Heal

Heal

Time to fracture healing depends on several factors: patient comorbidities, the age of the patient, bone involved (upper limb or lower limb), patient factors (diabetes) and choice of treatment. Well-known factors that slow down bone healing include diabetes mellitus (doubles time to union), diminished blood supply (peripheral vascular disease, vascular injury at the time of injury), smoking, non-steroidal anti-inflammatory drugs and infection at the fracture site. Several chemical and mechanical methods have been attempted to enhance fracture healing, including bone marrow injections into the fracture site and other orthobiologics such as bone morphogenic proteins. Mechanical methods include controlled axial micromotion (using an external fixator), elec tromagnetic stimulation and low-intensity pulsed ultrasound. There is good basic scientific evidence to support their theo retical benefit; however, to date there is little clinical evidence for their use in the primary trea tment of closed fractures. The surgical strategy is important in determining how bones heal. As surgeons, our technique helps dictate w hether the injury heals by primary bone healing, through compression; second ary bone healing, through forming callus that becomes ossified to bone over time; and, indeed, whether the fracture heals at all. Respecting the biological and biomechanical environment of the fracture is an important consideration when planning operative and non-operativ e management of fractures. /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF The main aim of treatment is to return the patient to a similar level of premorbid function as quickly as possible. Rehabilita - tion begins as soon as feasible. It is often not necessary to wait until bone union before beginning rehabilitation. It is import - ant to move the a ff ected joints and the joints in close proximity to the fracture (e.g. elbow and shoulder exercise while in a cast - f or a distal radial fracture), limiting global sti ff ness and wasting of the muscles on that limb.

TABLE 32.11 Indications for surgery in limb trauma. The main indication is that operation will produce a better outcome; the principles are given in the text. A fracture requiring treatment that is unsuitable for non

operative measures Open fractures Failed non-operative management Multiple injuries Pathological or impending pathological fractures Displaced intra-articular fractures Fractures through the growth plate, where arrest is possible (Salter–Harris types III–V) Avulsion fractures that compromise the functional integrity of a ligament/tendon around a joint (e.g. olecranon fracture) Established non-unions or malunions

Heal

Time to fracture healing depends on several factors: patient comorbidities, the age of the patient, bone involved (upper limb or lower limb), patient factors (diabetes) and choice of treatment. Well-known factors that slow down bone healing include diabetes mellitus (doubles time to union), diminished blood supply (peripheral vascular disease, vascular injury at the time of injury), smoking, non-steroidal anti-inflammatory drugs and infection at the fracture site. Several chemical and mechanical methods have been attempted to enhance fracture healing, including bone marrow injections into the fracture site and other orthobiologics such as bone morphogenic proteins. Mechanical methods include controlled axial micromotion (using an external fixator), elec tromagnetic stimulation and low-intensity pulsed ultrasound. There is good basic scientific evidence to support their theo retical benefit; however, to date there is little clinical evidence for their use in the primary trea tment of closed fractures. The surgical strategy is important in determining how bones heal. As surgeons, our technique helps dictate w hether the injury heals by primary bone healing, through compression; second ary bone healing, through forming callus that becomes ossified to bone over time; and, indeed, whether the fracture heals at all. Respecting the biological and biomechanical environment of the fracture is an important consideration when planning operative and non-operativ e management of fractures. /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF The main aim of treatment is to return the patient to a similar level of premorbid function as quickly as possible. Rehabilita - tion begins as soon as feasible. It is often not necessary to wait until bone union before beginning rehabilitation. It is import - ant to move the a ff ected joints and the joints in close proximity to the fracture (e.g. elbow and shoulder exercise while in a cast - f or a distal radial fracture), limiting global sti ff ness and wasting of the muscles on that limb.

TABLE 32.11 Indications for surgery in limb trauma. The main indication is that operation will produce a better outcome; the principles are given in the text. A fracture requiring treatment that is unsuitable for non

operative measures Open fractures Failed non-operative management Multiple injuries Pathological or impending pathological fractures Displaced intra-articular fractures Fractures through the growth plate, where arrest is possible (Salter–Harris types III–V) Avulsion fractures that compromise the functional integrity of a ligament/tendon around a joint (e.g. olecranon fracture) Established non-unions or malunions

Heal

Time to fracture healing depends on several factors: patient comorbidities, the age of the patient, bone involved (upper limb or lower limb), patient factors (diabetes) and choice of treatment. Well-known factors that slow down bone healing include diabetes mellitus (doubles time to union), diminished blood supply (peripheral vascular disease, vascular injury at the time of injury), smoking, non-steroidal anti-inflammatory drugs and infection at the fracture site. Several chemical and mechanical methods have been attempted to enhance fracture healing, including bone marrow injections into the fracture site and other orthobiologics such as bone morphogenic proteins. Mechanical methods include controlled axial micromotion (using an external fixator), elec tromagnetic stimulation and low-intensity pulsed ultrasound. There is good basic scientific evidence to support their theo retical benefit; however, to date there is little clinical evidence for their use in the primary trea tment of closed fractures. The surgical strategy is important in determining how bones heal. As surgeons, our technique helps dictate w hether the injury heals by primary bone healing, through compression; second ary bone healing, through forming callus that becomes ossified to bone over time; and, indeed, whether the fracture heals at all. Respecting the biological and biomechanical environment of the fracture is an important consideration when planning operative and non-operativ e management of fractures. /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF The main aim of treatment is to return the patient to a similar level of premorbid function as quickly as possible. Rehabilita - tion begins as soon as feasible. It is often not necessary to wait until bone union before beginning rehabilitation. It is import - ant to move the a ff ected joints and the joints in close proximity to the fracture (e.g. elbow and shoulder exercise while in a cast - f or a distal radial fracture), limiting global sti ff ness and wasting of the muscles on that limb.

TABLE 32.11 Indications for surgery in limb trauma. The main indication is that operation will produce a better outcome; the principles are given in the text. A fracture requiring treatment that is unsuitable for non

operative measures Open fractures Failed non-operative management Multiple injuries Pathological or impending pathological fractures Displaced intra-articular fractures Fractures through the growth plate, where arrest is possible (Salter–Harris types III–V) Avulsion fractures that compromise the functional integrity of a ligament/tendon around a joint (e.g. olecranon fracture) Established non-unions or malunions