Closed Fracture Treatment
Most bone fractures heal in six to eight weeks; however, that may vary depending on the severity of the broken bone.

Human bones are very strong; however, they have a tendency to fracture when exposed to intense external forces. Fractures come in various shapes and sizes. A broken/fractured bone is a catastrophic injury, which makes daily life more difficult. 

A closed fracture occurs when the bone fractures but does not penetrate the skin, whereas, in an open fracture, the bone penetrates the skin. Closed fractures need surgery or treatment but not immediately because there is no risk of infection from the wound.

Sometimes, the skin may have a bleeding wound that is not too deep, implying no connection between the broken bone and the skin. Serious soft tissue injuries may necessitate rapid medical treatment or surgical intervention.

What are the nonsurgical ways to fix a closed fracture?

A closed reduction procedure with no skin incisions can be used to reset closed fractures without surgery. The bones are realigned before the injury is covered with a cast or splint. Closed reduction is often performed to treat fractures that have a single breakage site, as determined by an X-ray.

A closed fracture can be treated in the following ways:

  • Cast fixation
    • If the closed fracture is unstable, the injured limb or body part must be immobilized to ensure that the bones mend properly.
    • Although splints and braces can be used, the most frequent immobilization technique is using a plaster or fiberglass cast.
    • The cast encases the injured area, holding broken bones in place while they heal. It is very effective in preserving the alignment of broken bones during recovery.
  • External fixation
    • A method of treating closed fractures involves securing the bones in place without requiring open surgery.
    • This technique is used in case of a soft tissue injury, which makes open surgery risky, such as substantial swelling at the injury site.
    • In certain circumstances, external fixation is used as a first aid technique, followed by internal fixation once the edema or soft tissue damage has subsided.

What are the surgical ways to fix a closed fracture?

Open reduction internal fixation (ORIF) is a surgical procedure used to repair fractures that cannot be treated with a cast or splint. 

  • ORIF
    • A closed fracture is surgically realigned by creating an incision through the skin and binding the shattered bones together using plates, pins, and screws.
    • Pins work well for stabilizing tiny bones, such as those in the hands and wrists.
    • This method is frequently paired with an open reduction procedure to allow the person to have only one operation.
    • An intramedullary rod is a type of internal fixation in which a metal rod is placed into the hollow medullary canal of a damaged bone. This is the area of the bone that contains the marrow.
    • This approach is typically used for fractures in the lower extremities or those that are distant from the joints. People who undergo this treatment can walk and bear weight faster.
    • ORIF is beneficial if the fracture was not initially re-aligned by closed reduction and did not heal properly.

These treatments are sometimes combined, depending on particular circumstances. A closed fracture may be treated with a closed reduction technique followed by inserting pins percutaneously or without an open incision. During external fixation, percutaneous pin implantation is also done.

Every surgical procedure is different. The extent of your recovery is determined by the severity, type, and location of your fracture. If you have complications post-surgery, your recovery time may be extended.

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What is the procedure for a closed reduction?

To establish if a closed reduction is the best treatment choice, your orthopedic surgeon will evaluate you and take X-rays.

A closed reduction is a non-surgical procedure in which your orthopedic surgeon adjusts bone fragments back into their proper position and alignment. The technique is normally performed as an outpatient operation immediately after the fracture.

You will be given an anesthetic to block pain and discomfort before closed reduction begins. You may be awake or unconscious, depending on what you and your doctor decide. Your doctor will reposition the shattered bone fragments so that they can mend properly.

After your bone has been set, your doctor will take another X-ray to ensure it is in the proper position before covering it with a cast or splint to protect it while it heals.

The precise technique always necessitates the participation of two individuals (one to conduct the reduction maneuver and one to offer countertraction), with a third person required to apply the plaster.

Principles of reduction

Reduction is the process of restoring the anatomical alignment of a fractured or dislocated limb. Reduction facilitates the following:

  • Reduces traction on the surrounding soft tissues, resulting in reduced swelling
  • Lowers the risk of neuropraxia by applying less traction on the traversing nerves
  • Restores disrupted blood supply

The primary goal of any reduction, regardless of technique, is to rectify the deforming forces that caused the damage.

How long does a fracture take to heal?

Most fractures heal in six to eight weeks; however, this varies greatly from bone to bone and person to person because of the reasons mentioned above. Hand and wrist fractures typically heal in four to six weeks, whereas tibia fractures can take up to 20 weeks to recover.

The fracture healing period is separated into the following three stages:

  1. Inflammatory phase
    • Begins at the moment of damage and lasts about one to two weeks.
    • Bleeding around the fracture forms a hematoma (blood clot).
    • Tissue damage causes cell death, which is cleared up by an inflammatory reaction.
    • The blood clot forms a protein mesh in which the bone begins to form.
  2. Healing phase
    • The formation of a bone callus is an important part of the healing process. It appears at the site of the fracture about two to six weeks after the bone is broken. A bone callus usually starts as soft fibrous tissue and cartilage.
    • Calcium deposits in the callus and is seen in X-rays two to three weeks after the damage.
  3. Remodeling
    • About six weeks after the injury, the remodeling stage begins. The hard callus is replaced by regular bone at this stage.
    • An X-ray of the healing bone would show unevenness. However, the bone is reformed over the next few months to look like it did before the injury.
    • Remodeling continues for months after the fracture stops hurting and seems to have healed on X-rays.

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Medically Reviewed on 10/19/2022
References
Image Source: iStock image

Fractures (broken bones): https://www.mayoclinic.org/first-aid/first-aid-fractures/basics/art-20056641

Fractures: https://www.piedmont.org/orthopedic/fractures