Indications for conservative therapy:
- Existing contraindications to surgical treatment.
- Fractures on the infantile growing skeleton
- Fractures whose conservative treatment is not superior to surgical therapy.
- Stable fractures
Basically, bone fracture therapy is carried out according to the principle: reduction – retention – rehabilitation (aftercare):
- If there is a fracture with dislocation of the fracture ends, the bone must be returned to the anatomically correct position. If reduction cannot be achieved by traction or countertraction because of, for example, soft tissue injury or joint involvement, surgery is usually required.
- Retention involves fixation and immobilization of the fractured bone. This is achieved, for example, by means of a plaster cast.
- Aftercare aims to restore functionality and includes, for example, rehabilitative measures.
Conservative therapy is the reduction with subsequent retention by means of plaster or plastic bandage. Here it should be noted that the limb is not plastered tightly circular immediately after the fracture event, because swelling and bleeding can lead to pressure damage. The cast should be well padded and the limb should be well examined the following day to rule out complications. Furthermore, decongestant measures, such as elevation or medication, are prescribed. A tight circular bandage can be applied after about 5-6 days. The course of bone healing is documented with regular X-ray examinations to prevent malunion. Aftercare focuses primarily on restoring functionality and mobility by strengthening the muscles (medical strengthening therapy) and improving joint mobility. This is done, for example, as part of subsequent physiotherapy.
Risks of conservative therapy
- Pressure points
- Fracture disease – secondary disease due to prolonged unloading and immobilization after a fracture.
- Inactivity atrophy of the muscles – due to lack of load.
- Inactivity osteopenia – bone loss due to lack of load.
Further notes
- Reduction followed by retention (fracture immobilization) by plaster or plastic bandage:
- Z. E.g., ankle fracture: specially modulated, tight-fitting plaster cast led to equally good functional results as surgical treatment with osteosynthesis in seniors with unstable ankle fracture in a comparative study.
