FRACTURES-WHEN TO OPERATE AND WHEN NOT TO?
A fracture is a break in the bone resulting in loss of function and pain. Few decades back all fracture were managed by, plaster of pairs castsor treated with weights hanging from bed. With improvements in metal technology, advances in anesthesia, and research more and more surgeries are performed for fracture. But does all fracture need surgery? Can we still use plaster of pairs?
Many fractures like wrist fractures in old people, children’s fractures (called greenstick fractures), arm bone fractures, some spine bone fractures (without spinal cord injury) can be treated without surgery some fractures definitely need surgery and some can be managed by both forms of treatment.
Generally speaking fractures through joint (called intra-articular fracture) definitely requires surgery; Because the joints which is a place where 2 bones meet and give movements require smooth surfaces. If the surfaces are rough of uneven due to fractures the smooth movement of joint is lost and pain results. Hence perfect positioning of fracture fragments are necessary to get best result in fractures through joints. Common fracture through joints which require surgery are ankle fractures, Knee fracture forearm and wrist joint fracture. So to reiterate ”All through the joints require surgery”.
Some fracture which heal quicker and better with surgery compared to plaster of parisimmobilization. For example, fractures of the collar bones are healed better with surgery than bandages. Similarly fractures of thigh bone, hip bone, leg bone are better operated than treated with plaster cast. The bone fragments may not be correctly alignedinside plaster cast and reduction will be lost. This can lead to deformities like bending of bone or angulations at fracture site.
Also hip fractures will either not heal or heal in a deformed position if treated without surgery ,hence surgery is better option here. Fracture surgery is done using metallic plates and screws or long rods inserted into the bone or sometimes with pins and rods outside the bone and skin (External fixator).Surgery is done under local or general anesthesia depending on site of fracture.
Advantages of surgery:
- Better positioning of broken bony fragments
- Reliable fixation of bone ends, compared to plaster cast fixation of bone ends, compared to plaster cast
- Quicker healing times
- Precisemia intenaance of reduction in fractures through joints
- Avoiding plaster helps in moving joints near the fracture
- No itching or skin dryness under cast.
Disadvantages of surgery:
- Failure of healing
Native bone setters-native bone setters are there in all parts of our state from putthoor to thalavoor. People flock to them fearing surgery and high medical costs. Though they can get away with fractures away from joints, joint fractures are a total failure in traditional bone setters. Many times people end up with deformities and non healing of fractures. Also excessive tight bandages can lead to stopping of blood supply in injured limb and cause death of cells; sometimes leading to amputation. Hence better to avoid quacks and traditional bone setters who do not set bone precisely.
Your orthopaedician is the best judge to decide whether a particular fracture requires surgery or not.
Dr. SATHISH DEVADOSS
M.B.B.S.,M.S.,(ortho)M.CH.,ortho (UK),FASIF (Aust)
Orthopaedic Surgeon | MEDICAL DIRECTOR
DEVADOSS MULTISPECALITY HOSPITAL