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Fractures

Fracture Prevention

For more information about Fracture Prevention, please click here.

Hip Fractures

The hip joint is a “ball and socket” joint.  The “ball” is the head of the femur, or thigh bone, and the “socket” is the cup shaped acetabulum.  The joint surface is covered by a smooth articular surface that allows pain free movement in the joint.

Hip fracture is a break that occurs near the hip in the upper part of the femur or thigh bone. The thigh bone has two bony processes on the upper part – the greater and lesser trochanters. The lesser trochanter projects from the base of the femoral neck on the back of the thigh bone. Hip fractures can occur either due to a break in the femoral neck, in the area between the greater and lesser trochanter or below the lesser trochanter.

Hip fracture is most frequently caused after minor trauma in elderly patients with weak bones, and by a high-energy trauma or serious injuries in young people. Long term use of certain medicines, such as bisphosphonates to treat osteoporosis (a disease causing weak bones) and other bone diseases, increases the risk of hip fractures.

Signs and symptoms of hip fracture include

  • Pain in the groin or outer upper thigh
  • Swelling and tenderness
  • Discomfort while rotating the hip
  • Shortening of the injured leg
  • Outward or inward turning of the foot and knee of the injured leg

Your doctor may order an X-ray to diagnose your hip fracture. Other imaging tests, such as the magnetic resonance imaging or (MRI), may also be performed to detect the fracture.

Depending on the area of the upper femur involved, hip fractures are classified as

  • Intracapsular Fracture
  • Intertrochanteric Fracture
  • Subtrochanteric Fracture

Hip fractures can be corrected and aligned with non-operative and operative methods:

Traction may be an option to treat your condition if you are not fit for surgery. Skeletal traction may be applied under local anesthesia, where screws, pins and wires inserted into the femur, and a pulley system is set up at the end of the bed to bear heavy weights. These heavy weights help in correcting the misaligned bones until the injury heals.

Hip fractures can be surgically treated with external fixation, intramedullary fixation, or by using plates and screws.

Pelvis Fractures

Pelvic fracture is a condition that arises due to breakage of the pelvis bones. It may damage internal organs, nerves, and blood vessels associated with the pelvis region.

The pelvis is a round structure of bones located at the base of the spine, connected to the sacrum of the spine with the help of strong ligaments. The pelvis is composed of three bones, namely ilium, ischium, and pubis that are fused together. The side of the pelvis is composed of a cup shape socket, known as acetabulum.

Various organs related to the digestive and reproductive systems lie within the pelvis ring. Also, several large nerves and blood vessels supplying the lower limbs pass through the pelvis. The pelvis ring also acts as point of attachment for muscles approaching from the upper and lower part of the body.

Based on the damage of the pelvis ring and associated structures, pelvic fractures can be categorized as:

  • Stable pelvic fractures: Have single point breakage in the pelvis ring and broken bones remain in position; shows less bleeding
  • Unstable pelvic fractures: Have breakage at two or more points, followed by severe bleeding. Unstable pelvic fractures may cause shock, extensive internal bleeding, and damage to the internal organs. It requires immediate medical care followed by long-term physical therapy and rehabilitation.

Causes

The common causes responsible for pelvic fractures include:

  • Sports injuries or trauma
  • Abrupt muscle contraction
  • Conditions such as osteoporosis, especially in elderly people
  • Accidental injury or fall from a great height

Symptoms

The common symptoms associated with pelvic fractures are:

  • Pain and swelling in the groin or hip region that may worsen with ambulation
  • Abdominal pain
  • Bleeding through the urethra or vagina and the rectum
  • Problems in urination
  • Unable to stand or walk

Diagnosis

The diagnosis of pelvic fracture starts with physical examination including checking the functional activity of the various body organs present in the pelvic region. Imaging techniques such as X-rays, CT (Contrast Tomography) and MRI (Magnetic Resonance Imaging) scan may also be used to confirm the exact condition or breakage of the pelvic bones. In some cases, additional contrasting studies using radioactive dye may be recommended to evaluate the structural and functional activity of organs such as the urethra, bladder, and the pelvic blood vessels.

Treatment

Treatment of the pelvic fracture depends upon the severity of the injury and condition of the patient. Minor or stable fractures can be treated with conservative methods such as rest, medications, use of crutches, physical therapy, and if required minor surgery. These methods may take 8–12 months for complete healing.
The treatment of unstable fractures includes management of the bleeding and injuries of the internal organs, blood vessels, and nerves. Surgical intervention may be employed for fixation of the fractured pelvic bones using screws and plates. Pelvic bone fixation provides stability to the pelvic bone and promotes natural healing of the fracture.

Tibial Plateau Fractures

The tibia or shin bone is a major bone of the leg which connects the knee to the ankle. A fracture or break in the upper part of the tibia is known as a proximal tibial fracture and commonly occurs just below the knee joint.
The knee joint is the largest weight bearing joint of the body, where the lower end of the femur or thigh bone articulates with the tibial plateau. The upper fourth of the tibia constitutes the proximal part and is composed of cancellous bone. By nature, cancellous bone easily undergoes compression and depression, following an injury. So the proximal tibia is at a high risk for injury. A fracture in the proximal tibia may or may not affect the knee joint but the surrounding soft tissues as well as the nerve and blood vessels may be affected. A fracture in the top of the shin bone or tibial plateau, involving the articular cartilage surface of the knee joint, may develop chronic arthritis.

Causes

A fracture of the proximal tibia may be caused by stress or trauma or secondary to weakening of the bone due to cancer or infection. High energy injuries such as a fall from height, sports related trauma or motor vehicle accidents may be responsible for fracture in young adults. Sometimes even low energy injuries such as a falling from a standing position may result in a fracture of the proximal tibia in elderly individuals.

Symptoms

The symptoms of proximal tibia fracture include painful weight bearing movements, tenseness around the knee, limitation of movement and deformity around the knee. In some individuals, impairment of blood supply secondary to the fracture may result in a pale or cool foot. Patients may also experience numbness or feelings of ‘pins and needles’ in the foot as a result of associated nerve injury.

Diagnosis

The diagnosis of a proximal tibia fracture is based on the medical history including history of any previous injuries, complete physical examination and imaging studies. The physician will evaluate a soft tissue around the joint to identify any signs of nerve or blood vessel injury. Multiple X-rays and other imaging studies such as CT and MRI scans may be used to identify the location and severity of the fracture.

Treatment

The management of the fracture is based on the severity of the fracture, medical condition of the patient and the patient’s lifestyle.

Non-surgical treatment

Non-surgical treatment comprises of immobilizing the fractured site with the help of casts or braces to prevent weight bearing and to help the healing process. X-rays are taken at regular intervals to assess the healing process. Weight bearing and movement are initiated gradually, depending on the nature of the injury and the condition of the patient.

Surgical treatment

Surgical treatment is considered to maintain alignment of the fractured bone. External or internal fixators may be used to align the fractured bone segments. If the fracture does not involve the knee joint, rods and plates can be used to stabilize the fracture.  For a fracture involving the knee joint, a bone graft may be required to prevent the knee joint from collapsing. An external fixator is used when the surrounding soft tissue is severely damaged, as the use of plate and screw may be harmful.

Rehabilitation

As the proximal tibial fracture usually involves the weight bearing joint it may cause long term problems such as loss of knee motion or instability and long term arthritis. Hence a rehabilitation program is initiated along with the treatment comprising of instructions on weight bearing, knee movements, and the use of external devices such as braces.

Driving after Musculoskeletal Injury/Surgery

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