The treatment for a fracture depends on the type of fracture and the bones that are involved. The goal of treatment is to align the fractured bones to allow them to heal. A fractured bone is able to grow back together. When a bone is fractured, it produces a protective blood clot and callus at the end of the bones. The callus includes cells that go through phases leading to eventual bone formation and healing.
Your doctor will use your X-ray as a guide to “set” or position your bones. Some bones can be kept in place with a cast while they heal. The cast keeps the bones from moving. The hard surface of the cast protects the injury. Casts are made of a variety of materials. They are usually worn for about one to two months, depending on the type of fracture and the bone involved.
A fracture which does not heal or "unite" within the usual period of time for that fracture is said to have delayed union. The reason for the delay is not always known, but usually results from excess motion at the fracture during healing or a poor blood supply. When healing does occur, it has taken longer than normal.
A nonunion is a fracture that just won't heal. This is usually determined by time and x-rays, which show that there is no possibility that the fracture will heal without additional intervention.
A malunion is a fracture that has healed in a position outside acceptable parameters. This can be any combination of angulation, displacement, malrotation or length differences.
Delayed unions, nonunions and malunions generally require additional treatment. Bone stimulators may be used to enhance fracture healing. These are usually used externally, but sometimes are placed surgically at the fracture site. They use either electricity or ultrasound which have been shown to enhance bone generation.
Malunions and many nonunions require surgery to heal properly. Direct access to the fracture is necessary to straighten the bone, in the case of a malunion, or to remove soft tissues and stimulate blood flow at the site of a nonunion. Bone grafts are typically placed to further enhance healing.
Your pain will probably cease before your fracture has completely healed. Your doctor will limit your activity while your bone is healing. An immobilized joint will become stiff and be difficult to move. Because of this, physical or occupational therapy usually follows fracture treatment. Your therapists will work with you to regain movement, strength, and flexibility that may have decreased while your bone or joint was immobile. Your therapists may apply modalities, such as heat or ultrasound, to improve blood flow, ease pain, and improve flexibility. Initial goals include pain relief and range of motion. This is followed by strengthening, and when necessary, balance retraining and sports or activity specific exercises. Your therapists can also recommend safety equipment that you can wear or use during sports, on the job, or with activities at home to support and protect your bones and joints.
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