Fracture Treatment in Indore

Understanding Bone Fractures 

A bone fracture can be as simple as a hairline crack in the bone, or it can result in the bone being split into several pieces. Fractures occur due to trauma (falling, accidents, sports injuries, assaults) or due to bone weakness (pathological fracture due to cancer or osteoporosis). 

The types of fractures differ according to fracture pattern, simple vs. comminuted; fracture location, shaft, end, intra-articular; and fracture relationship, closed vs. open/compound. The type of fracture can be used to direct treatment. 

Simple fractures are where the fracture is a clean cut into just two pieces and there is limited fracture fragmentation. A comminuted fracture is caused by the bone being broken into several pieces. Intra articular fracture is a fracture of the joint surface and must be reduced anatomically to maintain the function of the joint. Open (compound) fractures are fractures where the skin and bone are broken and the bone is exposed to the external environment, which causes a high risk for infection. 

Bone Anatomy and Fracture Healing 

Bone is a dynamic tissue that is rich in blood supply and can heal and remodel. The outer layer (cortex) is hard compact bone. The central part (medulla) is made up of cancellous (spongy) bone and marrow. 

A fracture of bone results in a collection of blood (hematoma) at the site of injury. The debris is removed by inflammatory cells. Specialized cells (osteoblasts) start to produce new bone. 

The healing process after fracture goes through four stages: Acute inflammation (hours to days), Soft callus formation (fibrous and cartilage tissue, weeks 1-2), Hard callus formation (bone mineralization, weeks 2-12), and Remodelling (months to years) (reorganisation and strengthening of bone). 

Generally, healing takes about 6-12 weeks to form initial callus and may involve months to years to heal. Healing time varies

Healing time varies

Depending on the fracture type, patient age and health, and other characteristics. Various factors that influence the healing of fractures. 

The age of the patient has an impact on healing, children heal faster than adults. Elderly people recover more slowly and complications are more likely to occur. 

Smoking seriously affects the healing of fractures. Smoking affects blood flow to bone and hinders healing. Strongly recommended to quit smoking. 

If not well managed, diabetes prevents proper healing of fractures. Healing is facilitated by good glycemic control. 

Nutrition is a factor; good protein, vitamin C, zinc and other nutrients help heal. Malnutrition delays healing. 

Movement at the fracture site will interfere with healing; immobilization is necessary.  Good support (casts, braces or internal fixation) promotes healing. 

Any infection, especially in open fractures, significantly affects the healing process and may result in non-union or chronic osteomyelitis. 

Poor blood supply to bone (vascular compromise) delays healing, especially at the femoral neck and other sites with weak blood supply. 

Types of Fractures 

Transverse fractures are those that occur across the bone, perpendicular to the axis of the bone. Oblique fractures are diagonal fractures of the bone. Spiral fractures run around the length of the bone. 

Stress fracture is a small crack in bone caused by repetitive stress which is frequent in athletes and military. These often aren’t visible on initial X-rays. 

Pathological fractures are broken bones caused by a weakened bone when the bone becomes weak from cancer, osteoporosis, infection or other causes. These will need treatment of the underlying condition as well as fracture management. 

Epiphyseal (growth plate) fractures in children are fractures that occur at the growth plate between the metaphysis and epiphysis. Care must be taken with these to prevent disturbances in growth. 

Fractures that are broken into several pieces are unstable and usually need surgery to fix. 

Intra-articular fractures penetrate into the joint surface. Anatomic reduction is key in restoring congruity of the joint and in reducing the likelihood of the development of post-traumatic arthritis. 

Fracture Diagnosis 

The pain, swelling, deformity and crepitus (bony fragments rubbing together) are evaluated by clinical examination. A neurovascular exam tests function of nerves and blood vessels beyond the fracture. 

The first investigation is usually an X-ray, which will usually be taken in at least two perpendicular views (anteroposterior and lateral), and images of the surrounding joints are also taken to detect other injuries. 

CT scanning offers good 3D imaging and is helpful in complicated fracture, especially intra-articular or pelvic fractures.

MRI can also be used to get for some fractures, such as stress fractures, fractures of the femoral neck, and other injuries when the initial imaging is not definitive. 

Fracture Treatment Options 

For simple and stable fractures, a conservative (non-surgical) treatment can be used. Healing occurs with the cast/brace and rest/elevation. Limited activity or weight bearing in crutches may be suggested. 

Closed reduction is the technique of manipulating the bone into proper position without an incision. Care consists of immobilisation (cast or brace). 

Surgical (open reduction and internal fixation) treatment is recommended for complex, unstable and intra-articular fractures. In the surgical exposure, direct visualisation, anatomic reduction and stable internal fixation are possible. 

Intramedullary nailing involves insertion of a metal rod through the bone canal  to stabilize fractures. Usually used in long bone fractures (the femur and tibia). 

Plate and screw fixation uses a metal plate to span the fracture and then screws are placed in the plate on both sides of the fracture to secure the plate. This technique often applied to periarticular fractures. 

The external fixation is a device that pinpoints the skin and muscle through to bone and ties them together with a metal framework outside the body. This is done in the event of a severe soft tissue injury and/or where immediate fixation is required. 

Cast and Brace Immobilization 

Casts are most useful for simple stable fractures and can be used to provide complete immobility. Traditional plaster casts are lighter and more durable fiberglass casts. Casts will be worn for 4-12 weeks, depending on the type of fracture and healing rate. 

Braces offer some more mobility than casts, but are not as rigid.  Some fractures are stable and require bracing or in the later healing phases to allow progressive mobilization. 

Splints are used for temporary immobilisation, usually directly after an injury, before more permanent treatment occurs. 

The greatest danger of immobilization is stiffness (loss of range of motion) if it is immobilized too long. The removal of the brace or progression to a more flexible brace is important with the progression of healing. 

Ideal weight-bearing can be achieved with crutches or a walker will minimise stress on the healing bone. Progressive weight-bearing is increased as bone healing  progresses. Weight bearing progression is assessed using serial X-rays which demonstrate healing progression.

Surgical Fracture Treatment 

Surgical incisions are made to improve the view of the fracture and bone fragments, this is called open reduction. The fracture is carefully manipulated to anatomic position, using direct visualization. 

To ensure a stable fixation and to keep the reduction, internal fixation devices (plates, screws, rods and others) are inserted. Early mobilization, and fewer hours of prolonged immobilization, facilitated by stable fixation.

Once fixated, the surgical incision is closed in layers.  Post-operative x-rays confirm adequate reduction and fixation. 

Benefits of surgical treatment include anatomic reduction (this is important in intra-articular fractures to decrease the risk of post-traumatic arthritis) and stable fixation (this will allow for early mobilization after surgery), a decrease in the need for prolonged immobilization, and a decreased risk of malunion (healing in the wrong position). 

The disadvantages are surgical trauma, risk of infection and the eventual need to remove the hardware in some instances. 

Recovery After Fracture Treatment 

Early therapy and treatment is directed towards pain control and elevation and icing to help decrease swelling. Neurovascular status is monitored to detect any vascular compromise or nerve injury. 

Early protected mobilization (unbroken joints) is used to prevent stiffness and encourage blood flow. Gentle range-of-motion exercises help  maintain motion. 

Progress with weight bearing will depend on fracture site and healing. Complications from prolonged immobility are minimized with progressive weight-bearing, which is monitored by serial imaging. 

Physical therapy increases ROM and strength. As healing occurs, therapists take patients through activities in a graduated manner. 

Return to activities is slow, more challenging activities are postponed until bone healing is certain. 

The healing of fractures takes about 8 to 16 weeks of complete healing and full functional recovery of uncomplicated fractures. More severe or complex fractures can take 6+ months to recover from. 

Complications of Fracture Treatment 

A small percentage of fractures are non-union (failed to heal), especially in fractures with poor blood supply (femoral neck), poor immobilization or in smokers. Non-union requires treatment such as revision  surgery and bone grafting. 

Bone healing in the wrong position (malunion) causes deformity and may impede function. Anatomic reduction is the key to prevention. Treatment may  require corrective surgery. 

Delayed union (slow healing) occurs in certain fractures, at certain sites.  Conservative treatment or surgery may hasten the healing process. 

A surgical emergency caused by an increase in pressure within a muscle compartment (fascia) that makes the muscle and nerve that reside in the compartment useless.  There is an urgent need for a fasciotomy (surgical opening of the fascia). 

Osteomyelitis (bone infection) usually caused by infection (especially in open fractures) and needs antibiotics and further surgery. 

There may be intraarticular fractures with cartilage damage or with persistent joint irregularities that can lead to post-traumatic arthritis years after the actual trauma. 

If there is prolonged immobility or inadequate rehab, stiffness and lack of range of motion may develop. Aggressive physical therapy helps prevent  this.

Complex Regional Pain Syndrome (CRPS) is a chronic pain condition sometimes  following fractures or injuries. Treatment requires comprehensive pain  management and physical therapy. 

Managing Specific Fracture Types 

Femoral neck fracture is a serious injury and has a high likelihood of non-union and avascular necrosis. Urgent internal fixation of the fracture or replacement (in older patients) is generally advised. 

Intramedullary nailing is the usual treatment of a fracture of the femoral shaft as it allows for the early mobilization of the patient and provides a stable fixation. 

To reduce the risk of post-traumatic arthritis, tibial plateau fractures (knee joint) must be treated with anatomic reduction and stable fixation. Frequently have to be surgically fixed. 

Ankle fractures can be simple – lateral malleolus fracture or complex – trimalleolar fracture. In most cases, surgical fixation is necessary to achieve a stable ankle and early mobilization. 

Wrist fractures are common in older patients and patients who fall on  outstretched hands. These range from simple undisplaced fractures (conservative  treatment) to complex intra-articular fractures (surgical treatment). 

A careful evaluation of vertebral fracture is required to exclude neurologic injury.  Conservatively treated vertebral fractures heal well with conservative treatment, and surgical treatment is warranted in cases where there is neurological compromise. 

Fractures of the pelvis can be simple (stable) or complex (unstable) enough to require surgery to keep them stable. Injuries such as internal bleeding should be treated promptly and urgently. 

Pediatric Fractures 

Kidney bones break differently from grown-up bones as a result of open development plates.  Treatment for growth plate fractures must be carefully done to prevent any growth disturbances. 

Children’s bones heal quicker than adult bones, and may need to be immobilized for a shorter time. In children fractures are potentially liable to angulation and rotational malalignment, however, if care is not taken in reduction and fixation. 

In growing children, remodeling (natural correction of minor angulation) may allow for acceptance of some angulation that would be unacceptable in adults. 

They are called physeal (growth plate) fractures, and anatomic reduction is essential to avoid growth disturbances. Fractures that have been displaced frequently will need surgery. 

Why Choose Dr. Sanjay Rawat for Fracture Treatment 

Dr. Sanjay Rawat has vast experience in the treatment of fractures in all the anatomical regions and all types of fractures. He has trained and experienced in conservative treatment for fractures, closed reduction techniques and advanced surgical fixation of fractures. 

Dr. Sanjay Rawat’s methodology involves thorough fracture evaluation, personalized treatment planning, and, if necessary, a precise surgical procedure, and detailed post-op rehabilitation plans. 

He is very patient and communicates well, sets realistic expectations, and maximises potential outcomes. Dr. Sanjay Rawat’s management always sees excellent results and high satisfaction from the patients pertaining to fracture treatment.

Schedule Your Consultation 

If you have sustained a fracture or bone injury, Dr. Sanjay Rawat invites you to schedule a consultation. He will evaluate your fracture, discuss treatment  options, and provide expert care to optimize your recovery and functional  outcomes. 

Contact Dr.Sanjay Rawat‘s office today for expert fracture treatment.