Wednesday, June 22, 2011

Healing of Fractures - Treating Fractures

Fracture healing is both fascinating and complex.  It basicly involves a series of processes designed to remove dead-injured tissue and bone from the fractured site. This is then followed the movement of cartilage and bone forming cells to form the structure necessary for repair.
The steps and process can be broken down basically to include:
               Inflammation – the stage of removal of damaged tissue and bone.
Repair – The process of building the new bone and tissue scaffold
Remodelling – The stage where the newly healed fracture undergoes further modification based on the areas stressed with movement and load. The bone is thickened at points that undergo most pressure during function.
The fracture has to be well aligned in a 3 dimensional plane to enable healing to occur in good position. This can be done using a splint, cast or surgery. As the fracture heals, the amount of support needed reduces and the part can be loaded by bodyweight or its use increased.
Fractures in the upper limb generally require 6 weeks to unite satisfactorily. Lower limb fractures on the other hand require 12 weeks. In children these durations are halved. These figures are only estimates and depend on the serial follow up progress radiographs and examination findings that often change the duration of splintage and care.
Fractures which involve the joint require perfect reduction of fragments as incongruency of the joint will lead to arthritis and pain, especially in the those joints which bear weight – lower limbs. This need in care favours surgical options for these fractures especially when the fragments are displaced.
Fractures that are not involving the joint require techniques that will adequately hold position but allow the patient to be relatively mobile. This is often the reason why surgical option is chosen for fractures of the thigh bone and hip to allow rapid ambulation and avoid the problems of prolonged bed rest.
The need for rapid return to activity and function brings about continued research in fracture treatment techniques and protocols.  Methods to speed up healing are also in frontline research.

Wednesday, June 8, 2011

Ankle Sprain - Ankle Injury

What do roller skating, ice skating, futsal and even high heel use have in common? No takers?
Well, these are all common causes of outer ankle sprain!!
 Ankle ligament injury is common. Almost 25000 people experience it daily! Many of us have found this fact out the more painful way.
These injuries often occur due to a combination of causes,; from poor footwear,  poor foot dynamics to plain bad luck. It happens when the foot twists, rolls or turns beyond its normal limits. The ligaments are effective restraints but with excessive force this may partially or totally tear. Often, an awkwardly placed foot when running, stepping up or down, or even a simple task as getting out of bed may cause an ankle sprain. The injury also occurs during stepping on irregular surfaces especially when this happens unexpectedly, as seen when stepping into a hole. Some athletic events such as basketball and netball involve close body jumps where there is always a risk of planting your foot awkwardly and injuring the ankle.
The foot usually rolls inwards – inversion which is the more common form of ankle sprain seen.
How do you know that you have a sprain?
Firstly the abnormal movement has to be one than can cause a sprain. The most common one would be that of a plantar flexed foot being awkwardly planted with a subsequent movement of the foot.
If you find you ankle swelling up especially the part over the outer part, congratulations you’ve probably sprained it or worse. Movements are usually painful.
When to worry?
Most mild ankle sprains don’t require an immediate trip to the doctor. Please worry (don’t panic) if:
The pain is poorly controlled by the RICE Protocol ( please see RICE and Use of Cold and Hot in Injury) and over the counter medications.
You are unable to comfortably walk for more than 4 steps or you experience severe pain when pressing over the medial or lateral malleolus, the bony bulges on each side of the ankle – this requires an radiograph to rule out a fracture.
You cannot move the injured ankle comfortably.
The foot or ankle is misshapen beyond normal swelling.
You experience loss of feeling in the foot or toes.
You are not fairly improved by a few days.
Why worry?
Most ankle sprains can be treated conservatively but this has to be done right from the word go. The more severe sprains may require the use of a specific ankle brace which allows the injured ligament to heal in its best possible position.
It is also necessary to rule out the more serious injury too.
This will often require the input of your Orthopaedic or Sports Surgeon.
Most important of all…….. Take home message numero uno…….
Please visit your Orthopaedic Surgeon if you are unsure about the severity of your injury.

RICE - Rest - Ice - Compression - Elevation

RICE Protocol
Rest – Ice – Compression – Elevation for Acute Injury.

It is unfortunate that you have sustained an acute injury.  But at least after this you would be getting things right from the start and will be on the road to recovery in no time.

To heal one needs to rest. PERIOD. No buts.
The use of ICE-Cold helps reduce pain and swelling. This is by reducing the metabolic demands of the injured tissue. Please see the section  - Use of Cold and Heat in Injury.
Application of a crepe bandage (apply firmly with gentle stretch) helps reduce pain by a splintage effect apart from reducing the swelling more rapidly. The idea is not to strangulate the injured area – if it is painful – it is too tight!
This helps reduce swelling. The effected part should at least be higher that the more proximal joint. Eg – for injuries of the ankle, elevate the ankle to a higher level than the knee; for injurie to the wrist, elevate to a level higher that the elbow.
Elevate for an long possible for the first 24-48 hours especially when the swelling is significant.