Broken bones are among the most common orthopaedic problems, tens of millions of patients come to the doctor each year. If you live in a developed country you can expect two fractures in your lifetime.
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Extremity fractures are most common and usually occur in men younger than 45, and then become more common in women over 45 years of age. The reason for the difference is that women in menopause don't produce estrogen and the rate of bone loss increases. This is why women are particularly susceptible to osteoporosis and fractures. The most common fracture prior to age 75 is a wrist fracture. In those over age 75, hip fractures become the most common broken bone.
How do you know that that fall from the bicycle broke your arm? A great pain is the first sign. If it is unbearable or it lasts for more than one hour, the chances are something is broken. There is another usual situation: when a small bone, usually in hand or foot, is broken, you won't feel any pain. But, after a few days you will see a red area, and the next day it will be bigger. This is the sign that you have "secondary infection", and that means that bone is broken, its fragment hurts your tissues, an infection develops and your body reacts. One of the consequences of that reaction is that red area.
Every bone in our body continually absorbs and replaces the cells, and because of that process the healing of the injured bone happens naturally. However, in order for a fracture to heal as well as possible, a good placement of the bones must be done. When doctors talk about reduction of a fracture, they are talking about improving the alignment of the broken ends of the bone.
The treatment of a fracture depends on many factors but in most cases reducing a fracture involves placing the broken bone in the cast. If the reduction cannot be satisfactorily achieved, that usually means surgery with fixation of the bone with pins, plates, screws or rods.
When you get the cast (another name for plaster), in the case of non-complicated fracture the pain will go away after few hours. However, it is not unusual to be in pain for a 3 or 4 days. There are three things you should pay attention to.
First, if the pain lasts longer, go to the doctor. Second, if you feel great pain in the first 24 hours, go and see the doctor, the chances are the bone is not properly placed. Third, if after a few days you have a feeling that cast makes a great pressure to your limb, go and see the doctor: your limb is probably swollen and that's not a good sign. And fourth, if you can't move your fingers or they are unusually cold, this is the problem with blood flow and the doctor must check that.
You will usually have the cast for one to two months. When it is removed, don't be scared: that pale - or very dark - weak thing, this is still your limb. During that period you will lose some muscles and the colour of the skin will be changed. Allow your arm or leg a few days of resting and then start to use it slowly. You will need approximately one month to get it in the shape again.
One potential complication of fracture treatment is either a mal-union or non-union of bone. This problem is more common in elderly individuals and in people who sustain more severe fractures. In the case of some fractures (for example, hip fracture in older people) the rate of non-union is high enough that instead of trying to heal the bone, the damaged segment of bone is replaced.
According to theory developed by Julius Wolff in 19th century, the bone adapts to the pressure it is placed under. In other words, if you get a lot of physical activity your bones will be stronger and more resistant to breaking. If you add to that vitamin D and calcium via milk and broccoli (yuck!) your bones will be intact in situations where other people's bones may break. This stands true for children and adults alike. ■