Sports Medicine and Wellness
Fractures and Trauma
The word “Fracture” implies to broken bone. A bone may get fractured completely or partially and it is caused commonly from trauma due to fall, motor vehicle accident or sports. Thinning of the bone due to osteoporosis in the elderly can cause the bone to break easily. Overuse injuries are common cause of stress fractures in athletes.
Our body reacts to a fracture by protecting the injured area with a blood clot and callus or fibrous tissue. Bone cells begin forming on the either side of the fracture line. These cells grow towards each other and thus close the fracture.
The objective of early fracture management is to control bleeding, prevent ischemic injury (bone death) and to remove sources of infection such as foreign bodies and dead tissues. The next step in fracture management is the reduction of the fracture and its maintenance. It is important to ensure that the involved part of the body returns to its function after fracture heals. To achieve this, maintenance of fracture reduction with immobilization technique is done by either non-operative or surgical method.
Non-operative (closed) therapy comprises of casting and traction (skin and skeletal traction).
Closed reduction is done for any fracture that is displaced, shortened, or angulated. Splints and casts made up of fiberglass or plaster of Paris material are used to immobilize the limb.
Traction method is used for the management of fractures and dislocations that cannot be treated by casting. There are two methods of traction namely, skin traction and skeletal traction.
Skin traction involves attachment of traction tapes to the skin of the limb segment below the fracture. In skeletal traction, a pin is inserted through the bone distal to the fracture. Weights will be applied to this pin, and the patient is placed in an apparatus that facilitates traction. This method is most commonly used for fractures of the thighbone.
- Open Reduction and Internal Fixation (ORIF)
This is a surgical procedure in which the fracture site is adequately exposed and reduction of fracture is done. Internal fixation is done with devices such as Kirschner wires, plates and screws, and intramedullary nails.
- External fixation
External fixation is a procedure in which the fracture stabilization is done at a distance from the site of fracture. It helps to maintain bone length and alignment without casting.
External fixation is performed in the following conditions:
- Open fractures with soft-tissue involvement
- Burns and soft tissue injuries
- Pelvic fractures
- Comminuted and unstable fractures
- Fractures having bony deficits
- Limb-lengthening procedures
- Fractures with infection or nonunion
Fractures may take several weeks to months to heal completely. You should limit your activities even after the removal of cast or brace so that the bone become solid enough to bear the stress. Rehabilitation program involves exercises and gradual increase in activity levels until the process of healing is complete.
Trauma is any injury caused during physical activity, motor vehicle accidents, electric shock, or other activities. Sports trauma or sports injuries refer to injuries caused while playing indoor or outdoor sports and exercising. Sports trauma can result from accidents, inadequate training, improper use of protective devices, or insufficient stretching or warm-up exercises. The most common sports injuries are sprains and strains, fractures, and dislocations.
The most common treatment recommended for injury is rest, ice, compression and elevation (RICE).
- Rest: Avoid activities that may cause injury.
- Ice: Ice packs can be applied to the injured area which will help to diminish swelling and pain. Ice should be applied over a towel to the affected area for 15-20 minutes four times a day for several days. Never place ice directly over the skin.
- Compression: Compression of the injured area helps to reduce swelling. Elastic wraps, air casts, and splints can accomplish this.
- Elevation: Elevate the injured part above heart level to reduce swelling and pain.
Your doctor may recommend other treatments to help your injury heal. These include:
- Nonsteroidal Anti-Inflammatory Drugs: These drugs reduce swelling and pain.
- Immobilization: Immobilization is minimizing the movement of injured area to prevent further damage. It also reduces pain, swelling, and muscle spasm. Slings are given to immobilize the arms and shoulders.
- Rehabilitation: Rehabilitation involves exercises that get the injured area back to normal condition. Exercises start with gentle range-of-motion exercises followed by stretching and strengthening exercises.
- Other Therapies: Other common therapies that help in the healing of sports injuries include mild electrical currents (electrostimulation), cold packs or cryotherapy, heat packs or thermotherapy, high-frequency sound waves (ultrasound), massage and platelet rich plasma (PRP injections).
- Surgery: Surgery is the last resort for management and is indicated only if conservative techniques are not helpful. Surgeries are performed to repair torn tendons and ligaments or to realign the broken bones.