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Surgery for Broken Bones

Bone is a living tissue, and when a bone breaks, it can heal itself. However, the bone has to be held in place (immobilised) to make sure it heals in the right position.

This can sometimes be achieved using non-surgical methods, such as a sling or plaster cast. But if this isn’t possible, you may need to have surgery to fix the broken parts of your bone together with a metal plate, rod (also called an intermedullary nail) or pins and a frame (also called external fixators). Plates are fixed to the outside of your bone and hold the broken segments together, whereas rods are inserted inside your bone. Pins pass into your bone through your skin and are fixed outside your body with a frame.

Once your bone has been fixed in place, your body will produce new bone to join the broken parts together.

What are the alternatives?

You may not need surgery if your broken bone can be held in place using non-surgical methods, such as a sling or plaster cast.

Another alternative to surgery is traction. This involves using weights to pull the bones in your leg into place, while they heal. However, this treatment involves a long stay in hospital, and isn’t used very often any more.

Whether or not your surgeon advises surgery depends on a number of factors individual to you, including whether you have any other injuries, the type of fracture, your age and how active you are.

Preparing for surgery for a broken bone

Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery. It can also delay fracture healing.

Your surgeon or another healthcare professional will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

Surgery for broken bones is carried out under general anaesthesia. This means you will be asleep during the operation. You will be asked to follow fasting instructions before you have a general anaesthetic. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon or anaesthetist’s advice.

You may be asked to wear compression stockings and/or have an injection of an anticlotting medicine called heparin to help prevent blood clots forming in the veins in your legs. You will usually be put on an antibiotic drip before surgery. This is to reduce your risk of getting an infection during surgery.

What happens in surgery for a broken bone?

The device used to fix your broken bone will depend on a number of factors. Rods are more commonly used for broken legs and plates and screws for broken arms. Pins and frames tend to be used as a temporary measure for broken legs or if you have severe injury to your leg or arm.

Rods

Your surgeon will first position your arm or leg to line up the broken parts of bone. He or she will then make a small cut to reach your bone. This may be at the top of your arm or leg or in your knee or elbow, depending on which bone you have broken. Your surgeon will then insert the rod down the centre of your arm or leg bone.

Plates and screws

To fix a plate, your surgeon will make a cut through the skin and muscle along the length of your arm or leg. He or she will manoeuvre the broken fragments of bone back into position and then insert the plate so that it is lined up against the length of your bone. The plate will be fixed in place with metal screws.

External fixators

Your surgeon will insert the pins through your skin in your broken arm or leg and fix them together with metal bars. Your surgeon may replace the pins and frame for a plate or rod after two to three weeks.

Your surgeon may use X-rays during the surgery to make sure the plate, rods or pins are positioned correctly. Your surgeon will close your wound with stitches or staples and cover it with a sterile dressing.

What to expect afterwards

Your surgeon or nurse will give you painkillers to help with any discomfort as your anaesthetic wears off.

You may need to keep your arm or leg elevated at first. If you have had surgery for a broken arm, you may be given a sling or splint to keep it supported while it heals. If you have broken your leg, you will be given crutches to use so that you don’t put any weight on your leg. If you have metal pins inserted, you will be told how to keep the insertion points clean.

You will usually be able to go home after one to two days, as long as there are no complications.

You will be started on a rehabilitation programme as soon as possible. A physiotherapist will give you some exercises to do to start getting the movement back in your arm or leg.

Recovering from surgery

If you had surgery for a broken leg, you may be able to start putting some weight on it within a few weeks of your operation, and you may be able to return to work within two weeks if your occupation doesn’t involve any physical work.

It usually takes about six to 10 weeks to make a full recovery from surgery for a broken arm or leg, but this depends on a number of factors, including your age and the type of surgery you have had, so it’s important to follow your surgeon’s advice.

The length of time your dissolvable stitches will take to disappear depends on what type you have. However, they should usually disappear in about three to six months.

Risks

Surgery for broken arms and legs is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

  • You will feel tired and need to rest as the effects of the anaesthetic wear off.
  • You are likely to have some pain where the nail or plate was inserted. You will be given painkillers, however, tell your surgeon if the pain persists.

Complications

Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, or DVT).

  • Your broken bone may not heal (non-union), or heal in the wrong position (mal-union). This is uncommon, but your surgeon will X-ray your bone during your follow-up appointments to check how well it is healing and discuss further treatment options with you if necessary.
  • Damage to a nerve – this may cause some loss of movement or feeling in your arm or leg. This is uncommon and when it does happen, it tends to only be temporary.
  • If you had a rod inserted in your knee for a broken leg, you may continue to have knee pain over the long term. Talk to your surgeon if this happens.
  • Infection. If you develop an infection, your surgeon will give you antibiotics to take or you may be put on an antibiotic drip. If the infection spreads, you may need to have the infected tissue removed.
  • Compartment syndrome – this is when the nerves and blood vessels become compressed, and can lead to tissue death as your leg or arm doesn’t receive enough blood. You may feel extreme pain in the affected limb. If you develop compartment syndrome, you will need to have immediate surgery to relieve the pressure.

The exact risks are specific to you and differ for every person, so we haven’t included statistics here. Ask your surgeon to explain how these risks apply to you.

Get professional opinion about your Broken Bones, call us at +65 6471 2744 (24 Hours) / Email: info@boneclinic.com.sg

Open Reduction Internal Fixation

An open reduction internal fixation (ORIF) refers to a surgical procedure to fix a severe bone fracture, or break. “Open reduction” means surgery is needed to realign the bone fracture into the normal position. “Internal fixation” refers to the steel rods, screws, or plates used to keep the bone fracture stable in order to heal the right way and to help prevent infection.

Open reduction internal fixation can also refer to the surgical repair of a joint, such as a hip or knee replacement.

Open Reduction Internal Fixation (ORIF)

Open Reduction Internal Fixation (ORIF)

The surgical procedure is performed by a doctor who specializes in orthopedics, which is a branch of medicine concerning the musculoskeletal structure of the body. Under general anesthesia, an incision is made at the site of the break or injury, and the fracture is carefully re-aligned or the joint replaced. The hardware is installed, and the incision is closed with staples or stitches. The steel rods, screws, or plates can be permanent, or temporary and removed when healing takes place.

Once the open reduction internal fixation is performed, a cast is usually applied. In the case of an ankle fracture, for instance, the first cast is a non-weight bearing cast, and crutches can be used to help keep weight off the healing bones. Later, when the healing has progressed, this cast will be replaced with one that can bear weight. Eventually, after a period of some weeks, the cast will be removed entirely.

Recovery from a bone fracture after an open reduction internal fixation can be quite painful, and pain management becomes a concern. Commonly, acetaminophen with codeine is prescribed, as research has shown ibuprofen or other non-steroid anti-inflammatory drugs (NSAIDs) may slow down or inhibit the rate of healing. It is important to take the drugs as prescribed to help manage the pain cycle.

Physical therapy is also an important part of the recovery process after an open reductioninternal fixation. Since the part of the body that has been injured is usually held still or immobilized for a long period of time, the muscles, tendons, and ligaments can become weak. Physical therapy helps to restore the strength, range of motion, and endurance of the affected area. It can also help with pain management. Physical therapy can consist of exercises, hot or cold packs, ultrasound, and nerve stimulation, or a combination of treatments.

Complications of ORIF can include infection, swelling, and movement of the installed hardware. The recovery process can take months, because bones grow slowly. Other factors that can affect recovery are the location and severity of the break, the age of the person, and the type of bone broken.

For inquiry or to schedule for an appointment, please call +65 6471 2744 or Email to: info@boneclinic.com.sg

Treating Osteoporosis

Treating Osteoporosis

Prevent and Treat Osteoporosis Now!

MEDICATION

If you have been diagnosed with osteoporosis, or are at high risk of it, you will need to be treated to prevent fractures. Although calcium and Vitamin D intake, exercise and lifestyle modifications are essential steps for osteoporosis patients, they are not able to stop the excessive bone loss process. Your doctor may recommend a treatment plan that includes medication.

  • Bisphosphonates
Bisphosphonates are non-hormonal drugs that inhibit bone resorption and bring about an increase in bone mass. They are commonly used to treat osteoporosis in post-menopausal women and in men. They come in a once-weekly tablet for convenience and compliance, and have been found to help prevent osteoporotic bone fractures of the hip and spine.
In order to avoid oesophagitis (inflammation of oesphagus), you are advised to remain upright for about half an hour after taking the medicine.
Bisphosphonates include alendronate sodium, etidronate and risedronate sodium. Etidronate is available in once daily dosing which needs to be taken cyclically at 2 weeks apart. Risedronate sodium is available in daily and once weekly formulation. Alendronate sodium is available in daily and weekly formulation. A dual-therapy of alendronate and colecalciferol (vitamin D) is also available as a once-weekly tablet.
  • Calcitonin
Calcitonin is a hormone that inhibits bone loss – the removal of bone calcium into the blood – and helps to retain the levels of these materials in the bone. It is available in nasal spray and injectable forms.
  • Hormone Replacement Therapy (HRT)
HRT provides supplementary female hormones, including oestrogen, that were naturally produced by the ovaries before menopause. Nonetheless, the long-term use of combined HRT has been linked to various health risks. Women whose sole indication for using HRT is to prevent osteoporosis should be aware that there are currently many non-HRT alternatives (like bisphosphonates and SERMs) which may be effective both in preventing as well as treating osteoporosis.
FURTHER CARE AND SUPPORT
If you are a recently diagnosed osteoporosis patient, you and your family may feel greatly concerned by the discovery. Give yourself some time to sort out your feelings and make suitable adjustments. While the immediate goal is to be safe from fractures, the good news for the long term is that osteoporosis is treatable and preventable with a combination of medication, adequate vitamin intake, exercise and lifestyle modifications. Learn more about preventive and treatment options, and adhere to the doctor’s advice to ensure optimal results.
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Other Sources of Information

GET YOUR OSTEOPOROSIS CHECKED TODAY. CALL +65 6471 2744 OR EMAIL TO: info@boneclinic.com.sg

Preventing Osteoporosis

Managing Osteoporosis

DIET AND VITAMINS

Your doctor may advise you to change your diet or add dietary supplements. To ensure that your body can counteract osteoporosis, medications for osteoporosis are often accompanied by calcium and vitamin D supplements:

Calcium

Adequate calcium intake is essential in restoring bone health, as calcium is a major building block of bone. Choose calcium-rich foods and if dairy products upset your stomach, try other calcium-rich foods such as fish with soft bones (ikan bilis, sardines) or tofu. To maximise calcium absorption,  avoid eating too much protein or salt, as large quantities of these are related to a loss of calcium.

Vitamin D

Vitamin D is the key to unlocking the benefits of calcium – it helps the body absorb calcium. The best way to obtain sufficient vitamin D is 30 minutes of outdoor sunshine a day. Nonetheless, a recent study conducted in 18 countries worldwide found vitamin D inadequacy to be widespread among postmenopausal women with osteoporosis, even in countries where there is ample sunlight.

Important Reminder

Even if you have a calcium-enriched diet, your body cannot absorb the calcium consumed unless you have enough vitamin D. Inadequate vitamin D in the body contributes to bone loss and hinders efforts to combat osteoporosis.

Exercise

Moderate Exercises

Exercise at Moderate Intensity

You should aim to exercise at moderate intensity, at least 5 times a week, for 30 minutes each time, and always with warm-up and cool-down exercises. Include a variety of activities to keep all parts of the body exercised, and discuss with our doctor an exercise program that is suitable for you. It may include:

  • Resistance exercises such as light weight-training, which may help maintain bone health by strengthening the muscles around them.
  • Weight-bearing exercises including brisk walking, stair climbing, dancing, or those that require your bones and muscles to work gently against gravity.
  • Non-weight-bearing exercises such as tai chi, swimming or other water exercises, which may help prevent back strain and pain by building your trunk and leg muscles.

Lifestyle Modifications

Lifestyle modifications can be crucial to successfully treating and preventing osteoporosis – your doctor may suggest that you:

  • Stop smoking – smoking may increase your chance of getting osteoporosis, and many other diseases
  • Reduce your alcohol intake – heavy alcohol intake is associated with a higher risk of osteoporosis, and injuries that can cause fractures.

How to prevent falls:

  • Always anchor rugs and carpets
  • Ensure that rooms are well-lit
  • Conceal all electrical and telephone cords to avoid tripping over them
  • A flashlight by your bed is helpful at night. Check the batteries often
  • Stairways should have railing and non-slip surfaces
  • Grab bars and other aids, such as night-lights, are especially helpful in bathrooms
  • Use non-slip mats or adhesive strips in your tub or on your shower floor
  • Ensure chairs and couches are easy to get in and out of

Further Prevention of Spinal Problems

Osteoporosis can cause the vertebrae in your spine to collapse. To prevent or lessen such spinal problems:

  • Practice good posture
  • Use proper techniques if you need to lift heavy objects – bend your knees instead of your back to reach low down items
  • Do back exercises to help your posture
  • Lie on your back when you have pain

Detecting Osteoporosis

Osteoporosis is also known as ‘the silent crippler’ because it can occur without symptoms. This is where the danger lies, as most people would not know about their osteoporotic condition until a major fracture occurs, often with devastating effects.

The Osteoporosis Self-Assessment Tool for Asiana (PSATA) is a 1-minute guide, formulated to help assess an Asian woman’s risk of osteoporosis – by simply comparing weight measurement (in kilograms) to age for an indication of the individual’s risk profile.

If your risk is medium or high, it is very important that you see Dr. Kevin Yip for help as soon as possible.

Those with medium or high risks, or those who may have symptoms of osteoporosis, are advised to see a doctor as soon as possible.

Our doctor may recommend a dual energy X-ray absorptiometry (DEXA) test to help determine your bone mineral density (BMD), a reading that is indicative of your bone health.

Unlike bone scans that require an injection of a radioactive material, the DEXA test requires no special preparation, medication, or injection. Its test result, known as T-scores, compare your bone density with that of a normal young adult of your gender.

An individual with bone mass of 2.5 standard deviations or more below the normal density (which also means 25-30% or more below) is diagnosed as osteoporotic.

Osteoprosis Around Us

  • Osteoporosis is not just an ‘old women’s’ disease. According to the International Osteoporosis Foundation, younger females too need to take note, as bone loss in women can begin as early as age 25, and a woman’s lifetime risk for osteoporotic fracture is 30-40%. The prevalence of osteoporosis in men is also higher than previously thought – affecting approximately one in five men.
  • And, the incidence of osteoporosis is increasing in Singapore’s ageing population – since the 1960s, hip fractures have risen 1.5-fold in men aged over 50 years and 5-fold in women older than 50.
  • In the United States, Europe and Japan, about 1 in every 3 post-menopausal women are osteoporotic – in 50 years time, more than half of all hip fractures in the world are projected to occur in Asia.

Consequences of Osteoporosis

Sometimes, nothing happens, as osteoporosis is asymoptomatic. However, the lower your BMD, the higher your risks of bone fracture. Most alarmingly, osteoporosis can cause sudden fractures during everyday activities that would not have otherwise affected normal bone.

The devastating and painful fractures usually occur at the spine, wrist, hip, pelvis or upper arm. They can lead to:

  • chronic pain
  • reduced height
  • considerable deformity including hunching of the back
  • loss of mobility
  • a need for surgery, hospitalisation and after-care
  • reduced physical independence and quality of life
  • death in severe cases of hip fractures

Osteoporosis is a treatable condition. It is preventable too.

With effective medication, osteoporosis can be treated and its risks prevented. But calcium alone is not enough to achieve this. Understanding, managing and preventing your risks of osteoporosis can improve your risk profile, enhance your quality of life, and reduce your burden of care.

Discuss early with our doctor the appropriate medicine, diet and vitamin intake, exercise and lifestyle modification that an effectively help to reduce your risk of osteoporosis.

Related Articles:
Understanding Osteoporosis
Preventing Osteoporosis
Treating Osteoporosis
Bone Mineral Density Test (DEXA Scan)

Understanding Osteoporosis

A Healthy Bone

Osteoporosis vs Normal Bone
Osteoporosis comparing with normal bone

Bone is a living tissue. The body is always making and losing (resorbing) bone. While the bone-making cells form new bone using calcium and other minerals from the food we eat, the bone apart so that its minerals can be sued to repair an injury or make new bone. The bone-making cycle is in balance so long as the same amount of bone is built and resorbed.

An Osteoporotic Bone

Osteoporosis is characterised by an imbalance in the bone-making cycle, triggered by changes in the body’s hormonal levels, activities, medications, or dietary patterns. It results in bone being broken-down faster than the bone-making cells can replace it. This reduces bone density.

Left untreated, the weakened and brittle bone can easily fracture with a simple slip or fall, or even under the body’s own weight. When a fracture occurs in the vertebrae due to body weight, parts of the spine compress, causing the back to bend or hunch over time. Some symptoms (eg, cyfosis, unsolved backpain, protruding abdomen) may be indicative of your risk osteoporosis.

Bone Density through the Ages

When we are young, any loss of bone is easily replaced. Our bones are their strongest from the mid-20s to the early 30s. However, as we age, more bone is lost that it is made.

Osteoporosis and Aging

Osteoporosis and Aging

In the first 6 years of menopause, a woman can lose up to 1/3 of her spinal bone mass as her ovaries stop producing oestrogen, a female hormone that keeps her bones strong during the reproductive years.

Later in life, both men and women’s bones are at risk of becoming weakened, brittle, and prone to fractures.

Related Articles:

Detecting Osteoporosis
Preventing Osteoporosis
Treating Osteoporosis

 

Bone Fractures

What are Bone Fractures?

Bone Fractures are are injuries of bone tissue, which compromise their ability to support the body. A bone fracture can occur in several situations, like a car accident, an assault, a fall in the bathroom or from a height, due to a pre-existing bone disease, like osteoporosis, rickets, and so on. The symptoms of bone fracture may vary depending on the types of bone fractures, their location, as well as their severity. However, every fracture results more or less from an unbalanced force, which overcomes the strength of the bone.

Bone Fracture Physiology

Bone tissue is structurally very hard, but when it is subjected to forces higher than its capacity it responds in two ways. When the forces are applied in one instant, like a sudden fall, it results in a bone fracture. But if it is applied slowly over a period of time, it results in remodeling of the bone to a shape that balances the forces e.g. bowing of legs in rickets. Thus, the bone has a dynamic nature and adjusts to the changing loads of weight bearing and physical stress. This ability of bones is due to the constant erosion of bone by osteoclasts and deposition of new bone by osteoblasts.

A delicate balance between these cells is responsible for thickening or thinning of bones, depending on the activity performed by a person. Hence, a manual laborer has a much sturdy skeleton than a sedentary working clerk in an office. Thus, after a bone fracture, the bones have an intrinsic ability to heal themselves due to the deposition of bone by osteoblasts. It also indicates that pressure acting on a particular bone tends to increase the thickness of the bone over time and helps better healing of bone fractures.

Types of Bone Fractures

Type of bone fracture

There are several ways to classify a bone fracture, which satisfies specific motives. Each of the bone fracture types, gives us certain information about the fracture, which influences the type of treatment given to a person. Hence, it is very important to understand which of the several types of bone fractures, does one actually have.

Displaced Bone Fracture is when the broken ends of a fracture move away from each other and there is a significant gap between them, when seen on an x-ray. The significant gap is different for different types of bone fractures, for example, a gap of 3-4 mm may be insignificant in a humerus bone fracture, but can be significant in a finger phalanx fracture.

Undisplaced Bone Fracture or Hairline Fracture is when a bone develops a crack or breaks through and through, but the broken ends remain in place, without any displacement or gap. These bone fractures, are best treated with a simple fiberglass or plaster cast and generally do not require surgical treatment.

Pathological Bone Fracture is when a bone has been weakened by a disease, like cancer, osteoporosis, etc., and develops a fracture. Such bone fractures do not require a lot of force and are possible after trivial falls or even without any traumatic incident.

Compound Bone Fracture is when the broken bones pierce the skin and create an external wound. These bone fractures are associated with higher rates of infection, due to exposure of the bone to the surrounding dirt and also cause profuse bleeding from the wound.

Long Bone Fracture Types

Long bones, like femur (thigh bone), tibia & fibula (leg bones), humerus (arm bone), radius & ulna (forearm bones) or clavicle (collar bone), have particular types of bone fractures, where the edges of broken bones have a characteristic shape. This not only influences the outcome of the bone fracture, but also dictates the bone fracture repair method which can be used for treatment.

Spiral Fracture is when a twisting force is applied to a bone, resulting in long curvy edges of the broken bones, like a spiral. Due to the zig-zag nature of the fractured ends of bone, it is slightly easier to treat a spiral fracture of long bones.

Comminuted Fracture is when a bone breaks into several small pieces and is the result of high velocity injuries, like car accidents, or falls from a height. Such bone fractures generally are very difficult to treat, and result in a deformity of the injured part even after treatment.

Bone Fracture Symptoms

Symptoms of bone fractures can range from a mild bone pain to severe bruising, bleeding, and inability to move the part of the body.

  • Pain – is due to pain signals from the injured bone in response to pressure on the bone fracture.
  • Swelling – is due to injury to local blood vessels and also the action of the cells of immune system of the body.
  • Inability to walk – is after an injury to the weight bearing bones of the body, mainly the bones of the leg or thigh.
  • Instability – is when the bone fracture is near a joint and causes the joint to dislocate.
  • Inability to breath – is in the case of rib fractures, where a sharp stabbing pain can be felt at each breath.

Bone Fracture Treatment

Treatment for bone fractures consist of immobilization of the injured part in most of the cases. This is accomplished with the help of a cast moulded on to the injured part. Plaster of Paris (cheap) or Fiberglass (expensive) may be used for the cast depending on the requirement and availability. Several splints are also available for the same purpose, are more comfortable than a cast and provide similar results. Generally, such an immobilization has to be retained for 4-6 weeks, to allow sufficient time for bone fracture healing.

Prior to immobilization, it is essential to ensure that the displacements between the fractured ends of bones are reversed and the bones are brought into their natural anatomical alignment. This procedure is called fracture reduction and involves manipulation of the ends of the broken bones. Reduction can be accomplished under x-ray guidance with the help of a C-Arm. Due to the painful nature of fracture reduction procedure, it is essential to give the patient adequate analgesic cover or iv sedation. By reducing bone pain a person is able to relax the muscles of the injured part, which helps greatly in fracture reduction.

Bone Fracture Surgery

Surgical treatment for bone fractures is reserved for displaced fractures and primary management of compound fractures. Displaced bone fractures have a higher propensity of developing non-union or mal-union. Hence, surgery has to be performed, preferably within a week after injury to bring the broken ends of the bones together. The broken edges are approximated as neatly as possible and secured in that position with the help of orthopedic screws and plates. This provides temporary support, which is sufficient to maintain the position of the bones, until bone fracture healing.

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