Q: What is fracture?

A fracture is defined as a broken bone. A bone may be partially fractured or completely broken in any number of ways, e.g. crosswise and lengthwise. Fracture can also be present as a bone crack without dislocation, called a non-displaced fracture. In fact, the severity of a fracture depends primarily on the force directly or indirectly applied to the affected bone. If the bone’s breaking point has been exceeded slightly, the bone may crack rather than break. If the force is extreme, the bone may shatter in multiple pieces. Hinging upon its severity and complication, fracture might lead to long-term disability or even death.

Q: How is fracture caused?

Most fractures are caused by a sudden excessive force applied to the bone, either direct (bone typically breaks at point of impact) or indirect (bone breaks some distance away from the affected part). In some cases, fracture is a result of certain underlying bone diseases or conditions.

1. Direct force injuries: Direct force refers to any impact or compression that transfers force directly to the affected bone, e.g. blunt trauma and car collision.
2. Indirect force injuries: Indirect force refers to any force that strikes one area and is transferred to another area away from the point of impact. For example, arm wrestling causes the fracture of the humeral shaft in the upper arm, instead of the wrist.
3. Underlying bone diseases: Certain bone conditions that interrupt with bone density and lead to fractures are, for instance, osteoporosis and bone tumor.

Q: How many types of fracture?

Fractures can be broadly characterized into 2 main types:

1. Closed fracture: A closed fracture is a break or crack in the bone that does not penetrate the skin. Therefore, there is no puncture or open wound in the skin.
2. Open fracture: An open fracture or a compound fracture is a fracture in which there is an open wound in the skin near or at the site of the broken bone. Most often, this wound is caused by a fragment of bone breaking at the moment of the injury. Nevertheless, the bone may or may not be visible in the wound. Compared to a close fracture, open fracture with open wound or skin puncture are at greater risk of being infected, leading to serious complications.

Q: How can fracture be treated?

The goals of treatment are to promote bone healing and strengthen the broken bones while preventing complications and restoring normal use and function of the fractured area. Treatment of fractures involves the joining of the broken bones either by immobilizing the broken area, allowing the bone to heal naturally, or surgically aligning the broken bones and stabilizing it with devices, such as metal pins, rods or plates. Although several treatment options are available, both non-surgical and surgical methods, selected approach for each individual patient will be customized and determined by expert orthopedic surgeons based on fracture severity, complications and personal conditions.

Fracture treatments can be classified as follows:

1. Fractures that can be treated by using non-surgical approaches: Non-surgical approaches are used to treat non-displaced fractures or fractures that the broken bones can be repositioned by cast immobilization, functional cast or brace and traction. Cast immobilization is often used for fractures of the arm or lower limb. Cast or brace can be also used for realignment in children with some forms of deformity. Whereas traction is usually used to align the bones in the femur (thighbone) or other areas present with muscle tension by a gentle, steady pulling action.
2. Fractures that can be treated by using surgical approaches: Surgery is often considered to treat fractured bones that have shifted out of place or joint fractures. There are 3 main types of fixation devices used to keep fractured bones stabilized in alignment:
   1. Nails: Nails are used for the fixation of various bones in the arm and leg, such as the femur, tibia and humerus.
   2. Plates and screws: Plates and screws are used for stabilizing frame that holds the bones in the proper position while they heal after the bone fragments are repositioned into their normal alignment.
   3. External fixators: An external fixation device is used to stabilize fractured bones in alignment. The device can be adjusted externally to ensure the bones remain in an optimal position during the healing process. This device is only used in open fractures.
3. Fractures that can be treated by using either non-surgical or surgical approaches: Fractures that happen in some parts of the body can be treated by either non-surgical or surgical treatments. Nonetheless, every option poses advantages and disadvantages. Thus, pros and cons must be clearly discussed and a customized treatment plan for each individual should be mutually agreed by expert orthopedic specialist and patient.

To achieve the best possible treatment outcomes, a patient-centric approach remains essential. In addition, multidisciplinary team supported by cutting-edge technology plays a vital role in improving successful outcomes in a timely manner while restoring patient’s ability and preserving quality of life.

Orthopedic Center, Bangkok International Hospital is truly committed to provide a comprehensive care in fractures by our highly experienced and well-certified orthopedic surgeons specialized in fracture and trauma. Our hybrid operating theater is fully equipped with advanced surgical technology and devices such as robotic C-arm, ARTIS pheno, aiming at enhancing surgical accuracy and precision as well as promoting safety and minimizing post-operative complications. As a result, patients can achieve a faster recovery with a quick return to their daily lives and activities as desired.

Reference:

Dr. Suthorn Bavornratanavech
Senior director of Orthopedic Center, Bangkok International Hospital.