Did I Break the Bone or Just Fracture It?
Yadier Molina broke his wrist in May 2007 while catching for the St. Louis Cardinals, and some may be surprised that he may not have been casted for a few days. And while I don't understand the rules for baseball's injury reserve list (why was he put on the 15 day disabled list, when the team knows he will be out for four to six weeks?), I do however, know what's going on with fracture care.
First a few quick definitions.
Initially in the emergency department or the doctor's office, once the diagnosis of a fracture is made, and the decision is made that an operation is not needed, then the fracture is splinted. The splint is a bulky half cast that immobilizes the injury but also allows the routine swelling that occurs after a break. In a few days, if the patient has been following instructions, icing and elevating the injury, and the swelling is controlled, the splint is removed and a circular cast is applied. The cast gives better protection and allows the fractured bone to heal.
If a circular cast were put on immediately after the injury, then one of two things would happen. Either the area would swell, or the patient would return with intense pain because the cast acts like a tourniquet and cuts off blood supply, or the swelling that was already there might subside and the cast would become loose and have to be replaced.
On occasion, the orthopedic surgeon may choose to put on a cast right away to try to hold a fracture in place and hopefully prevent the need for an operation. This would require close follow-up to make certain the tourniquet effect of swelling did not occur.
Timing is the key to the care of broken bones. As long as alignment is reasonable, the skin is not broken, the blood vessels and nerves are still working, and the pain is controlled, then the opportunity exists to go a little slower with the decision making. For some fractures, the operating room is the only option, but for others, the body is pretty good at healing itself, if the docs can help it along.
Last Editorial Review: 10/5/2007