Orthopedic Trauma Service

Types of Treatment

Open reduction and internal fixation (ORIF): In this type of treatment, the orthopaedic surgeon must perform surgery on the bone. During the surgery, the bone fragments are first repositioned (reduced) into their normal alignment and then held together with special screws or by attaching metal plates to the outer surface of the bone. The bone fragments may also be held together by inserting rods down through the marrow space in the center of the bone. These methods of treatment can reposition the fracture fragments exactly.

External fixation: In this type of treatment, pins or screws are placed into the broken bone above and below the fracture site. Then the orthopaedic surgeon repositions the bone fragments. The pins or screws are connected to a metal bar or bars outside the skin. This device is a stabilizing frame that holds the bones in the proper position so they can heal. After an appropriate period of time, the external fixation device is removed. Internal fixation may then be necessary.

Traction: Traction is usually used to align a bone or bones by a gentle, steady pulling action. The pulling force may be transmitted to the bone through skin tapes or a metal pin through a bone. Traction may be used as a preliminary treatment, before other forms of treatment like internal or external fixation.

Casts, splints, slings and braces

All of these devices are designed to protect the area of your surgery and/or injury to allow healing to occur. Some devices can be removed for bathing and/or exercise, but it will depend on your specific injury, surgery and the amount of healing that has occurred. Your doctor will determine the appropriate times when these devices can be removed.

•  Casts are plaster or fiberglass cylinders applied to immobilize the injured area. They may be split in half (called “bivalve”) so the skin and the circulation can be checked. You should not get your cast wet by soaking in a bath, pool or shower. If your cast feels too tight and circulation in your toes or fingers looks limited, you should call your doctor. If your cast becomes too loose — which may occur as swelling decreases — you may need to have the cast changed. You should not bear weight directly on your cast unless you have been instructed to do so. If your doctor allows you to put weight on your cast, be sure to use a cast boot to avoid slipping and/or damage to the cast.

•  Splints are removable protective devices — usually plastic with Velcro straps. They may be worn during the day or at night to protect and sometimes limit joint motion and allow optimal positioning. Your splint can be removed to wash and dry your skin and to clean the splint. Any areas of redness from rubbing of the splint should be reported to your therapist for adjustment. A cotton stockinette between your skin and the splint will minimize skin irritation from sweating.

Walkers, crutches and canes

All these devices provide support through your arms to limit the amount of weight going through the injured leg or to improve your balance and safety. The device will be chosen according to your ability and the amount of weight-bearing allowed for your injury.

The possible weight bearing statuses determined by your doctor are:

• Non-weight bearing = No body weight should be put on the injured leg.
• Touch down weight bearing = Almost no body weight should be placed on the injured leg; just touch the floor for balance.
• Partial weight bearing = About half the normal body weight should be placed through the injured leg.
• Weight bearing as tolerated = As much body weight as you are able to put on the injured leg without pain or instability can be applied.
• Full weight bearing = Full body weight may be put on the injured leg.

If your doctor has restricted your weight bearing status, you may use a walkerwhen you first start walking. If your strength and balance are good enough, you will progress to crutches, which offer more freedom to get around at home. Eventually, you may progress to a cane; however, before you can use a cane you must first be able to put full weight on your leg.  Walkers, crutches, and canes all need to be specifically adjusted to your height by the therapist who also will show you how to use them.

Each of these treatment methods can lead to a completely healed, well-aligned bone that functions well. Remember that the method of treatment depends on the type and location of the fracture, the seriousness of your injury, your physical condition and needs, and the judgment of you and your doctor.

Successful treatment of a fracture also depends greatly on the patient’s cooperation. A cast or fixation device may be inconvenient and cumbersome, but without one, a broken bone cannot heal properly. The result may be a painful or poorly functioning bone or joint. Exercises during the healing process and after the bone heals are essential to help restore normal muscle strength, joint motion and flexibility. You can help your broken bone heal properly by following the advice of your doctor and therapist.