complete ligament injury occurs when all the fibers are torn. Ligament injury may cause pain and swelling and limit the movement of hands and wrist joints. Ligament injury is effectively treated with splinting and taping with restriction of movement of injured structures.

Fractures: A fracture is a break in the bone, occurs when more force than the bearable limit is applied against a bone. Crushing injuries to the hand or wrist occurring due to high degree of force or pressure may also cause fractures. A fracture may cause severe pain, swelling, bruising or bleeding, discoloration of the skin and limit the mobility of the limb. Fracture of a finger bone can only be treated by using a cast or splint while the bone heals. Sometimes surgery may be needed where the plates, pins or screws may be placed to keep the stable.

Repetitive Trauma Syndrome: Repetitive stress injury occurs as a result of repeated similar movements for longer periods of time. This often causes pressure on the joints resulting in inflammation, pain, and decreased function in the extremity. The condition is more likely to develop with repetitive, rapid, forceful and prolonged movements of the hand and wrist, or vibration or frequent pushing, pulling or carrying heavy objects. Carpal tunnel syndrome is the most common of these syndromes.

Carpal Tunnel Syndrome: Carpal tunnel syndrome is a condition characterized by numbness or pain in the thumb and first two fingers and occurs when the median nerve is compressed at the wrist. Carpal tunnel syndrome is often a common complaint in individuals who use their hands for prolonged period of time in particular occupation. Immobilization of the affected part for certain period may help heal the condition. Medications, physical therapy, and surgery may also be recommended. Often, splinting for a shorter period of time can treat the condition.