How to Care for a Fracture

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One of Tri-County Orthopedics’ surgeons, Dr. Mark McBride, provides an overview of fractures in the upper extremities and treatment options available.

Dr. McBride: Hello, I'm Dr. Mark McBride, part of Tri-County Orthopedics. I'm a board-certified specialist in hand and upper extremity, and one of my specialties is fractures of the upper extremities.

A fracture of a bone is when the bone has been disrupted from some type of force, commonly it can be a direct blow, commonly it can be a fall, some energy has injured the upper extremities, and in the hand, as many bones as there are, it's common to have a fracture involving the hand, wrist, and up towards the elbow area.

A fracture can occur in many ways. Very commonly in orthopedics, fractures that we see occur either in sports environments or something very simple, like a slip, fall, or motor vehicle accident, or some kind of trauma has affected the person; and the bones actually fail and actually will break.

When a bone breaks or fractures, you're going to get a deformity of the hand, limb, whatever you want to refer to it as, and the area around it will tend to get so you get some swelling and fairly significant pain, and basically, the limb normally becomes fairly dysfunctional.

Since I specialize in upper extremity work, all the fractures I see tend to be from the elbow out to the hand. You can diagnose a lot of our fractures just by visualization, and clinical symptoms are the extremity tends to swell, tends to get discolored, and has fairly localized pain to the area the injury took place.

In dealing with fractures of the upper extremity, treatment will completely depend on where the location is and the amount of deformity inherent in the fracture. Fractures that involve joints, they disrupt the joint circuits, almost all of them will have to be dealt with operatively, as it's important to restore the integrity of the joint.

In other fractures that do not involve joints, it all depends on the degree of the deformity you have for the bone actually ends, you have to straighten them out. We try our best to get them done conservatively through manipulation. Sometimes we actually have to open them up and operate on them and fix them.

There, our whole purpose is to re-establish the normal anatomy of the bone. If conservative treatment fails in treating an upper extremity fracture, we will normally go to different techniques of what we call open reduction and internal fixation. Which basically is surgery.

Surgery will involve different methods depending on the bone and the patient; there's a variable amount of different systems we have. We have a model here, it's a longer bone, we normally have a system, what we call a plating system, which is a piece of metal that fits on the bone with screws. If it's part of the smaller bones like the scaphoid bone, which is the most commonly fractured carpal bone, we have methods to put a screw inside the bone with what we call a canulated wire, which is a wire that goes in the small bones of the skin and scoops it right over into the bone and compressed, fixed. Makes it much less incision, much less tissue damage.

Recovery from a fracture has multiple things that vary, the most common of which is going to be which bone is fractured. Some bones get pretty stable in 3 to 4 weeks, some require 4 to 6 weeks.

Our ultimate goal though is to get people moving through rehabilitation as fast as possible, So if we can have a fracture that's stable, a cast, start to rehab on the rest of the upper extremity. One of the better things when it comes to internal fixation and and we have plenty things, since the bone is being held by a very solid metal plate. We can usually actually start moving the extremity and all the remaining areas around it within about 48 hours.

Once you've undergone surgery for fixation of a fracture, postoperatively a patient can normally get moving very quickly. The nice thing about internal fixation aiding systems is it gives such great stability within 24 to 48 hours. People can do changes and normally get the incisions wet, and you can start on a rehab, supervised rehab program almost immediately.