Treatment of a fracture starts with lining up the ends of the broken bone so that the natural healing process can begin. Aligning the broken bone is known as reducing the fracture.
Fracture reduction is normally done under general anaesthetic (where you are asleep). Surgery may be used to realign bones or bone fragments or it may be done without surgery by manipulating or pulling the bone fragments (closed reduction).
Once aligned, the ends of the broken bone must be held in the proper position while they heal. This is known as immobilisation. Different ways to do this include:
- Plaster casts or plastic functional braces to hold fractures in position until they have healed.
- Metal plates and screws, using minimally invasive techniques rather than large skin incisions.
- Internal steel rods, called intra-medullary nails, which are down the centre of long bones such as the thighbone and shinbone. In children, flexible wires can be used in the same way.
- External fixators. These devices resemble scaffolding lying outside the body. They can be made of metal or carbon fibre and have steel pins that pass into the bone directly through the skin, in order to hold the bones in place. It is called an external fixator as it is outside the body.
Immobilisation lasts between two and eight weeks, depending on the bone and any complications, such as infection or damage to the blood supply.
The healing process
Most broken bones heal successfully once they have been aligned correctly and immobilised.
During the healing process, bone cells called osteoclasts absorb any old or damaged bone, so that it can be replaced with new bone made by other bone cells called osteoblasts. New bone formed around a fracture is called callus. Callus forms on either side of the fracture and grows towards each end until the fracture gap is closed. Over time, the excess bone is smoothed off and the bone returns to normal.
The time it takes for a broken bone to heal fully depends on the age of the patient, the site of the bone affected and the type of fracture. Smoking can delay the healing of fractures.
In some cases, physiotherapy is needed after the bone has healed to help build up strength in the muscles and restore mobility in the injured area. Fractures near or through joints may result in the joint becoming permanently stiff or being unable to bend properly.
Compound and complicated fractures often require plastic surgery to repair the damage to the skin and soft tissue surrounding the bone or joint.
Fractures that are slow to heal are known as delayed unions. Those that fail to heal are called non-unions.
When bones do not heal, ultrasound therapy may be used. Low-intensity ultrasound, similar to that used to look at babies developing in the womb, is applied to the area of the break. This is usually done daily for a short amount of time. There is evidence that in some cases the energy the ultrasound transmits helps the fracture to heal. It is still being investigated as a therapy for delayed unions.
When fractures refuse to heal, a bone graft may be needed, although this is rare. A bone graft is when a natural or synthetic bone is transplanted, to stimulate the broken bone.
Scientists are currently researching the use of stem cells to heal fractures that otherwise fail to heal.
Tissues: Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.
Ultrasound: Ultrasound scans are a way of producing pictures of inside the body using sound waves.
Physiotherapy: Physiotherapy is a treatment that uses physical movements, massage and exercise to relieve illness or injury.
Anaesthetic: Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.
Blood: Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Joint: Joints are the connection point between two bones that allow movement.