Freqently asked questions in Fracture Clinics
What is the difference between a fracture and a break in the bone?
To medical professionals, there is no difference in these terms. Many patients assume that a break is worse than a fracture,
but we use these terms interchangeably.
Are fractures not all managed with a cast?
No. In fact many fractures are much better managed without a cast if possible. This is based on the 'stability' of the
fracture.
What are the factors that persuade surgeons to operate?
If a fracture is mal-aligned it should be 'reduced' (put back into proper alignment) before it 'sets'. This is usually
within 24hours, but can be anytime before about two week stage. Somtimes, fractures which are quite well aligned are known
to be 'unstable' and some sort of fixation is advised to avoid loss of position.
What are the options for holding a fracture until it is healed?
These are: traditional casting, bracing or splitage with off the shelf splints or even custom-made splints,
or internal fixation with thin wires, known a K (Kirschner) wires or plates and
screws. Internal fixation may also use nails (rods in the bone marrow, best for fractures of the
shaft of the bone). External fixation with frames is also commonly used and has the disadvantage of pin-site
infection and awkwardness, but this is offset by them being lighter than a cast, holding the bone more firmly than a cast,
allowing bathing (avoiding the itch of casts) and allowing joints either side of the fracture to move.
How does the doctor know when the bone is healed?
'Callus' (white cloudy new bone) appears on the x ray if one is taken. However, x rays are frequently not required as
a painless, stiff, strong bone is 'united'.
Is there anything I can eat or take to improve the healing?
If you are not vegan, and are eating a normal UK diet, there is no evidence that there is anything you can change in
your diet that will improve healing (including dairy products). Fracture healing can be enhanced by other means however (see
acceleration of fracture healing).
The fracture does not appear to be very well aligned on the x ray, but the surgeon says that is OK. Why is this?
In children in particular, the ability for the bone to remodel is extraordinary. Even in adults, some angulation or gap
is acceptable, particularly in midshaft fractures (less commonly in fractures that involve joints). If your surgeon feels
that the malalignment is acceptable and that the risks of surgery outweigh the benefits of correcting it further, then he
is likely to be right (even though this can sometimes be surprinsing). This does not mean you should not challenge the decision,
of course, if you wish. Surgeons are generally used to this and don't mind explaining.
