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What is the treatment for a broken bone?
The initial treatment of a fracture begins with stabilization and
immobilization. In the field RICE (rest, ice, compression and elevation) may
help make the patient more comfortable and prevent the fractured bones from
moving. Often the pain associated with a fracture is due to spasm of the muscles
surrounding the fracture site trying to prevent movement. Splinting may help
relieve some of that pain. Depending upon the injury, EMS providers may consider
traction to help with stabilization and pain control.
For non-open fractures, or other fractures that can be treated without emergency surgery, the
goal is to immobilize the injury to maintain anatomic alignment to allow the
bone to heal.
Bone heals in three stages.
Reactive stage: The blood clot that
forms at the fracture site begins to organize and the body's building blocks
start to bridge the gap between the two ends of the broken bone.
Repair stage: Specialized cells
located in the outer lining of the bone (periosteum), begin to form a lattice
work or grids of cartilage and bone, called a callus, which spans the fracture.
More bone is laid down to provide strength to the area.
Remodeling phase: Over the next few
years, the body will attempt to resculpt this mass of bone into it's original
size and shape.
In the emergency department, walk in clinic, or doctor's office, the extremity
is usually splinted using a combination of soft padding, casting material
(plaster, fiberglass), and ace wraps. This splint is not circumferential like a
cast, because a fracture has the potential for
swelling of the surrounding tissues, and if a tight cast were in place, that
swelling could cause complications including significant pain and potential
blood supply issues.
Once the patient is discharged, their instructions are to elevate the injury
and ice the area, even with the splint, to help decrease swelling and
After a few days, once the initial swelling has resolved, a circumferential
cast may replace the splint and will be worn until the fracture is healed. The
time frame for healing depends upon the type of fracture and its location.
X-rays may be used to help determine when it is time for the cast to be removed.
Finger and hand fractures may be more complicated. The hand is a complex web
of tendons, blood vessels, and nerves that allow fine motor function. What might
be acceptable healing and alignment in an arm or leg may not be appropriate in a
hand. Some finger injuries need nothing more than a metal splint or buddy taping
one finger to another for support, while others will need surgery. The type of
treatment will depend upon the type of injury.
Most toe injuries heal very well own and need nothing more than buddy
taping one toe to another for support.
The treatment for rib fractures involves pain control so that the patient can
take deep breaths and allow the lung to expand beneath the injury site to
prevent pneumonia. Rib injuries are not wrapped or
bandaged to help with pain control because this will limit their movement, and
prevent lung expansion. Because of this, rib fractures generally take 4 to 6 weeks to heal
and may cause pain throughout the healing process.