Trauma to the extremities represents one of the most common injury patterns seen in emergency medical and surgical practice.
The Trauma services offered at Mediclinic City Hospital for simple and complex fracture of all age groups including pediatric. The services deals with all fracture of the lower and upper limbs.
1)- Upper Limb fractures:
Upper limb fractures include:
Broken forearm, hand, fingers, wrists, shoulder, elbow and collarbone,
- Clavicle fracture:
The clavicle or the collarbone is the bone that connects sternum / breastbone to the shoulder. It is one of the common contact sport surgery. A broken collarbone can be very painful and it becomes very difficult to move the arm.
Collarbone fractures are very common and usually happens in the middle portions, or shaft of the bone.
If the broken ends of the bones have significantly shifted out of the place. The surgery is performed to place the shifted bone back to its original position and prevent it to move until they are healed.
Open reduction and internal fixation which is a surgery where bone fragments are first reposition (reduced) to their normal alignment with the special metal hardware such as plates, screws or pins.
- Shoulder and Elbow Fractures:
Upper arm and shoulder fractures are treated surgically when nearby joint fractures, open fractures or comminuted fractures exist. Depending on the fracture, different procedures with screws, plates, intramedullary nails or prostheses are used.
An upper arm fracture, also known as a humerus fracture, generally occurs as a result of massive force when a person falls on their arm. In the case of older people with reduced bone density (osteoporosis), a mild fall where they support their weight on their arm can sometimes be sufficient to cause such a fracture. Uncomplicated fractures can be treated conservatively. This means when there are no injuries to the soft tissues, no displacements and no bone fragments. On the other hand, complicated comminuted fractures, i.e. open fractures or fractures of the head of the humerus near the shoulder joint (shoulder fracture) should be treated surgically.
- Forearm and Wrist Fractures:
Wrist breaks are those which occur in the forearm bones (medical terms: radius, ulna) near the wrist. Uncomplicated wrist breaks, i.e. those where the break is not displaced and the wrist is unaffected can be conservatively treated. However, if the wrist is impacted by the fracture, the break is displaced or any of the soft tissues are injured, the patient will require surgery.
When forearm fractures are displaced or bone fragments and soft tissue injuries exist, they are treated surgically. Different materials such as screws, plates or external fixation devices are used to fix these fractures.
There are two bones in the forearm: the radius and the ulna. When someone suffers a forearm fracture, both bones as well as only one of them can break.
- Hand and fingers fractures:
Hand or finger fractures includes the breakage of small bones of fingers (phalanges) and the long bones within the palm (metacarpals). The fractures are caused by a fall, crash, twisting or through any direct contact sports. In most cases, a hand and finger fractures are healed without any surgery. Depending on the type and location of fracture, a patient may only require to wear a cast, splint or buddy strap for a period. For serious fracture, surgery may be required to realign the broken pieces of the bone and may use small metal devices such as wires, screws, pins, staples and plates
2)- Lower Limb fractures:
Lower limb fractures include:
Foot, ankle, Knee, thigh, hip, and pelvis fractures:
- Femoral and knee Fractures:
Thighbone (femur) is the longest and strongest bone in the body. The long straight part of the femur is called the femoral shaft. Femur shaft fracture depends on the type of force the causes the break.
They bones pieces can either be lined up correctly (stable fracture) or be have misalignment (displaced fracture). The skin around the fracture may be intact (closed fracture ) or the bone may puncture the skin open ( open fracture).
Depending on the type of fracture, either external fixation like metal pins and screws will be used to stabilize the bone in its right positons. In other cases special metal rod is inserted in femur canal across the fracture to keep it in correct position.
Kneecap fracture is also known as patella fracture is common in vehicle injury with direct impact on the shaft. Some patella fracture can be treated by wearing a cast or splint until bone heals but in complicated fractures surgery is needed. Transverse fracture is a two part fracture which is fixed in its place by using screws, pins or wire "figure-of-eight" configuration tension band. This procedure is best for treating fractures that are located near the center of the patella. In other type of fracture if kneecap is crushed into small pieces that can’t be fixed together, it will be removed completely as a last resort in comminuted fracture.
- Tibial and ankle Fractures
Lower leg fractures with complicated or periarticular fractures of the tibia are treated surgically, i.e. fixed with plates, screws or nails. Simple tibia fractures or fibula fractures can be treated with a plaster cast.
The lower leg consists of two bones; the thicker of the two is called the tibia and the thinner the fibula. A firm bandage is usually sufficient to treat a fibula fracture. A plaster cast or even surgery is rarely needed. Tibia fractures are always treated with a plaster case or with an operation. A plaster case is used for simple, uncomplicated shaft fractures. If the patient has suffered an open fracture, then plates, screws or nails are used to fix it. The same applies for particularly complicated breaks (several fragments, displaced fractures) and periarticular fractures (tibia head fracture). [Osteosynthesis] is the treatment of bone fractures with metal parts.
- Foot and toes fractures:
Toes and foot fractures are quite common which results from the direct blow to the foot- such as kicking something hard or dropping heavy object on the toe. It can also be result of overuse or repetitive stress – such as high impact sports like basketball and running. Foot and toe fractures are very painful but rarely require surgery. Buddy tapping and change of activities can help relieve the pain and other nonsurgical treatments are considered for its treatment however in case of complicated fracture such as if bone is out of place and toe is deformed surgery is performed for its correction.
- Acetabular and hip fractures:
Hip joint is a ball and socket joint in which ball is the head of the femur or thigh bone and the socket is cup shaped acetabulum.
The most common type of fracture is a hip fracture which is a break in the top quarter of the thighbone called femur. In this fracture patient complains about the pain over the outer upper thigh or in the groin and suffers significant discomfort with flexing or rotating the hip. Hip fracture is most frequently caused minor trauma in elderly or high energy sports in young people. Long term medication can also increase the right of hip fractures.
Depending on the area of the upper femur involved, hip fractures are classified as:
- Intracapsular Fracture
- Intertrochanteric Fracture
- Subtrochanteric Fracture
An acetabular fracture is a break in the socket portion of the "ball-and-socket" hip joint. When the acetabulum is fractured, the femoral head may no longer fit firmly into the socket, and the cartilage surface of both bones may be damaged. In case of longer irregularity and instability of joint, the ongoing cartilage damage can lead to arthritis.
Depending on the pattern of the fracture, bone displacement, and overall health of the patient, treatment and the timings surgical or non-surgical technique is decided.
Pelvic fracture arises due to breakage of the pelvis bones, which may also damage internal organs, nerves, and blood vessels associated with the pelvis region.
Based on the damage, pelvic fractures can be categorized as:
- Stable pelvic fractures: single point breakage in the pelvis ring with broken bones in position and less bleeding
- Unstable pelvic fractures: Breakage at two or more points, followed by severe bleeding. It may cause shock, extensive internal bleeding, and damage to the internal organs and requires immediate medical care
Depending on the severity of the injury and condition, the treatment is decided. In case of minor or stable fracture conservative method such as medication, crutches, physical therapy and or minor surgery. In case of unstable fracture, immediate surgical intervention is employed to fix fracture pelvic bone using screw and plates. Pelvic bone fixation provides stability to the pelvic bone and promotes natural healing of the fracture.