Just How Do You Fix a Broken Bone?

Orthopedic surgeons treat many types of problems with the human body. One of the most common is a fracture commonly known as a broken bone. In Haiti or any where else for that matter; when a rock house falls on a leg, bones are going to break. A large part of the work done by physicians in Haiti has been “fixing ” these fractures. Well just how do you “fix” a fracture?

Bones have an inherent capacity to heal. Typically this occurs more predictably and faster if the fractures are stabilized or held still. The most effective pain relief for a broken bone is to prevent it from moving. There are many ways to do this. We all know about a cast. This is some sort of rigid material (plaster or fiberglass) wrapped around the arm or leg to provide the support needed. This works great for hand and foot or ankle fractures but not so great for thigh or arm fractures. Also if a bone is displaced or aligned incorrectly then it must be reduced or replaced and held there. Casts can’t always do this. If the bone has broken through the skin, or if there is skin damage then a cast is less then ideal as it does not allow access to clean and care for the wound.

At this point frequently an external frame is assembled and used to stabilize the bones. Essentially the external fixation entails using large (5 milimeter) pins or screws and drilling them into the bone above and below the fracture. Then attaching a metal bar external or outside the skin to the pins. This frame acts as a new skeleton to stabilize the broken parts. It also allows the skin wounds to be cleaned and dressed without destabilizing the fracture. Another advantage is that no further “damage” is done to the soft tissues by actually cutting around the fractures to expose the bone for the placement of plates and screws directly on the bone also known as internal fixation. The advantage of internal fixation is the bones can be precisely aligned but open incisions must be made to do so. This is sometimes not advisable due to the risk of infection and problems with open wounds.

Another older technique is traction. Just like it sounds, traction is a method of fracture stabilization where a pin is placed through a bone and a weight is hung from the pin to provide a pull on the bone holding it “still”. This is a rarely used technique in modern medicine, but still has its place in some injuries.

In Haiti, due to the type of injuries (crush) and difficult living conditions (high infection risk) many fractures were treated with external fixation. These frames will probably stay on for >3 months and then be removed. Hopefully with most of the fractures healed. If they have not healed, reconstructive surgery with bone grafting will be necessary.

Each fracture has its own personality. Each orthopedic surgeon has their own “style” or preference for fracture management. There is always more than one way to get the job done . God has designed a pretty good system for healing injuries so usually function can be restored by these techniques.

Picture: Drs. Hurt, Le, Smith and Joseph putting on an external fixator