The Ultimate Guide to the Treatment of Fractures in Singapore

What Are Fractures?

Boasting a strength as strong as steel but fifty times lighter, bones provide our body with the much-needed structure we need – not only for movement but also protection of our fragile internal organs.

Bones are rigid, but like steel, they do bend and can eventually break when an overwhelming amount of outside force is applied, much like how a plastic ruler breaks when it is bent too far. The occurrence where a bone breaks is called a fracture, and bone fractures are considered medical emergencies.

Bone fractures most commonly occur during accidents and can exist in a range of severities, ranging from a hairline crack in the bone, to the bone being completely shattered into separate pieces. However, regardless of the type of fracture, they all require immediate medical attention, proper treatment and aftercare in order to restore bone integrity and avoid losing its function.

Types of Fractures

Fractures can exist in many different forms, often determined by the type and severity of the fracture. There are three 3 main categories of fractures: mainly open fractures, closed fractures, and displaced fractures. Each type of fracture requires different medical procedures and needs varying levels of emergency attention.

Closed Fractures

Starting from the bottom of the severity scale, closed fractures are fractures that do not penetrate the skin and remain inside the body. They carry a much lower risk of infection as compared to open fractures, and are generally considered “safer” or less critical in nature. This is because the fractured bone does not protrude out from the skin and expose the body to foreign contaminants.

However, they still require prompt treatment as the damaged bone can harm the surrounding tissues, and in more severe cases, may harm the internal organs that they are made to protect, such as the lungs and heart. For cases like these, the patient is usually required to wear a cast to protect the fracture site for recovery. Surgery is optional, depending on the severity of the fracture.

Displaced Fractures

These fractures are considered more severe than closed fractures, but could be seen as equally as severe as open fractures, determined by the protrusion of the broken bone from the skin. A displaced fracture is a fracture where the bone breaks into two or more pieces and moves out of alignment; this can happen in both closed or open fractures.

A comminuted fracture is a break or splinter of the bone into two or more fragments, and this usually happens when the fracture is caused by high-impact trauma.

Pathological fractures are caused by disease rather than injury. These conditions weaken the bones, making them easier to break. There can be incidences where actions of small force, like coughing, could lead to a fracture.

A greenstick fracture usually occurs in children aged 10 and below. These are caused when a bone breaks or cracks, instead of splitting into several pieces.

It is very difficult to treat displaced fractures with immobilization by placing a cast because in many cases, the broken pieces of bone do not align, and oftentimes, surgery is required to piece the bone fragments back together.

Open Fractures

Also known as a compound fracture, an open fracture is the most severe of all fractures. Open fractures happen when a broken bone breaks through the skin, exposing the insides of the body to foreign contaminants.

Incidences like these usually  happen during big accidents and immediate medical attention is required. Open fractures can become infected easily and more often than not, diseased tissues have to be removed during surgery. Furthermore, if it is an open fracture, the bone is highly likely displaced as well, and requires metal plates or rod implants to hold it in place as it heals.

How do Bone Fractures Happen?

Fractures occur when a force stronger than the bone itself is applied to it. This can happen at any point in time from any form of accident, more commonly falls, trauma, and direct impact to the bone. The difference in an individual’s bone density determines the likelihood of suffering a fracture during an injury.

Different factors can affect the likelihood of an individual suffering a fracture. For example, in the elderly, osteoporosis can weaken the bones, and therefore, fractures become a risk factor due to the wearing down of bone integrity or the lack of production of bone.

Individuals with compromised bone density due to various diseases such as bone cancer, Paget’s disease, and Rickets are also at a higher risk of suffering from fractures during trauma and injuries.

Stress fractures can also occur in runners, where repetitive forces caused by constant stress applied to the runner’s feet could eventually cause a fracture. Hence, it is paramount to use proper exercise equipment and get adequate rest for bones to heal.

What are the Symptoms of a Fracture?

The symptoms of a fracture are usually rather obvious and are significant enough to warrant a sense of urgency in an individual.

First and foremost, after a trauma or accident occurs, it is important that you assess any part of the body that was involved in the accident and check to see if there are any visual indicators of a fracture, such as an open fracture, or an obvious deformity in the affected area.

However, if the fracture is not visually present, it is important to be mindful of the following symptoms, as each individual may experience them differently:

• Pain in the affected area
• Swelling in the affected area
• Restricted movement of the affected area
• Redness, bruising, tenderness, and hot feeling in the affected area.

It is important to note that these symptoms are not exclusive only to fractures and may be an indication of other diseases. Consult a doctor to get an accurate diagnosis of your condition, especially after sustaining an injury.

How is a Fracture Diagnosed?

The first thing that a doctor will do when accessing you would be to ask for a recount of how the accident happened, accompanied by a physical examination of the affected area. After which the doctor may conduct further testing, depending on how much more information is needed to make a proper diagnosis.

The most basic test is the use of X-rays. X-rays are a diagnostic tool that utilise electromagnetic energy beams to produce images of internal tissues, organs, and bones. In doing so, the doctor can then check for any broken bones in the affected area. If the fracture is significant, the X-ray can detect it easily and a proper diagnosis can be given.

However, in minor fractures where the broken bones are not obvious in the X-rays, a more thorough form of visualization is needed. CT scans can show detailed images of any part of the body, including bones, and generate greater clarity scans, so even the smallest of injuries can be detected. These are used to detect minute and hairline fractures that would not show up on regular X-rays.

An MRI can also be ordered instead of a CT scan. However, in this scenario, organs or soft tissues are the ones being studied. Hence, MRI can also be used but for the secondary purpose of studying the integrity of soft tissues surrounding the injured area.

Complications of Fractures

Unfortunately, sustaining a fracture does not only involve bone problems. There are numerous complications that could happen, depending on the type of fracture and the location of the fracture, such as:

• Wound infection from an open fracture
• Haemarthrosis: Bleeding into a joint space, causing the joint to swell
• Damage to surrounding organs and soft tissue
• Shock
• Delayed bone healing
• A blood clot in blood vessels
• Compartment syndrome: Increased pressure within a closed part of the body, causing the blood supply to be cut off from muscles. This is due to bleeding and blood clots around the fracture.

These complications vary in severity, but can all be detrimental to the patient if left untreated. The doctor will assess these issues during bone treatment, and will try to eliminate all of them so your body can return to normal sooner.

Treatment of Fractures

Contrary to popular belief, treating fractures does not involve simply placing a cast over the affected area and letting it heal by itself. The actual treatment process is much more complex and requires different types of treatment, all of which depend on the type and severity of the fracture.

Furthermore, treatment is also tailored to the individual as different individuals react differently to specific medications, procedures, or therapies, making the treatment of fractures unique to every individual.

The main goal of fracture treatment is to control the pain and help promote bone healing, as well as to prevent further complications to help restore the quality of the patient, and help him/ her get back to perfect functionality as soon as possible.

Small fractures do not require surgery and are often simply immobilized with a cast or a splint. This helps prevent that area from movement to promote bone alignment and healing.

In certain cases where the bone is small, such as fingers and toes, a cast cannot be applied. As such, wrapping is instead used to immobilize the fracture. Medications such as painkillers are also administered to help alleviate the pain from the fracture.

However, for more serious fractures such as open fractures, which are considered a medical emergency, the patient would require surgery to fix the bone. The surgeon would have to manually realign the bones and even use internal and external fixators, rods or pins to hold the bone in place to allow the bones to realign.

Also, traction, the use of pulleys and weights to stretch the muscles and tendons around the fracture, may also be required to help stabilize and realign fractures before surgery. The surgeon will assess the extent of the fracture and tailor a treatment plan before performing the surgery.

Post-treatment of Fractures

The post-treatment recovery for fractures is a very long process. This is because the bone is very dense and has to be re-strengthened in order to continue carrying out its functions. As such, the minimum time needed for a fracture to heal is six to eight weeks.

However, this varies according to the severity of the fracture and an individual’s general health. For example, a younger individual would heal at a much faster rate as compared to an elderly person suffering from osteoporosis.

Following the surgery, pain will be the main problem that everyone faces. Acute pain directly after the surgery is unavoidable and painkillers are often administered to help the patient cope.

However, following the weeks after surgery, sub-acute pain will start to commence. Sub-acute pain is due to the inability to move the affected area due to immobilization. As such, the muscles around the fractured bone start to weaken and the soft tissues start to stiffen, causing aches and pains that will usually affect an individual’s quality of life.

At this stage, physical therapy is recommended. A physical therapist will help to ensure that the affected area remains mobile to help regain muscle strength. Depending on the severity and location of the fracture, you may have to go for regular therapy sessions at the hospital or the physical therapist will recommend some home exercises to do on a daily basis to help improve range of motion and reduce inflammation and pain.

Patients are also recommended to take foods that are rich in calcium, vitamin C, and vitamin D, such as cheese, milk, yogurt, and citrus fruit to assist with the healing process. These foods help promote bone growth and healing, allowing the fracture to repair quicker and also promoting better bone strength for the rest of the bones in your body.

Prevention of Fractures

The simple answer to this question is to stay safe. Accidents and trauma are the main causes of fractures. By staying safe and keeping your surroundings clear of clutter, you eliminate the chances of falling. Always stay alert of your surroundings when outdoors and handle exercising equipment properly when working out.

As we age, our bones start to deteriorate and we are more likely to have weaker bones. As such, a steady intake of calcium is needed to promote bone health. Ensuring that the daily requirement of 1200mg-1500mg of calcium and 800-1000IU of Vitamin D is taken helps to keep our bones strong, preventing osteoporosis and promoting good bone health. If the need arises, walking aids can also be used to minimize the chances of falling.

Unlike diseases, fractures can happen to anyone. It is important to always stay alert of your surroundings and put yourself out of harm’s way. Bones provide the much-needed structure and are integral to the protection of our body. Maintaining good bone health is paramount in reducing the chances of a fracture. Don’t wait, start building strong bones now.

For more information, Consult with our orthopaedic surgeon & specalist in Singapore. Dr. Henry Chan is an orthopaedist provides orthopaedic services relating to knee, hips, shoulder & other orhopaedic concerns. Contact us at +65 6732 8848 now.

References

• https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/fracture/types.html
• https://www.muirortho.com/orthopedic-blog/2020/february/what-are-the-different-types-of-fractures-/ 
• https://www.orthopedic-institute.org/fracture-care/types-of-fractures/
• https://my.clevelandclinic.org/health/diseases/15241-bone-fractures/management-and-treatment/