FRACTURES

Management of fractures

Bones may be fractured due to trauma such as a car accident or osteoporosis which causes weakening of bone density. As an experienced orthopaedic surgeon, Dr Khumalo is well-versed in the management of fractures in various parts of the body including the pelvis and acetabulum. Depending on the cause, fractures may vary. A fracture may be stable or an open compound fracture:

  • A stable fracture – the broken ends of the bone line up and are barely out of place.
  • An open, compound fracture – the skin may be pierced, and the bone may or may not be visible from the wound.

In addition the fracture line may be horizontal (known as a transverse fracture), angled (known as an oblique fracture) or comminuted in which the bone has shattered into fragments.

How are breaks managed?

Dr Khumalo prioritises blood supply and soft-tissue health during the initial management of fractures. After this, the management of fractures will depend on the severity and location of the break and may involve either non-surgical or surgical treatment.

Non-surgical methods may include immobilisation of the area in addition to splinting, casting, bracing or traction, while surgical approaches may be required for fractures including:

  • Unstable open fractures
  • Multiple traumatic injuries
  • Fractures of the vertebrae, femur, pelvis and the acetabulum
  • Fractures in growth areas
  • Non-union and malunion fractures

Treatment of these fractures may involve the following surgical approaches:

Open Reduction & Internal fixation

Internal fixation may be required for some fractures. During this surgery, the bone fragments are repositioned and a metal plate is attached internally to the outside of the bone with pins or screws, to join the broken bone. The bone fragments may also be held together by inserting rods through the bone marrow in the centre of the bone.

External fixation

External fixation is the surgical treatment of fractures in which a rigid frame is attached to the outside of the fracture site through wires or pins that are connected internally to the bone. This device stabilises the bone while it heals.

Fractures to the pelvis and acetabulum are however treated differently.

  • Pelvic fractures

    These fractures are usually caused by high impact trauma such as car accidents, or due to falls in the elderly. Because the pelvis is in proximity to major blood vessels and organs, fractures in this area may cause extensive bleeding and injuries that will require immediate attention. The pelvis is a ring-like structure, which means that fractures in this area are often accompanied by fractures or damage to ligaments in other areas of the pelvis. A pelvic fracture may be stable or unstable, and open or closed.

    The treatment for pelvic fractures will depend on the pattern of fracture, how many bones are displaced, whether the fracture is open or closed, and the associated injuries. Due to the area of the fracture, bracing and casting of the pelvis isn't possible. Therefore, non-surgical methods may include medication and walking aids such as crutches or a walker for up to three months until the fracture heals.

    Unstable and open pelvic fractures will require surgical treatments such as open reduction & internal fixation, external fixation or skeletal traction in which a pulley system of weights and counterweights is used to realign the pieces of bone.
  • Acetabulum fractures

    o Acetabulum fractures An acetabular fracture is a break in the socket portion of the "ball-and-socket" hip joint. These fractures are very rare but may be caused by high impact trauma such as car accidents, or due to falls in the elderly. Acetabular fractures may be stable or unstable, and open or closed but are often treated using surgery to stabilize the hip joint and restore its normal structure.

    The treatment for acetabulum fractures will depend on the pattern of fracture, how many bones are displaced, whether the fracture is open or closed, and the associated injuries. As with pelvic fractures, the non-surgical methods may include medication, positioning aids and walking aids such as crutches or a walker for up to three months until the fracture heals.

    Because acetabular fractures often damage the cartilage on the surface of the bone, surgical treatments are often needed. Open reduction & internal fixation may be done to reconstruct the normal anatomy of the hip joint by aligning the bone fragments, restoring the cartilage surface and fitting the femoral head back into the hip socket. Skeletal traction may also be used, in which a pulley system of weights and counterweights is used to realign the pieces of bone and pull the thighbone into position.

    For severe fractures where the acetabulum is too damaged, repair may not provide a good long-term result. In these cases, a total or half Hip Replacement may be better suited. During either of these surgeries, the damaged bone and cartilage is removed and replaced with prosthetic parts.

What does recovery entail?

Depending on the severity and the specific location of the fracture, the bone may take several weeks to heal. You may also be advised to have physiotherapy to regain the strength of the muscles in the area where the fracture took place. Future fractures may be prevented with a proper diet rich in calcium and Vitamin D will promote bone strength.

Read more 

Dr Dlozi Khumalo is a compassionate Specialist Orthopaedic Surgeon with a keen interest in spinal conditions, hip and knee replacements, hand & foot surgery and limb reconstructive surgery. Feel free to make an appointment at his Benoni based practice.

Suite 4, 2nd Floor, Sunshine Hospital, 1522 Soma Street, Actonville, Benoni, 1501

+27 (0)11 898 8000