Pediatrics - Fractures Treatment
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 fracture occurs, it produces a protective blood clot and callus at the end of the bones. The ends of the bones created new bone cells and blood vessels that grow towards each other. Once the fracture heals or closes, the callus is absorbed.
Your doctor will use your X-ray as a guide to “set” or position your child’s 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 special cast saw is used to carefully remove a cast. The cast saw can cut the cast material but not the skin.
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 will not 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 include 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 has 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.
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