Treatment of Broken bones

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For a satisfactory outcome, a fracture must be properly aligned. When this is attempted, the adjacent muscles contract, and a general anaesthetic and a strong pull (traction) is often needed to bring the ends of the fracture into alignment.

Once aligned, the fracture must be secured until the repair is strong enough for weight-bearing. There are various methods used to ensure immobilisation of fractured bones including:

Plaster, plastic or resin casts
Sustained traction with weights and pulleys
Steel plates and screws
Internal steel rods (intramedullary nails) for long bones
Cast bracing with a joint to allow joint movement
External fixing devices consisting of a steel beam to which are attached at least four steel pins (fixators) that pass into the bone above and below the fracture site.

Immobilisation may be necessary for a few weeks or months, depending on the bone involved and on whether there are complications such as infection or interference with the blood supply to bone fragments.

During the healing process, special cells (osteoclasts) remove damaged bone splinters, while other cells (osteoblasts) form a tissue called a callus, which forms a large swelling around the break and confirms that healing is taking place. In the course of time, the callus is smoothed off and eventually the bone returns to its normal thickness.

Compound and complicated fractures often require open operation. Bone grafting by packing with chips of the patientâ€™s own bone, taken usually from the crest of the pelvis, is sometimes necessary.

A major problem in the treatment of fractures is that some refuse to unite or are unduly slow to do so. In these cases it sometimes helps to subject the fracture site to pulsed electromagnetic fields or to ultrasound.