More Information About Bone Fractures in the Health Library
Specific treatment for a bone fracture should be determined by your doctor. Generally, it may include the use of:
Splints are usually temporary treatment options. They are applied to decrease movement at the fracture site and provide support and comfort. In the emergency room, splints are mainly used to stabilize some bone fractures until they can be evaluated by a consultant like an orthopaedic surgeon. After the evaluation, the surgeon may recommend a cast or surgery.
There are different types of splints. A few examples are:
Sugar Tong Splint
This is a special type of splint used to temporarily stabilize distal radius fractures (wrist fractures). A sugar tong splint can be used until surgery, or for the first two to three weeks in case of nonsurgical treatment — then a cast is applied..
Lower Leg Splint
This splint is used to temporarily stabilize simple or complex ankle fractures. A lower leg splint may be changed after two to three weeks into a lower leg cast. This applies only to certain ankle fractures — surgery is usually needed for this type of injury.
Long Leg Splint
This splint is used to temporarily stabilize injuries at the knee level. It is removed within one or two days of application to perform a surgery.
A cast is similar to a splint, but it fully wraps around an injury. Therefore, it can’t be easily removed or adjusted. A cast is usually applied for nonsurgical treatment, such as for certain types of wrist or ankle fractures. Length of time for casting varies and is usually between six and eight weeks.
An external fixator helps temporarily immobilize bones to allow soft tissue around a fracture to rest. External fixation is done by placing pins into the bone at different levels around the fracture site. The pins are then secured together outside the skin with clamps and rods (external frame). This procedure is usually used to treat complex knee or ankle fractures, or open fractures. However, it is not the only or the final treatment. It is usually applied in the operating room under general anesthesia and removed in two to three weeks so that surgery can be performed.
Intramedullary Nail or Rod
An intramedullary (IM) nail is a surgical option for treating long bone fractures (like tibia or femur fractures). It is inserted in the bone through either one of the two long bone ends. The nail is then secured at each end with screws inserted from the side of the limb through the bone. If part of the bone has been lost, like in open fractures, the surgeon may need a bone graft to ensure bone healing. Proper timing of bone grafting will be decided by your surgeon.
A bone graft is a bone substitute needed to fill an area of bone loss. A bone graft is typically taken from the patient’s own bone (autograft) or from a donor (allograft). Allografts come in different forms and consistency and are all FDA-approved.
Open Reduction and Internal Fixation
Open reduction and internal fixation (ORIF) is a two-part surgery. First, an incision (cut) is made over the fracture. This enables the surgeon to put the bone back into place (reduced) as close to the original anatomy as possible. Once the bone has been reduced, screws and plates are placed to stabilize it and hold the broken parts together. Plates come in different shapes and lengths — your surgeon will determine which one you will need. As with treatment with intramedullary nails/rods, bone grafting may be needed in ORIF to replace lost bone.
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Compartment Syndrome Release
When your arm or leg is injured, severe bleeding and swelling can occur inside the affected limb. This can result in increased pressure in the soft tissues. High pressure means less blood in the muscles and nerves, and may lead to the loss of the blood vessels. This condition is called the compartment syndrome.
When too high, this pressure can harm or kill the muscles and nerves and compromise limb function or survival. Nurses and physicians will check your limb regularly to assess pain, swelling and blood flow. Your physician may use a special machine to measure the soft tissue pressure. It requires inserting a small needle in your limb in different locations.
If compartment syndrome is very likely or confirmed, your physician will take you to the operating room to lower the pressure in the soft tissue as soon as possible. Compartment syndrome release is done with one or two large incisions on the affected limb. The wounds are left open and are treated with a special negative pressure wound dressing (wound VAC) until they can be closed. This wound dressing is necessary to avoid bone and soft tissue infections, which are risks after this surgery.
Swelling may take days or longer to go down, which may affect wound closure. The wounds of a compartment syndrome surgery are closed either by bringing the edges together or with a skin graft. Your surgeon will decide what is best after discussing all the options with you.
Compartment syndrome can also occur in open fractures. In such cases an external fixator will be applied to stabilize the fracture and to help soft tissue rest. Soft tissue will be released to address compartment syndrome and the wounds will be covered with a special wound dressing.
Pain relief medication can be used after the surgery. Before surgery, minimal medications will be given to allow nurses and physicians to properly assess your risk of developing compartment syndrome.