Fractures, Treatment And Complications

Although many bones in the human bone are very difficult to break, we think we have seen them all broken at one time or another in motor vehicle crashes. Most commonly we see fractures resulting from vehicle versus pedestrian impacts and wrecks involving motorcycles. But, we have also handled numerous cases with fractures resulting from freeway speed impacts. There are many types of fractures. An avulsion fracture happens when a bone breaks at an insertion point where a tendon or ligament attaches to the bone. These fractures are very complicated because the fracture has to be "reduced" or put back together exactly right in order for the connective tissue to regain its functionality. Often these fractures require pinning or wiring the fracture fragment back into place. In order for the bone to heal properly it is of paramount importance for the connective tissue to remain relaxed. Otherwise when the ligament or tendon is flexed, it may inhibit healing or even detach the fragment. Another type of fracture is a compound fracture. While typically associated with injuries where a portion of broken bone is pushed out through the skin, a compound fracture or "open" fracture is any fracture where a portion of fractured bone is exposed, such as a deep wound penetrating to the bone or a de-gloving injury. Compound fractures a more difficult to treat than simple fractures since the doctor has to take care of not only the broken bone but also all of the injured tissues, such as the muscles, ligaments, and tendons, in the area torn by the bone fragment. Since these fractures typically involve deep injuries and exposed bone, the victim has a much higher risk of infection and close follow-up is warranted. Another fracture type is the comminuted fracture when the result is two or more bone fragments. Comminuted fractures often result from crush injuries and high impact traumas where the bone splinters. Rebuilding the bone after a comminuted fracture for the doctor is like getting a jigsaw puzzle but without the picture on the box. The pieces should fit back together but identifying the correct order can be difficult. Plus once the pieces are placed in the correct order, keeping them together properly so that the bone can grow back together is another problem. Since this fracture type means the bone is broken in many places, the recovery time is often greater for the victim. Bones don't always break apart. A hairline fracture is a thin break along the bone. A spiral fracture is a type of hairline fracture with a rotational pattern along the length of the bone. This type of fracture happens in crashes when one end of the bone is stuck while the other end is exposed to a torsional force.

In the Emergency Department setting, when a fracture is suspected, usually the patient undergoes x-ray studies. When a fracture is verified, the healthcare provide will need to assess whether the fracture is "reduced" or "displaced." A reduced fracture is a broken bone where the broken pieces are properly aligned. A displaced fracture means the broken bone pieces are not properly aligned and bone needs to be physically manipulated so that the pieces are put back into place so that the bone can heal. Reducing a fracture can be a very painful experience and it is often done after the patient is anesthetized. Orthopedists often refer to serious fracture repair procedure as a ORIF. ORIF stands for open reduction, internal fixation. As discussed above, a reduction of a fracture refers to placing the broken pieces back into alignment so that the bone can heal. The term "open" refers to the doctor surgically opening the patient down to the bone so that the fracture pieces can be manipulated. The second part, "internal fixation" refers to the doctor using hardware, such as rods, screws, plates and wire, to hold the pieces together. On occasion, a doctor will use a bone stimulator in order to encourage the healing process.

In any fracture injury, follow up care after the fracture is reduced and immobilized is critical for a good recovery. Unfortunately, when some health insurance companies and healthcare providers learn that the fracture was the result of a motor vehicle collision, they want to discontinue service. For example, Medicaid publishes that it is the "payer of last resort" and Medicare considers itself as a "secondary payer." Where the at-fault driver has liability insurance, the injury victim can end up in without treatment while the payers point to each other. In the meantime, if the victim's fracture is not healing, the gap in treatment can lead to a bad recovery from the fracture. Sometimes victims are forced to obtain treatment outside of their coverage and put their healing ahead of the issue of who pays.