Fracture Treatment and Best Trauma Doctors in Delhi

What are ankle fractures?

The ankle joint is composed of three bones: the tibia, fibula, and talus which are articulated together. The ends of the fibula and tibia (lower leg bones) form the inner and outer malleolus, which are the bony protrusions of the ankle jointthat you can feel and see on either side of the ankle. The joint is protected by a fibrous membrane called a joint capsule, and filled with synovial fluid to enable smooth movement.

Ankle injuries are very common in athletes and in people performing physical work, often resulting in severe pain and impaired mobility. Pain after ankle injuries can either be from a torn ligament and is called ankle sprain or from a brokenbone which is called ankle fracture. Ankle fracture is a painful condition where there is a break in one or more bones forming the ankle joint. The ankle joint is stabilized by different ligaments and other soft tissues, which may also be injuredduring an ankle fracture.

What are the causes of ankle fractures?

Ankle fractures occur from excessive rolling and twisting of the ankle, usually occurring from an accident or activities such as jumping or falling causing sudden stress to the joint.

What are the symptoms associated with ankle fractures?

With an ankle fracture, there is immediate swelling and pain around the ankle as well as impaired mobility. In some cases blood may accumulate around the joint, a condition called hemarthrosis. In cases of severe fracture, deformity around theankle joint is clearly visible where bone may protrude through the skin.

What are the types of ankle fractures?

Ankle fractures are classified according to the location and type of ankle bone involved. The different types of ankle fractures are:

• Lateral Malleolus fracture in which the lateral malleolus, the outer part of the ankle is fractured.
• Medial Malleolus fracture in which the medial malleolus, the inner part of the ankle, is fractured.
• Posterior Malleolus fracture in which the posterior malleolus, the bony hump of the tibia, is fractured.
• Bimalleolar fractures in which both lateral and medial malleolus bones are fractured
• Trimalleolar fractures in which all three lateral, medial, and posterior bones are fractured.
• Syndesmotic injury, also called a high ankle sprain, is usually not a fracture, but can be treated as a fracture.

Diagnosis of ankle fractures

The diagnosis of the ankle injury starts with a physical examination, followed by X-rays and CT scan of the injured area for a detailed view. Usually it is very difficult to differentiate a broken ankle from other conditions such as a sprain, dislocation, or tendon injury without having an X-ray of the injured ankle. In some cases, pressure is applied on the ankle and then special X-rays are taken. This procedure is called a stress test. This test is employed to check the stability of thefracture to decide if surgery is necessary or not. In complex cases, where detail evaluation of the ligaments is required an MRI scan is recommended.

Treatment of ankle fractures

Immediately following an ankle injury and prior to seeing a doctor, you should apply ice packs and keep the foot elevated to minimize pain and swelling.

The treatment of ankle fracture depends upon the type and the stability of the fractured bone. Treatment starts with non-surgical methods, and in cases where the fracture is unstable and cannot be realigned, surgical methods are employed.

In non-surgical treatment, the ankle bone is realigned and special splints or a plaster cast is placed around the joint, for at least 2-3 weeks.

With surgical treatment, the fractured bone is accessed by making an incision over the ankle area and then specially designed plates are screwed onto the bone, to realign and stabilize the fractured parts. The incision is then sutured closed andthe operated ankle is immobilized with a splint or cast.

Post-operative care following ankle fractures

After ankle surgery, you will be instructed to avoid putting weight on the ankle by using crutches while walking for at least six weeks.

Physical therapy of the ankle joint will be recommended by the doctor. After 2-3 months of therapy, the patient may be able to perform their normal daily activities.

Risks associated with treatment of ankle fractures

Risks and complications that can occur with ankle fractures include improper casting or improper alignment of the bones which can cause deformities and eventually arthritis. In some cases, pressure exerted on the nerves can cause nerve damage, resulting in severe pain.

Rarely, surgery may result in incomplete healing of the fracture, which requires another surgery to repair.

The foot has 26 bones, and can be divided into 3 parts:

• The hind foot is comprised of two bones, the talus bone which connects to the bones of the lower leg, and the calcaneus bone which forms the heel.
• The midfoot is comprised of the navicular, cuboid, and three cuneiform bones.
• The forefoot is made up of five metatarsal bones and 14 toe bones called phalanges.

The hind foot is separated from the midfoot by the mediotarsal joint and the midfoot is separated from the forefoot by the lisfranc joint. Muscles, tendons and ligaments support the bones and joints of the feet enabling them to withstand theentire body's weight while walking, running and jumping. Despite this, trauma and stress can cause fractures in the foot. Extreme force is required to fracture the bones in the hind foot. The most common type of foot fracture is a stress fracture, which occurs when repeated activities produce small cracks in the bones.

Types of foot fractures

Foot fractures can involve different bones and joints and are classified into several types:

• Calcaneal fractures: This type affects the heel bone and occurs mostly as a result of high-energy collisions. It can cause disabling injuries and if the subtalar joint is involved it is considered a severe fracture.
• Talar fractures: The talus bone helps to transfer weight and forces across the joint. Talus fractures usually occur at the neck or mid portion of the talus.
• Navicular fractures: Navicular fractures are rare and include mostly stress fractures that occur with sports activities, such as running and gymnastics, as a result of repeated loading on the foot.
• Lisfranc fractures: This type of fracture occurs due to excessive loading on the foot, which leads to stretching or tearing of the midfoot ligaments.

Causes of foot fractures

Foot fractures commonly occur as a result of a fall, motor vehicle accident, dropping a heavy object on your foot, or from overuse such as with sports.

Symptoms of foot fractures

The common symptoms of a foot fracture include pain, bruising, tenderness, swelling, deformity and inability to bear weight.

Diagnosis of foot fractures

Your doctor diagnoses a foot fracture by reviewing your medical history and performing a thorough physical examination of your foot. Imaging tests such as X-rays, MRI or CT scan may be ordered to confirm the diagnosis. Navicular fractures can beespecially difficult to diagnose without imaging tests.

Treatment of foot fractures

Treatment depends on the type of fracture sustained. For mild fractures, nonsurgical treatment is advised and includes rest, ice, compression, and elevation of the foot. Your doctor may suggest a splint or cast to immobilize the foot. For moresevere fractures, surgery will be required to align, reconstruct or fuse the joints. Bone fragments may be held together with plates and screws.

Physical therapy may be recommended to improve range of motion and strengthen the foot muscles. Weight bearing however should be a gradual process with the help of a cane or walking boot.

What is a heel fracture?

The calcaneus or heel bone is a large bone found on the rear part of the foot. The calcaneus connects with the talus and cuboid bones to form the subtalar joint of the foot. A fracture is a break in a bone from trauma or various diseaseconditions. The types of fracture to the calcaneus depend on the severity and include stable fractures, displaced fractures, open fractures, closed fractures and comminuted fractures.

What are the causes of heel fractures?

A fracture of the calcaneus is most commonly due to a traumatic event such as falling from a height, twisting injury, motor accidents, sports injuries and ankle sprain.

Complications of heel fractures

Fracture of the calcaneus is considered serious and can cause longstanding problems if not treated correctly. Stiffness and pain in the joint and arthritis are commonly reported risks of a calcaneal fracture.

Symptoms of heel fractures

The commonly seen signs and symptoms of calcaneal fractures are

• Pain in the heel
• Swelling in the heel
• Bruises in the heel
• Inability to walk or bear weight on the foot

Diagnosis of heel fractures

The evaluation of the calcaneal fracture is done by imaging i.e., X-ray and CT scan. Based on the severity of the fracture, the doctor recommends the plan of treatment.

Treatment of heel fractures

Calcaneal fractures are treated based on the type of fracture and extent of soft tissue damage.

• Nonsurgical treatment
  • Rest, ice, compression, and elevation (R.I.C.E.) – is the most commonly used treatment option. Staying off (resting) the injured foot can heal the fracture to a great extent. Covering the affected area with ice packs over a towel reducesswelling and pain. Compression stockings and elastic bandages can also aid in healing the pain. Positioning the feet above the level of heart reduces swelling.
  • Immobilization – Casting the injured foot prevents the fractured bone from moving. Walking with the help of crutches is advisable to avoid bearing body weight until healing has occurred.
• Surgical treatment
  • Open reduction and internal fixation – This surgery involves putting the bone fragments back together with metal plates and screws to reposition them and set them to normal alignment.
  • Percutaneous screw fixation – This is the best preferred treatment in cases where the bone pieces are large. The bone can either be pushed or pulled to set into place without making a large incision. Metal screws are then inserted and fixedthrough small incisions to hold the bone pieces together.

Rehabilitation after heel fracture

Irrespective of the treatment procedure, the patient is recommended to undergo physiotherapy and practice simple exercises regularly to help restore function. This would help the muscles to gain flexibility and after complete recovery, thepatient can resume their daily living with normal activities.

Diagnosis of Lisfranc fracture

The doctor will first examine thephysical condition of the foot by inspection and palpation (feeling with hands). You may be advised to get an X-ray taken. You might also be sent to get a CT or MRI scan done to provide more information about your condition.

Treatment of Lisfranc fracture

If imaging scans show midfoot instability, surgical fixation is usually recommended to help reduce the chance of late arthritis. Sometimes midfoot fusion is needed.

What are hip fractures?

The hip joint is a "ball and socket" joint. The "ball" is the head of the femur or thigh bone and the "socket" is the cup shaped acetabulum. The joint surface is covered by a smooth articular surface that allows pain free movement in the joint.

A hip fracture is a break that occurs near the hip in the upper part of the femur or thigh bone. The thigh bone has two bony processes on the upper part – the greater and lesser trochanters. The lesser trochanter projects from the base of thefemoral neck on the back of the thigh bone.

What are the causes of hip fractures?

Hip fractures can occur either due to a break in the femoral neck, in the area between the greater and lesser trochanter or below the lesser trochanter. Hip fracture is most frequently caused after minor trauma in elderly patients with weak bones, and by a high-energy trauma or serious injuries in young people. Long term use of certain medicines, such as bisphosphonates to treat osteoporosis (adisease causing weak bones) and other bone diseases, increases the risk of hip fractures.

What are the symptoms associated with hip fractures?

Signs and symptoms of hip fracture include

• Pain in the groin or outer upper thigh
• Swelling and tenderness
• Discomfort while rotating the hip
• Shortening of the injured leg
• Outward or inward turning of the foot and knee of the injured leg

Diagnosis of hip fractures

Your doctor may order an X-ray to diagnose your hip fracture. Other imaging tests, such as the magnetic resonance imaging or (MRI), may also be performed to detect the fracture.

Depending on the area of the upper femur involved, hip fractures are classified as

• Intracapsular Fracture
• Intertrochanteric Fracture
• Subtrochanteric Fracture

Treatment of hip fractures

Hip fractures can be corrected and aligned with non-operative and operative methods:

Traction may be an option to treat your condition if you are not fit for surgery. Skeletal traction may be applied under local anaesthesia, where screws, pins and wires inserted into the femur and a pulley system is set up at the end of the bedto bear heavy weights. These heavy weights help in correcting the misaligned bones until the injury heals.

Hip fractures can be surgically treated with external fixation, intramedullary fixation, or by using plates and screws.

What are pelvic fractures?

A pelvic fracture is a condition that arises due to breakage of the pelvis bones. It may damage internal organs, nerves, and blood vessels associated with the pelvis region.

The pelvis is a round structure of bones located at the base of the spine, connected to the sacrum of the spine with the help of strong ligaments. The pelvis is composed of three bones, namely ilium, ischium, and pubis that are fused together. The side of the pelvis is composed of a cup shape socket, known as acetabulum.

Various organs related to the digestive and reproductive systems lie within the pelvis ring. Also, several large nerves and blood vessels supplying the lower limbs pass through the pelvis. The pelvis ring also acts as point of attachment formuscles approaching from the upper and lower part of the body.

Based on the damage of the pelvis ring and associated structures, pelvic fractures can be categorized as:

• Stable pelvic fractures: Have single point breakage in the pelvis ring and broken bones remain in position; shows less bleeding
• Unstable pelvic fractures: Have breakage at two or more points, followed by severe bleeding. Unstable pelvic fractures may cause shock, extensive internal bleeding, and damage to the internal organs. It requires immediate medical care followedby long-term physical therapy and rehabilitation.

What are the causes of pelvic fractures?

The common causes responsible for pelvic fractures include:

• Sports injuries or trauma
• Abrupt muscle contraction
• Conditions such as osteoporosis, especially in elderly people
• Accidental injury or fall from a great height

Symptoms of pelvic fractures

The common symptoms associated with pelvic fractures are:

• Pain and swelling in the groin or hip region that may worsen with ambulation
• Abdominal pain
• Bleeding through the urethra or vagina and the rectum
• Problems in urination
• Unable to stand or walk

Diagnosis of pelvic fractures

The diagnosis of pelvic fracture starts with physical examination including checking the functional activity of the various body organs present in the pelvic region. Imaging techniques such as X-rays, CT (Contrast Tomography) and MRI (MagneticResonance Imaging) scan may also be used to confirm the exact condition or breakage of the pelvic bones. In some cases, additional contrasting studies using radioactive dye may be recommended to evaluate the structural and functional activity oforgans such as the urethra, bladder, and the pelvic blood vessels.

Treatment of pelvic fractures

Treatment of the pelvic fracture depends upon the severity of the injury and condition of the patient. Minor or stable fractures can be treated with conservative methods such as rest, medications, use of crutches, physical therapy, and ifrequired minor surgery. These methods may take 8–12 months for complete healing.

The treatment of unstable fractures includes management of the bleeding and injuries of the internal organs, blood vessels, and nerves. Surgical intervention may be employed for fixation of the fractured pelvic bones using screws and plates. Pelvic bone fixation provides stability to the pelvic bone and promotes natural healing of the fracture.

What is a proximal tibia fracture?

The tibia or shin bone is a major bone of the leg which connects the knee to the ankle. A tibial fracture is a break in the continuity of the shin bone (tibia). A proximal tibial fracture is a break in the upper part of the shin bone or tibia. Proximal tibial fractures may or may not involve the knee joint. Fractures that enter the knee joint may cause joint imperfections, irregular joint surfaces, andimproper alignment in the legs. This can lead to as joint instability, arthritis, and loss of motion.

What are the causes of proximal tibia fractures?

These fractures are caused by stress or trauma or in a bone already compromised by disease, such as cancer or infection. Proximal tibia fracturescan result in injury to the surrounding soft tissues including skin, muscle, nerves, blood vessels, and ligaments.

What are the symptoms of proximal tibia fractures?

The symptoms of tibia fracture include painful weight bearing movements, tenseness around the knee, limitation of movement and deformity around the knee. In some individuals, impairment of blood supply secondary to the fracture may result in apale or cool foot. Patients may also experience numbness or feelings of ‘pins and needles' in the foot as a result of associated nerve injury.

Diagnosis of proximal tibia fractures

The diagnosis of tibial fracture is based on the medical history including history of any previous injuries, complete physical examination and imaging studies. The physician will evaluate a soft tissue around the joint to identify any signs ofnerve or blood vessel injury. Multiple X-rays and other imaging studies such as CT and MRI scans may be used to identify the location and severity of the fracture.

Treatment of proximal tibia fractures

The management of the fracture is based on the severity of the fracture, medical condition of the patient and the patient's lifestyle.

Non-surgical treatment comprises of immobilizing the fractured site with the help of casts or braces to prevent weight bearing and to help the healing process. X-rays are taken at regular intervals to assess the healing process. Weight bearingand movement are initiated gradually, depending on the nature of the injury and the condition of the patient.

Surgical treatment is considered to maintain alignment of the fractured bone. External or internal fixators may be used to align the fractured bone segments. If the fracture does not involve the knee joint, rods and plates can be used tostabilize the fracture. For a fracture involving the knee joint, a bone graft may be required to prevent the knee joint from collapsing. An external fixator is used when the surrounding soft tissue is severely damaged, as the use of plate and screwmay be harmful.

As the tibial fracture usually involves the weight bearing joint it may cause long term problems such as loss of knee motion or instability and long-term arthritis. Hence a rehabilitation program is initiated along with the treatment comprisingof instructions on weight bearing, knee movements, and the use of external devices such as braces.

What are paediatric femur fractures?

The femur or thighbone is the largest and strongest bone in the human body. Paediatric thighbone fractures can occur when your child falls hard on the ground and gets hit during sports, automobile accidents, and child abuse. In a thighbonefracture, the broken bones may be aligned or displaced. The fracture can either be closed (with skin intact) or open (with the bone piercing out through the skin).

What are the symptoms of paediatric femur fractures?

Your child may experience severe pain, swelling, inability to stand and walk, andlimited range of motion of hip or knee.

Diagnosis of paediatric femur fractures

Your child's doctor will conduct a physical examination. An X-ray or CT-scan may be recommended to locate the position and number of fractures and determine if the growth plate is damaged.

Treatment of paediatric femur fractures

Femur fractures may be treated with non-surgical orsurgical methods.

Non-surgical treatment involves stabilizing the bones so they can heal and fuse together. Braces, spica casting (cast applied from the chest, down the fractured leg) or traction (placing the leg in a weight system) may be used to ensure that thebones are properly set in their normal position.

Surgery is recommended for complicated injuries. Your child's surgeon aligns the broken bones and uses metal plates and screws to hold the fractured bones together in proper alignment. Your child may have to wear a cast for a few weeks untilcomplete healing. An external fixator may be used in case of open injury to the skin and muscles.

What are shinbone fractures?

The tibia or shin bone is a major bone of the leg which connects the knee to the ankle. A tibial fracture is a break in the continuity of the shin bone (tibia).

Types of shinbone fractures

• Fractures of proximal tibia: A proximal tibial fracture is a break in the upper part of the shin bone or tibia. Proximal tibial fractures may or may not involve the knee joint. Fractures that enter the knee joint may cause joint imperfections, irregular joint surfaces, andimproper alignment in the legs. This can lead to as joint instability, arthritis, and loss of motion. These fractures are caused by stress or trauma or in a bone already compromised by disease, such as cancer or infection. Proximal tibia fracturescan result in injury to the surrounding soft tissues including skin, muscle, nerves, blood vessels, and ligaments.
• Tibial shaft fractures: A tibial shaft fracture is a break that occurs along the length of the tibia or shin bone (larger bone of the lower leg) between the knee and ankle joints. These fractures can occur while playing sports such as soccer and skiing.

What are the symptoms of shinbone fractures?

The symptoms of tibia fracture include painful weight bearing movements, tenseness around the knee, limitation of movement and deformity around the knee. In some individuals, impairment of blood supply secondary to the fracture may result in apale or cool foot. Patients may also experience numbness or feelings of ‘pins and needles' in the foot as a result of associated nerve injury.

Diagnosis of shinbone fractures

The diagnosis of tibial fracture is based on the medical history including history of any previous injuries, complete physical examination and imaging studies. The physician will evaluate a soft tissue around the joint to identify any signs ofnerve or blood vessel injury. Multiple X-rays and other imaging studies such as CT and MRI scans may be used to identify the location and severity of the fracture.

Treatment of shinbone fractures

The management of the fracture is based on the severity of the fracture, medical condition of the patient and the patient's lifestyle.

Non-surgical treatment comprises of immobilizing the fractured site with the help of casts or braces to prevent weight bearing and to help the healing process. X-rays are taken at regular intervals to assess the healing process. Weight bearingand movement are initiated gradually, depending on the nature of the injury and the condition of the patient.

Surgical treatment is considered to maintain alignment of the fractured bone. External or internal fixators may be used to align the fractured bone segments. If the fracture does not involve the knee joint, rods and plates can be used tostabilize the fracture. For a fracture involving the knee joint, a bone graft may be required to prevent the knee joint from collapsing. An external fixator is used when the surrounding soft tissue is severely damaged, as the use of plate and screwmay be harmful.

As the tibial fracture usually involves the weight bearing joint it may cause long term problems such as loss of knee motion or instability and long-term arthritis. Hence a rehabilitation program is initiated along with the treatment comprisingof instructions on weight bearing, knee movements, and the use of external devices such as braces.

What are femur fractures?

The femur or thigh bone is the longest and strongest bone in the body, connecting the hip to the knee. A femur fracture is a break in the femur. The distal femur is the lower part of the thigh bone which flares out like an upside-down funnel andits lower end is covered by a smooth, slippery articular cartilage that protects and cushions the bone during movement. Fracture of the distal femur may involve the cartilaginous surface of the knee as well and result in arthritis.

Types of femur fractures

• Distal femur fracture: The distal femur is part of the femur bone that flares out like the mouth of the funnel. A distal femur (top part of knee joint) fracture is a break in thighbone that occurs just above your knee joint.
• Femoral shaft fracture: A femoral shaft fracture is a break that occurs anywhere along the femoral shaft, long, straight part of the femur.
• Proximal femur fracture: A hip fracture or proximal femur fracture is a break in the proximal end of the thigh bone near the hip.

What are the causes of femur fractures?

Femur fractures may be caused by high energy injuries such as a fall from height or a motor vehicle accident. Patients with osteoporosis, bone tumour or infections, or a history of knee replacement are more prone to femur fractures. In theelderly, even a simple fall from a standing position may result in a fracture as the bones tend to become weak and fragile with advancing age.

What are the symptoms associated with femur fractures?

Sudden, severe pain along with swelling and bruising are the predominant symptoms of femur fracture. The site is tender to touch with a visible physical deformity and shortening of the leg.

Diagnosis of femur fractures

The diagnosis of femur fracture is based on the patient's medical history including history of any previous injuries, complete physical examination and imaging studies. The physician will evaluate the soft tissue around the joint to identify anysigns of nerve or blood vessel injury. Multiple X-rays and other imaging studies such as CT and MRI scans may be used to identify the location and severity of the fracture.

Treatment of femur fractures

The management of the fracture is based on the severity of the fracture, medical condition of the patient and the patient's lifestyle.

Non-surgical treatment comprises of immobilizing the fractured site with the help of casts or braces to prevent weight bearing and to help the healing process. X-rays are taken at regular intervals to assess the healing process. Weight bearingand movement are initiated gradually, depending on the nature of the injury and the condition of the patient.

Surgical treatment is considered to realign the fractured bone. The use of advanced technology and special materials has improved the surgical outcome even in older patients. External or internal fixation or a knee replacement may be requireddepending on the extent of the fracture. Timing of the surgery is an important factor in improving the surgical outcome.

Timing of surgery

In most cases, the surgery is delayed for a few days to develop an effective treatment plan and for preparation of the patient. With most distal femur fractures the surgery can be delayed unless the fracture is open to the environment.

External fixator

An external fixator is used when the surrounding soft tissue is severely damaged, as the use of plates and screws may be harmful. The external fixator maintains the alignment of the bone till surgery.

Once the patient is prepared for surgery, the surgeon removes the external fixator and places internal fixation devices into the bone during surgery.

Internal fixator

The internal fixation may be performed using intramedullary nailing or plates and screws. In intramedullary nailing a metal rod is inserted into the marrow canal of the femur to keep the fractured fragment in position. In the plate and screwmethod the bone fragments are realigned and held together with screws and plates, attached to the outer surface of the bone. If the fracture is of the comminuted type or the bone has broken into many pieces, plates or rods may be used at the ends ofthe fracture without disturbing the smaller pieces. The plate or rod will maintain the shape or strength of the bone till it heals. In elderly patients and those with poor bone quality, bone grafting may be used to improve the healing. Kneereplacement may also be considered in complicated fractures or those with poor bone quality.

Knee replacement

Artificial implants may be used to replace the fractured segments of the bone and joint.

Rehabilitation after a femur fracture

Rehabilitation of the femur fracture depends upon several factors such as age, general health of the patient and the type of fracture. As the femur fracture usually involves the weight bearing joint it may cause long term problems such as lossof knee motion or instability and long term arthritis. Hence a rehabilitation program is initiated along with the treatment comprising of instructions on weight bearing, knee movements, and the use of external devices such as braces.

What is a broken arm?

The forearm is made up of 2 bones namely the radius and ulna. The primary function of your forearm is rotation i.e., the ability to turn your palms up and down. The fracture of the forearm affects the ability to rotate your arm, as well as bendand straighten the wrist and elbow. The breaking of the radius or ulna in the middle of the bone requires a strong force and it is most commonly seen in adults. In most of the cases, both bones are broken during a forearm fracture.

The forearm bones can break in several ways. The bones can crack slightly or can break into many pieces.

What are the causes of a broken arm?

Forearm fractures are generally due to automobile accidents; direct blow on the forearm or fall on an outstretched arm during sports, climbing stairs, etc.

Symptoms of a broken arm

The symptoms of a forearm fracture include intense pain in the arm, bruises and swelling. Your fractured forearm may appear bent and shorter compared to your other arm. You may experience numbness or weakness in the fingers and wrist. You may beunable to rotate your arm. Rarely, a broken bone sticks out through the skin or the wound penetrates down to the broken bone.

Diagnosis of broken arm

Your doctor may conduct a physical examination and record your medical history initially. Your doctor may feel your arm thoroughly to determine tenderness. You may be asked to get an X-ray done to determine displaced or broken bones.

Treatment of broken arm

Usually people with forearm fractures are immediately rushed to the emergency room for treatment. Treatment of forearm fracture aims at putting back the broken bones into position and preventing them from moving out of place until they arecompletely healed.

Nonsurgical Treatment

In case only one bone is broken and is not out of place, your doctor might treat it with a cast or brace and provide a sling to keep your arm in position. Your doctor will closely monitor the healing of the fracture. If the fracture shifts inposition, you may be advised to undergo surgery to fix the bones back together.

Surgical treatment

When both forearm bones are broken, surgery is usually required. During surgery, the cuts from the injury will be cleaned and the bone fragments are repositioned into their normal alignment. They are held together with screws and metal platesattached to the outer surface of the bone. The incision is sutured firmly and a sling is provided to facilitate healing.

What is a broken collarbone?

The clavicle or the collarbone is the bone that connects your sternum or breastbone to your shoulder. Clavicle fracture, also called broken collarbone is a very common sports injury seen in people who are involved in contact sports such asfootball and martial arts as well as impact sports such as motor racing.

What are the causes of a broken collarbone?

A broken collarbone normally occurs after a fall onto the shoulder or a motor vehicle accident. The most common sports associated with clavicle fractures include football, hockey, and skiing.

Symptoms of broken collarbone

A broken collarbone most often causes pain, swelling and bruising over the collarbone. Pain increases with shoulder movement. Your shoulder may be slumped downward and forward. You may also have a bump around the area of the break. You may heara grinding sound when you try to raise your arm.

Diagnosis of broken collarbone

To diagnose a broken collarbone, your doctor will take a brief history, about the injury, and perform a physical examination of your shoulder. An X-ray of the clavicle is taken to identify the location of the fracture. Your doctor may alsorecommend a computerized tomography (CT) scan in some cases.

Treatment of broken collarbone

Conservative Treatment Options

Most broken collarbones heal without a surgery. An arm sling may support the arm and hold the bones in their normal position. You may also be given pain medications to relieve the pain. After your pain reduces your doctor may recommend gentleshoulder and elbow exercises to minimize stiffness and weakness in your shoulder. Follow up with your doctor until your fracture heals.

Surgery

Surgery may be required in case of displaced fractures. Surgery is performed to re-align the fractured ends and stabilize them during healing. Surgery often involves use of pins or plates and screws to maintain proper position of the bone duringhealing.

Plates and Screws fixation

During this surgical procedure, your surgeon will reposition the broken bone ends into normal position and then uses special screws or metal plates to hold the bone fragments in place. These plates and screws are usually left in the bone. Ifthey cause any irritation, they can be removed after fracture healing is complete.

Pins

Placement of pins may also be considered to hold the fracture in position and the incision required is also smaller. They often cause irritation in the skin at the site of insertion and have to be removed once the fracture heals.

How do elbow fractures occur in children?

The elbow is a joint that consists of three bones – the humerus (upper arm bone), radius (forearm bone) and ulna (forearm bone). An elbow fracture most commonly occurs when your child falls on an outstretched arm. Fractures are more common in children due to their physical activities as well as their bone properties. Children’s bones have an area of developing cartilage tissue called a growth plate which is present at the end of long bones that will eventually develop into solid bone as the child grows.

What are the symptoms associated with elbow fractures in children?

An elbow fracture can lead to severe pain in the elbow and numbness in the hand.

Diagnosis of elbow fractures in children

Your child's doctor first evaluates your child's arm for signs of damage to blood vessels and nerves. An X-ray examination is then ordered to confirm and determine the severity of the fracture.

Treatment of elbow fractures in children

Treatment of elbow fractures depends on the degreeof displacement and type of fracture:

• Nonsurgical treatment: If there is little or no displacement from the normal position, nonsurgical treatment is recommended. Your child's doctor may immobilize the arm using a cast for 3 to 5 weeks. Regular X-rays are ordered to check if the bones are properly aligned.
• Surgical treatment: Surgery may be recommended if the fracture has caused the bones to move out of alignment. Your child's doctor brings the bones in correct alignment and may use metal pins, screws and wires to hold the bones in place. Your child will have to weara cast for a few weeks. Exercises to improve the range of motion will be instructed after a month of healing.

How do forearm fractures occur in children?

The radius (bone on the thumb side) and ulna (bone on the little-finger side) are the two bones of the forearm. Forearm fractures can occur near the wrist, near the elbow or in the middle of the forearm. Apart from this, the bones in childrenare prone to a unique injury known as a growth plate fracture. The growth plate, which is made of cartilage (flexible tissue) is present at the ends of the bones in children and helps in the determination of length and shape of the mature bone.

The healing of fractures in children is quicker than that in adults. Thus, if a fracture is suspected in a child, it is necessary to seek immediate medical attention for proper alignment of the bones.

Types of fractures

Forearm bones may break in many ways. Fractures may be "open" where the bone protrudes through the skin, or "closed" where the broken bone does not pierce the skin. The common types of fractures in children include:

• A stable fracture that compresses the bone on one side, forming a buckle on the opposite side of the bone, without breaking the bone (Buckle or torus fracture)
• One side of the bone breaks and bends the bone on the other side (Greenstick fracture)
• Displacement of the radius, and dislocation of the ulna at the wrist where both bones meet (Galeazzi fracture)
• Fracture affecting the upper or lower portion of the bone shaft (Metaphyseal fracture)
• Fractured ulna and dislocated head of the radius (Monteggia fracture)
• Fracture occurring at or across the growth plate (Growth plate fracture)

What are the causes of forearm fractures in children?

Forearm fractures in children are caused due to a fall on an outstretched arm or direct hit on the forearm, which may result in breakage of one or both bones (radius and ulna).

What are the signs and symptoms of forearm fractures in children?

A fractured forearm causes severe pain and numbness. Other signs and symptoms include:

• Swelling
• Tenderness
• Inability to turn or rotate the forearm
• Deformed forearm, wrist or elbow
• Bruising or discoloration of the skin
• Popping or snapping sound during the injury

Diagnosis of forearm fractures in children

Forearm fractures in children can be diagnosed by analysing X-ray images of the wrist, elbow or the forearm.

Treatment of forearm fractures in children

The treatment of forearm fractures in children is based on the location, type of fracture, degree of bone displacement and its severity.

Non-surgical therapy

Your child's doctor will advise you to apply an ice pack over a thin towel on the affected area for 15-20 minutes 3-4 times a day, to relieve pain and swelling. For severe angled fractures, in which the bones have not broken through the skin, your doctor will align the bones properly without the need for surgery (closed reduction). A splint or cast may be required for 3 to 4 weeks for a stable buckle fracture. Immobilization for 6 to 10 weeks is recommended for more serious fractures.

Surgical treatment

Surgery may be necessary for severe fractures such as fractures of the growth plate or the joint. Other conditions, such as broken skin, bone displacement, unstable fractures, misaligned bones, and bones healing in an improper position may alsorequire surgical repair. Your surgeon will first align the bones through an incision and use fixation devices like pins or a metal implants to hold the bones in place while the wound heals. A cast or a splint may be placed to hold the bones in place.

Conclusion

In the long run, the forearm of your child may have a slightly different or crooked look than before the fracture, which is normal. It may take around 1-2 years for the bones of the forearm to straighten while the bones undergo the process ofremodelling (reshaping). For growth plate fractures, your child's doctor will carefully monitor the hand for many years to ensure that growth occurs normally.

What is a scapular fracture?

The scapula (shoulder blade) is a flat, triangular bone providing attachment to the muscles of the back, neck, chest and arm. The scapula has a body, neck and spine portion.

What are the causes of scapular fractures?

Scapular fractures are uncommon but do occur and require a large amount of force to fracture. They are usually the result of intense trauma, such as a high-speed motor vehicle accident or a fall from height onto one's back. They can also occurfrom a fall on an outstretched arm if the humeral head impacts on the glenoid cavity.

What are the symptoms associated with scapular fractures?

Symptoms of a scapular fracture include the following:

• Pain: Usually severe and immediate following injury to the scapula.
• Swelling: The scapular area quickly swells following the injury.
• Bruising: Bruising occurs soon after injury.
• Impaired Mobility: Decreased range of motion of the joint occurs, often with inability to straighten the arm.
• Numbness: Numbness, tingling, or coldness of the hand and forearm can occur if blood supply is impaired or nerves are injured.
• Popping Sound: A cracking or popping sound, also referred to as crepitus, can often be heard or felt at the time of the fracture.

Diagnosis of scapular fractures

Scapular fractures should be evaluated by an orthopaedic surgeon for proper diagnosis and treatment.

Your surgeon will perform the following:

• Medical History
• Physical Examination

Diagnostic Studies may include:

• X-rays: A form of electromagnetic radiation that is used to take pictures of bones.
• CT scan: This test creates images from multiple X-rays and shows your physician structures not seen on regular X-ray.
• MRI: Magnetic and radio waves are used to create a computer image of soft tissue such as nerves and ligaments.

Treatment of scapular fractures

Most scapular fractures are not significantly displaced due to the strong supporting soft tissue structures surrounding it. Therefore, a majority of scapular fractures are treated conservatively and with early motion to reduce the risk ofstiffness and will usually heal without affecting shoulder movement.

Conservative treatment options include:

• Immobilization: A sling is used for comfort and to support the shoulder to allow healing to take place. This is usually worn about 3-6 weeks depending on the type of fracture and how well you heal.
• Prescription Medications: Pain medications will be prescribed for your comfort during the healing process.
• Physical Therapy: Early progressive range of motion exercises is essential in restoring full shoulder function. Your physician will most likely refer you to a Physical Therapist for instruction on proper exercises and early motion of theshoulder to prevent complications.

Surgical Introduction

Fractures of the scapula involving the neck or glenoid or with severe displacement have been associated with poor outcomes when treated non-operatively. will usually require surgical intervention to realign the bones properly and restore afunctional, pain free range of motion to the shoulder joint.

Scapular fracture repair surgery has historically been performed through a large, open incision. Newer, minimally invasive techniques have evolved and surgery to repair scapular fractures can now be performed through arthroscopy.

What are olecranon fractures?

Three bones, humerus, radius and ulna make up the elbow joint. The bones are held together by ligaments thus providing stability to the joint. Muscles and tendons around the bones coordinate the movements and help in performing various activities.

Olecranon fractures occur at the bony prominence of the ulna. The fractures, if stable, are treated using an immobilizing splint followed by a regimen of motion exercises. However severe fractures require surgical repair.

What are the causes of olecranon fractures?

Olecranon fractures and other elbow fractures may occur from trauma resulting from a variety of reasons, some of them being a fall on an outstretched arm, a direct blow to the elbow, or an abnormal twist to the joint beyond its functional limit.

What are the symptoms associated with olecranon fractures?

Symptoms of an olecranon fractures include pain, swelling, bruising, stiffness in and around the elbow, a popping or cracking sound, and deformity of the elbow bones.

Diagnosis of olecranon fractures

To diagnose olecranon fractures X-rays of the joint are taken. In some cases, a CT scan may be needed to get to know the details of the joint surface.

Treatment of olecranon fractures

The aim of the treatment is to maximize early motion to reduce the risk of stiffness. Nonsurgical treatment options include use of a splint or a sling to immobilize the elbow during the healing process. Surgery is indicated in displaced and openfractures to realign the bones and stabilize the joint as well as to avoid deep infections. Strengthening exercises, scar massage, therapy with ultrasound, heat, and ice are recommended to improve the range of motion. Splints are also used to facilitate stretching of the joint.

What are radial head fractures?

The elbow is a junction between the forearm and the upper arm. The elbow joint is made up of 3 bones namely the humerus bone in the upper arm which joins with the radius and ulna bones in the forearm. The elbow joint is essential for themovement of your arms and to perform daily activities. The head of the radius bone is cup-shaped and corresponds to the spherical surface of the humerus. The injury in the head of the radius causes impairment in the function of the elbow. Radial headfractures are very common and occur in almost 20% of acute elbow injuries. Elbow dislocations are generally associated with radial head fractures. Radial head fractures are more common in women than in men and occur more frequently in the age groupof 30 and 40 years.

What are the causes of radial head fractures?

The most common cause of a radius head fracture is breaking a fall with an outstretched arm. Radial head fractures can also occur due to a direct impact on the elbow, a twisting injury, sprain, dislocation or strain.

What are the symptoms associated with radial head fractures?

The symptoms of a radial head fracture include severe pain, swelling in the elbow, difficulty in moving the arm, visible deformity indicating dislocation, bruising and stiffness.

Diagnosis of radial head fractures

Your doctor might recommend an X-ray to confirm the fracture and assess displacement of the bone. Sometimes, your doctor might suggest a CT scan to obtain further details of the fracture, especially the joint surfaces.

Treatment of radial head fractures

The treatment of a fracture depends on the type of fracture.

• Type 1 fractures are usually very small. The bone appears cracked, but remains fitted together. The doctor might use a splint (casting) to fix the bone and you might have to wear a sling for a few days. If the crack becomes intense or thefracture gets deep then your doctor might suggest surgical treatment.
• Type 2 fractures are characterized by displacement of bones and breaking of bones in large pieces and can be treated by surgery. During surgery, your doctor will correct the soft-tissue injuries and insert screws and plates to hold the displacedbone together firmly. Small pieces of bone may be removed if it prevents normal movement of the elbow.
• Type 3 fractures are characterized by multiple broken pieces of bone. Surgery is considered the compulsory treatment to either fix or to remove the broken pieces of bone, sometimes including the radial head. An artificial radius head may beplaced to improve the function of the elbow.

What is shoulder trauma?

Shoulder injuries most commonly occur in athletes participating in sports such as swimming, tennis, pitching, and weightlifting. The injuries are caused due to the over usage or repetitive motion of the arms.

Shoulder injuries cause pain, stiffness, restricted movements, difficulty in performing routine activities, and popping sensation.

Some of the common shoulder injuries include sprains and strains, dislocations, tendinitis, bursitis, rotator cuff injury, fractures, and arthritis.

• Sprains and strains: A sprain is stretching or tearing of ligaments (tissues that connect adjacent bones in a joint). It is a common injury and usually occurs when you fall or suddenly twist. A strain is stretching or tearing of muscle or tendon (tissues thatconnect muscle to bone). It is common in people participating in sports. Strains are usually caused by twisting or pulling of the tendons.
• Dislocations: A shoulder dislocation is an injury that occurs when the ends of the bone is forced out of its position. It is often caused by a fall or direct blow to the joint while playing contact sport.
• Tendinitis: It is an inflammation of a tendon, a tissue that connects muscles to bone. It occurs as a result of injury or overuse.
• Bursitis: It is an inflammation of fluid filled sac called bursa that protects and cushions your joints. Bursitis can be caused by chronic overuse, injury, arthritis, gout, or infection.
• Rotator cuff injury: The rotator cuff consists of tendons and muscles that hold the bones of the shoulder joint together. Rotator cuff muscles allow you to move your arm up and down. Rotator cuff injuries often cause a decreased range of motion.
• Fractures: A fracture is a break in the bone that commonly occurs as a result of injury, such as a fall or a direct blow to the shoulder.
• Arthritis: Osteoarthritis is the most common type of shoulder arthritis, characterized by progressive wearing away of the cartilage of the joint.

What are the symptoms associated with shoulder trauma?

Shoulder injuries cause pain, stiffness, restricted movements, difficulty in performing routine activities, and popping sensation.

Treatment of shoulder trauma

Early treatment is necessary to prevent serious shoulder injuries. The immediate mode of treatment recommended for shoulder injuries is rest, ice, compression and elevation (RICE). Your doctor may also prescribe anti-inflammatory medications tohelp reduce the swelling and pain.

Your doctor may recommend a series of exercises to strengthen shoulder muscles and to regain shoulder movement.