Jeffrey R. Carlson, MD CPE
In the last two articles, I’ve reviewed the reasons why bone fracture can go untreated and what happens to the human body as a result. In this last segment, I will address what can be done for those fractures that are finally given proper medical attention.
Non-union – this means that the bone just doesn’t heal completely and is typically caused by an under-the-radar infection, lack of blood supply to the bone, instability of the fracture, patient smoking
Treatment: After a complete physical examination, diagnostic imaging (x-rays, possibly a CT or MR scan), blood work to reveal possible infection and what kind, I need to make a definitive diagnosis as to why the bone isn’t healing. I may try a Bone Growth Stimulator that the patient will wear for multiple hours a day to encourage bone remodeling, but typically, this will require surgery. I may have to clean out infection, infected or necrotic bone, build a scaffold with rods, plates, wires, pins, a cage or any combo of those, use bone grafting or synthetic bone, in order to get the broken bone in question to start healing.
- Mal-union – this means the bone heals, but in a deformed or misaligned way – could be shortened or rotated
Treatment: After examination and diagnostic imaging, treatment will typically be surgical repair to restore the original anatomy as close to normal, to improve function and realign the body part/body.
- Arthritis – although this typically refers to a joint and the presence of cartilage, breaks can happen through or near joints and greatly increase the possibility of the development of arthritis
Treatment: mild osteoarthritis can be treated with exercise, OTC anti-inflammatory medication like naproxen sodium or ibuprofen, topical cremes or rubs, hot baths, or showers, whatever helps ease the pain. Keeping one’s weight down, moving regularly and eating nutritious foods may help slow its progression.
As arthritis becomes more severe, treatments include Physical Therapy, oral and injected steroids, viscosupplementation (hyaluronic acid) injections, arthroscopic surgery and finally, joint replacement as a last resort.
- Misalignment/length discrepancy of the limbs causing wear and tear on joints – if the bone heals incorrectly and is not in correct alignment, the body will try to adjust and let you carry on with life as best as you can. However, your joints may wear out trying to do so, causing you to have arthritis or your spinal discs to degenerate.
Treatment: Depending upon what the physical examination and diagnostic imaging show, surgery to either correct the bone deformity/misalignment may be performed or if there is extensive damage to a joint or levels of the spine, restorative surgery may be needed there.
- Infection of the bone or bone marrow – called osteomyelitis when the infection becomes chronic and severe.
Treatment: Typically, acute osteomyelitis is a big deal and requires surgery to remove infected/dead bone. There may be a need for external fixation, massive dosing of IV antibiotics and it is notoriously hard to manage and heal. Chronic osteomyelitis is typically managed with oral antibiotics (think managing a case of chronic acne) and surgery is avoided if at all possible.
- Avascular Necrosis (AVN) – an excruciatingly painful loss of blood supply to the bone resulting in bone death.
Treatment: AVN must be addressed surgically to remove the dead and dying bone. Thankfully, AVN does not mean infection, just loss of blood supply. If this happens near a joint, you will be the owner of a shiny new joint prosthetic implant as well.