ORTHOPEDICS

incorrectly fused fractures

Improperly fused fractures are one of the most difficult complications of fractures – learn how to treat them without surgery!

Fractures in everyday life

Interruption in the continuity of bone structure

Fractures or fractures of bones are defined as a break in the continuity of bone structure. The reasons for this can be many, but fractures are generally divided into three larger groups, which are then divided into a series of smaller subgroups. For the purposes of this text, we will consider only the division of fractures into:

  • Traumatic fractures
  • Stress fractures
  • Secondary fractures (fractures that have their primary cause in another disease, but as one of the consequences of this disease there is bone weakness and an increased risk of fractures, eg in osteoporosis or tumors that have metastasized to the bone)

The number of scientific studies on the topic of fracture epidemiology is not large. There are several reasons for this, but most of all the underestimation of the total number of fractures due to the impossibility of objectively estimating the number of fractures that occur on a daily basis (a large number of institutions where these fractures are repaired prevent proper addition and assessment). overestimation of the suffered injury (for example, a young doctor wishing not to overlook a fracture will classify an injury as a fracture and treat it in spite of the fact that it may not be a fracture), as well as the fact that objective diagnosis of fracture requires a certain amount time, which is why doctors often characterize an injury as a fracture based on their experience, although this may not be the case. Also, the epidemiology of fractures varies from area to area, from state to state, and from continent to continent. Nevertheless, it is possible to draw some conclusions about the epidemiology of fractures even on the basis of data at the local level, so one study from 2000. conducted in Edinburgh, there was a fracture incidence rate between 9 and 22 per 1000 population in one year.

This figure is not large, but it is also not negligible and represents one of the challenges for medical professionals and professionals due to long-term and financially demanding treatment. An additional problem in the whole story is the potential complications in the treatment itself, which can lead to an even greater time and financial burden on the health system, which will be discussed in this text. Namely, these are inadequately or incorrectly fused fractures. In this text, we will try to answer the questions of how often this complication occurs, how it is presented and recognized, how it is diagnosed and treated, and whether there are potential long-term health consequences and if so, what the consequences are.



FRACTURES

From other sources on this topic

Incorrectly fused fractures are one of the most common complications of fractures themselves.


How do I know if I have had a fracture?


After the traumatic event itself, the first typical, but also non-specific symptom of a fracture, is severe pain at the site of trauma. Over the next few hours, there is increasing local swelling at the fracture site. Among other non-specific symptoms of fractures, the appearance of hematomas stands out, which is why the localization of trauma can deceive a person with its appearance and indicate a worse diagnosis than it actually is. A poor prognostic sign and indication for emergency hospitalization is pain that intensifies between 12 and 24 hours after the trauma, as this type of pain indicates the potential development of “compartment syndrome”. Symptoms that definitely indicate a fracture, and in this way we define them, are crepitations (creaking) when moving the injured part of the body, deformity, loss of function and pathological mobility.

Treatment is carried out depending on the type of fracture and the clinical picture of the patient with the fracture. There are several terms on the basis of which the type of fracture is defined, and thus the urgency and method of treatment. First of all, the criterion of openness or closedness of the fracture will significantly affect its repair. Furthermore, the X-ray image determines:

  • the appearance of a fracture crack
  • fracture crack placement
  • the angle at which the bone fragments are located
  • position of bone fragments relative to each other

In accordance with the above parameters, a decision can be made on conservative treatment with immobilization with plaster bandages (plaster) and RICE protocol (Rest, Ice, Compression, Elevation – sparing, application of ice at the fracture site, bandage, elevation of the injured limb), or surgical treatment ( most often ORIF method – open reposition and internal fixation). Recently, the RICE protocol has been replaced by the use of the POLICE protocol, and you can find out more about it HERE.



How to recognizea wrongly fused fracture?

What shall I do?

Fracture healing is a critical step in the clinical treatment of patients with different types of fractures. The evaluation of fracture healing is based on similar methods as the diagnosis of fractures – radiographic findings and clinical tests. If the levels of calcium and vitamin D in the body are in line with the reference values, and the bone tissue is healthy, the fractures usually heal in a few weeks or months, through the process of reshaping – first soft, new tissue (callus) is created, which serves as a precursor for the development of mature tissue. The bone itself forms at different speeds during the first weeks and months. Finally, in order to achieve optimal bone reshaping, it is necessary to gradually restore normal mobility and range of motion in the joint. However, if the action of force or movement of the joint occurs prematurely, the reshaping may be interrupted, and a re-fracture may occur; therefore, immobilization is usually required.

Chronic complications can also be caused by fractures that spread to the joints, as they usually involve the articular cartilage. Improperly healed joint cartilage has a tendency to form scars, and they in turn can lead to osteoarthritis and reduced function of the affected joint (reduced range of motion, pain).

Risk factors for wrong fracture healing include divided into patient-specific factors and non-patient-specific factors rather than the type of injury itself. Patient-specific factors are:

  • age
  • other health comorbidities
  • smoking
  • regular consumption of nonsteroidal antirheumatic drugs such as aspirin
  • various genetic disorders
  • metabolic diseases
  • nutritional deficiency (inadequate nutrition) and factors

Factors unrelated to the patient include:

  • type of fracture
  • fracture localization
  • the severity of the surrounding soft tissue damage
  • degree of damage to the bone itself
  • the quality of the performed surgical procedure
  • the possible occurrence of infection at the fracture site, which is common in open fractures in which prophylactic antitetanus therapy is not performed.


When fracture fragments are in an inadequate position in relation to each other (inadequate angulation or rotation of fracture fragments, shortened limb), then we are talking about a wrongly fused bone. The causes of this phenomenon lie in inadequate bone reposition after fracture, inability to maintain a favorable position of fracture fragments during bone healing, progressive deterioration of newly formed tissue due to other reasons or inability to form strong bone tissue (eg due to osteoporosis).

X-ray examinations are a key asset in the diagnosis of fused fractures, however, recognizing this phenomenon is extremely difficult due to the distinct individuality among patients related to fracture healing – each person heals differently and what is normal for one person may not be normal for someone another.

Treatment of misaligned fractures has so far involved a variety of conservative and surgical methods that have been applied with greater or lesser success. These methods most commonly involved repositioning, remanipulation, or osteotomy with concomitant internal fixation. However, recent research suggests a potentially beneficial effect of platelet rich plasma, as well as mesenchymal stem cells, in the process of treating malformed fractures. The platelet rich plasma is a derivative of your own blood, which after the centrifugation process is applied directly to the site of tissue damage. Tako obrađena krv, odnosno krvna plazma koju izdvajamo tim procesom, bogata je krvnim pločicama, trombocitima. Platelets, in addition to blood clotting, play a significant role in the regeneration of tissues, especially soft ones, as they are extremely rich in growth factors, which allow proper and rapid healing and reduce the risk of recurrence (repeated injuries).

Regenerative medicine is an absolute hit of the 21st century when we talk about medical achievements, and its popularity is due, among other things, to the use of mesenchymal stem cells. Mesenchymal stem cells can be extracted from several different localizations in the body, and the most common and painless is the soft adipose tissue on the abdomen. This adipose tissue is then filtered through a specially designed device, leaving only stem cells behind. Stem cells are special because of their ability to differentiate into several different tissue types, and this feature is further emphasized when used in combination with platelet rich plasma, as plasma growth factors further enhance the effect of stem cells by encouraging them to multiply and differentiate.

The method of applying platelet rich plasma and mesenchymal stem cells in the treatment of orthopedic disorders and damage is an absolute hit of modern medicine. Polyclinic Ribnjak, led by its founder Dr. Milan Milosevic, proudly points out that our institution was among the first institutions in this area to introduce this type of treatment in its offer, which makes us a kind of pioneers in this area. Visit us at our address at Ulica grada Mainza 17 and contact us with full confidence. We will know how to take care of you.

Polyclinic Ribnjak. Health and beauty. Together .




In short


Polyclinic Ribnjak is a unique institution in the Republic of Croatia. It unites different branches of medicine, all in order to stay true to its slogan “Health and Beauty. Together”. Orthopedics, advanced sports diagnostics, functional and kinesiological rehabilitation, cosmetic surgery and treatments are the services we provide on a daily basis, professionally and in accordance with the latest professional standards.






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