Best Techniques For Management of Bone Fractures
Accidents often happen when we least expect them. Accident prevention is a large part of safety and is everyone's responsibility. However, let’s just face it, we cannot prevent everything.
Fractures from accidents
One of the most common reasons for a bone to break or fracture is car accidents. Crashes can be devastating, as the tremendous force that the body is forced to absorb can sometimes cause one or more bones to break. Other causes are:
- Work related accidents especially people who operate machines or heavy equipment
- Sports accident especially extreme or adventure sports
- Falls in the elderly
Damage control – stabilizing and reducing damage
Effective care of the seriously injured patient requires the skills of clinicians of several clinical specialties. Tasks are carried out in parallel rather than sequentially and the management plan may change on a minute-by-minute basis as the clinical state of the patient evolves. The care of trauma patient has been a field of remarkable change over the past decade and this reduces morbidity and mortality rate of the patients.
Damage control concept is to provide sufficient stabilization of fractures while preventing further tissue damage and injury.
Dr. Suthorn Bavonratanavech, director of accident and orthopedic center and senior director of Bangkok orthopedic center at Bangkok Dusit Medical Services, said that the outcome of trauma care depends on speed (time to treatment). The most important thing is resuscitation in order to save life. Trauma patients require multidisciplinary care from board-certified emergency medicine physicians, general surgeons, orthopedic surgeons (team leader), neurosurgeons, pediatricians, surgical physician assistants, nurses and other experienced clinical staff.
When an ambulance arrives at accidental scene, coordination of care begins and a team of doctors will be informed in order to prepare for trauma cases. Damage control is the concept of managing fractures in patients with multiple injuries by containing and stabilizing the fractures and injuries, and delaying complete surgical repair until the patient’s overall condition improves. It focuses on stabilizing fractures with external fixation methods, managing and preventing soft-tissue injuries, controlling bleeding and preventing deterioration of the patient’s condition.
Co-management – increasing speed, improving patient’s outcome
The most common mechanism of injury in the elderly population is falling. Hip fractures in elderly patients are the most severe form of fragility fractures. They can lead to significant morbidity and mortality. Treatment of hip fractures in elderly patients should be based on a prompt initial evaluation, followed by surgical treatment (within 24-48 hours) without unnecessary delays under the collaborative efforts of a multidisciplinary team. Delayed treatment can lead to complications such as pressure sore and pneumonia. This increases mortality rate.
Treating injuries in elderly are difficult because usually the patients will have other comorbidities. Therefore, for trauma patients with comorbidities, co-management with multi-specialists is needed in order to come up with an individualized treatment plan.
“It took 2 years to put the system in place and we have been using a co-management system for 3-4 years. Currently, there are around 200 patients in the system and the outcome is positive. There is no re-admission in those patients within 28 days. Usually, in patients with hip fracture, the mortality rate is 25% in 1 year. After implementing the system, we have been able to reduce the mortality rate to 15% and also improve patient’s quality of life.”
In addition, the new surgical technique “Minimally Invasive Plate Osteosynthesis (MIPO technique)” also helps improve the patient’s outcome. This technique reduces muscle and surrounding tissue damage. The recovery time and hospital stays are shorter.
Types of bone fractures
There are many types of bone fractures.
- Complicated fractures and severe injuries
- Open fractures
- Multiple fractures
Minimally invasive fracture surgery
In patients with multiple fractures, a team of orthopedic surgeons will use a new surgical technique called minimally invasive fracture surgery, in order to reduce blood loss, complications, and infection rate. The main benefits are smaller incisions, less muscle dissection, decreased disruption of blood supply to the bone, and less disruption of fracture hematomas. These benefits may allow faster fracture healing and patient recovery.
Our team expertly treats the full range of injuries, no matter how complex, including fractures of the upper and lower extremity. The team also specializes in treating post-traumatic conditions such as mal-unions and non-unions (fractures that fail to heal properly), osteoporotic fractures, and pathological fractures.
Signs and symptoms of fractures
- Pain and swelling over a bone or joint
- Visible deformity
- Pain in the injured area that gets worse when the area is moved or pressure is applied
- Affected extremity is shortened
- Bone protruding through the skin
First-aid for fractures and dislocations
If you suspect that someone has a broken bone, provide first-aid treatment and help them get professional care.
- Do not attempt to force a fracture or dislocation back into place
- If necessary, cut away the clothing right around the injury so you can examine it
- Immobilize the injured area or broken bone by using a splint or sling
- Apply an ice pack or bag of ice cubes in a piece of cloth and place it on the injured area
- Do not move the person except if necessary to avoid further injury
For more information:
Bangkok fracture center, Bangkok hospital
1st Floor, D Building, Bangkok hospital
Call 0 2310 3000 or 1719