Bone Fracture: Treatments and Remedies

The correct therapy for a bone fracture depends primarily on the type, severity and location of the fracture, but individual factors such as age or concomitant diseases also play a role. There are various forms of treatment, which are divided into conservative and surgical. Which form is the right one is decided by the treating physician in each individual case. We present the common methods of treating a bone fracture.

How is a bone fracture treated?

In order for the fractured bone to heal, both ends of the bone must be joined together so that they are back in the correct anatomical position (reduction) – otherwise a restriction of movement or an axial buckling will result. It is also important that there is no large gap between them, otherwise no new bone tissue will be built up. Bone healing takes some time, during which the bone must be immobilized (retention and fixation). This is usually done in simple fractures with a rigid bandage made of plaster or similar materials. The third important component of treatment is rehabilitation, in which targeted exercises are used to prevent loss of function or restore function. Treatment of a fracture should be carried out as soon as possible after the accident, because once swelling has formed around the fracture, surgery, for example, is more difficult to perform.

Treatment is not always necessary

However, not every broken bone requires treatment. For example, an uncomplicated rib fracture or a nasal bone fracture without displacement of the bones will heal without treatment. In such cases, treatment is usually limited to relieving the pain, for example, by cooling and administering pain medication.

Conservative treatment of a bone fracture

Conservative treatment of a bone fracture involves immobilizing the bone (after reduction, if necessary) in the correct position until it heals. Possible adjuvants include:

  • Plaster cast or plaster splint
  • Orthosis respectively splint
  • Special dressing techniques
  • Extension treatment (stretch bandage)

Conservative treatment is usually possible if the fracture is not dislocated, that is, displaced. Surgery is usually required for complicated or open fractures.

Surgery for complicated fractures

Complicated fractures are often operated on, for example, to put the individual parts of the bone back together or to compensate for an axial misalignment. In this case, the bone fragments are joined together with special wires, nails, screws, and plates to restore the exact anatomical shape (this is called osteosynthesis). Often, the inner space of the bone is used to anchor particularly thick screws. These metallic aids stabilize the bone to such an extent that it can be subjected to limited weight-bearing. For older patients with a femoral neck fracture in particular, this rapid mobilization often saves their lives – in the past, many older patients died as a result of being confined to bed for long periods (for example, pneumonia) following a femoral neck fracture. The metal parts are usually removed after six months to two years. However, in some cases (especially in older people) they are left in the body permanently. There are also cases in which wires, for example, can be removed after only a few days.

External fixator – the “external tensioner”

Another surgical option for treatment is a so-called external fixator. In this procedure, the bone is stabilized from the outside by fixing a steel rod outside the body with the help of long screws through undamaged parts of the bone. This method is mainly used when the bone is shattered into many small pieces, the tissue at the site is severely damaged, or the wound is (presumably) infected. The advantage of the procedure is that no pressure is exerted on the soft tissues or the damaged bone. However, healing usually takes longer.

Rehabilitation as part of treatment

As described earlier, rehabilitation often begins when pain decreases and allows movement. Targeted physiotherapeutic exercises and normal use, if possible, should prevent affected muscles and joints from being damaged as a result of the lack of movement.As healing progresses, the affected part of the body can be subjected to increasing loads. In other cases, however, it may be advisable to completely rest and relieve the affected body part until it has healed completely. The attending physician decides which measures are suitable in each individual case.

What are the complications?

If the fracture is not adequately immobilized, the bone ends do not make firm contact with each other or shift again, the body cannot build up new bone tissue in the fracture site. It builds inferior tissue into the bone gap, which only slowly remodels into stable bone tissue. This secondary bone healing can take up to two years. If it does not take place, a so-called pseudarthrosis develops, i.e. an unstable bone area that leads to pain and restricted movement. Especially in the case of open fractures, there is also a risk of bone inflammation (osteitis, osteomyelitis), which requires lengthy treatment and can lead to the bone not growing together. Apart from this, a bone fracture can also always be accompanied by further injuries, for example to muscles, nerves or tendons, or severe blood loss. Infections by bacteria, especially by the tetanus pathogen Clostridium tetani, are also conceivable consequences, as is thrombosis from lying down for a long time in the case of complicated fractures. However, most fractures heal without complications or long-term consequences.