Basics of Treating Broken Bones (Fracture Care)

Orthopedic surgeons treat everything from the neck down.

Thats a lot of bones to take care of!  

Each of our hands has 27 bones, our foot has 26...add in the arm bones, forearm bones, thighbones, leg bones, pelvis, spine... thats nearly 200 bones to look after (humans have a total of 206 in our body, the ones above our neck are cared for by neurosurgeons).  

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What makes orthopedics interesting is that all of these bones are unique. They each break a little differently and they each heal a little differently.  They each perform a different function and therefore different treatment to restore function.

So how do doctors remember what to do with each of these bones?

There is an general principal for treating any broken bone, that helps guide every orthopedic surgeon: "OBTAIN AND MAINTAIN GOOD BONE ALIGNMENT"

That is the mantra of orthopedics, but what does it mean?

Lets take a closer look at each of the words in this phrase.  

1) OBTAIN alignment

"If its bent, make it straight":  Many times our bones dont just crack, but also bend out of postion.  Or sometimes the whole bone becomes dislocated at the same time it breaks.  So the first step in treating an broken bone is to restore alignment (return our bones to their normal position).  A quick pull on a bent finger may be all thats needed to Obtain alignment (see talk), but sometimes surgery is needed, like in the case of a broken femur (its much harder to pull a bent thighbone straight, see talk).  This sounds obvious: "straighten the bone" but its half the battle in orthopedics.  Its also harder than it sounds, sometimes Obtaining alignment feels like putting humpty dumpty back together again.

MAINTAIN alignment: 

"When repairing bones and bridges, stability is essential": Once the bone is back in position, it must stay in position for many weeks to allow for heal.  The bone will only heal if stable.  Most simple breaks are stable once put inside a splint or cast, so surgery isnt needed.  However, in a spiral fracture, a comminuted fracture (multiple cracks), or other complicated injuries, the bone is very unstable and needs metal plates and screws to restore stability.  Many orthopedic surgeries are performed to restore stability so that alignment is Maintained once its obtained. Now healing can occur.  

GOOD alignment:

"Thats good enough for government work": In treating broken bones form follows function (in other words: good function determines what is acceptable alignment).  Doctors treat people not x-rays, and so the goal of treatment is always to return normal function to a broken arm or leg.  Normal function does not always require a completely normal alignment on x-ray.  Oftentimes alignment only needs to be good, not perfect.  A broken thumb often requires perfect alignment, while a broken fingertip just needs to be "straight enough" not to look weird.  Although this sounds like a half-ass treatment, theres a famous saying in surgery: "the enemy of good, is better"...meaning that a lot of complications and bad outcomes are the result of some doctor over-treating an injury, unnecessarily performing surgery to make a bone with good alignment into a bone with perfect alignment (while accidentally cutting a nerve).  If that slight improvement doesnt have any effect on function ("lifestyle"), then who cares.  Its just like that chinese saying: "if a tree falls in the woods and no one is around...who cares?

So next time you see a broken bone, and want to know whats the best treatment, just ask: How can I obtain and maintain good alignment?