Trauma
Fractures and Trauma
Most fractures are dealt with in an emergency department first, and the questions come afterwards: does this need an operation, how long in a cast, when can I use it again, and why does it still hurt at three months. This page is about that part, and about the fractures that need a second look.
By appointment only, at Kharar (Mohali) or Solan. Your confirmation says which.
What happens immediately
A suspected fracture belongs in an emergency department, not a clinic. Go straight there, the same day, if there is obvious deformity, you cannot use the limb, the bone has broken the skin, or the hand or foot beyond the injury is numb, pale or cold.
Before you get there: do not eat or drink anything in case an anaesthetic is needed, keep the limb still and supported, and raise it if you can. Do not try to straighten anything yourself.
An open fracture, where the skin is broken over the break, is a surgical emergency because of the risk of infection. It needs antibiotics within hours.
Whether it needs an operation
Plenty of fractures heal perfectly well in a cast or a brace. Surgery is used when the bone will not hold its position, when the break involves a joint surface, or when fixing it means you can use the limb far sooner.
- Position. Bone ends that are displaced, angled or rotated, and that will not stay put once reduced.
- Joint involvement. A break running into a joint surface needs that surface restored accurately, or arthritis follows. Where that surface is the top of the upper arm in an older patient and will not reliably heal, a reverse shoulder replacement is sometimes a better answer than fixing it.
- Which bone. Some fractures are notorious for failing to unite, including the scaphoid in the wrist and parts of the femoral neck.
- Getting you moving. In older patients, and after a broken hip above all, fixing the fracture so you can put weight on it early prevents the complications of lying in bed. Those are often more dangerous than the fracture itself.
- Multiple injuries. When several are present, that changes which get fixed and in what order.
Healing, and what is normal
Bone heals on its own timetable and cannot be hurried. As a rough guide, fractures in the arm usually take six to eight weeks to unite and fractures in the leg twelve weeks or more, and the bone goes on remodelling for a year or longer.
Some things are expected and worry people unnecessarily. Swelling that persists for months. Stiffness in the joints above and below (this is why they are moved early wherever possible). A visible lump of healing bone at the fracture site. Aching in cold weather.
Some things are not normal, and need an earlier appointment: pain that gets worse instead of settling after the first fortnight, a cast that becomes tight or causes numbness, a wound that starts discharging, fever, or a fracture that is still tender well past the point it should have united.
Follow-up and getting function back
Fracture care does not end when the bone unites. What usually holds people back afterwards is the stiffness, the weakness and the loss of confidence, and those respond to structured rehabilitation.
- Repeat X-rays at intervals to confirm the position is holding and the bone is uniting
- Moving the joints above and below early, wherever the fixation allows it
- A graded return to weight bearing and loading, paced by the imaging instead of by how it feels
- Physiotherapy for range of movement first, then strength
- Checking bone health after a fracture from a minor fall, since that often signals osteoporosis that nobody has looked for
Metalwork does not usually need removing. It is taken out only when it causes symptoms.
Common questions
Do plates and screws have to come out later?
Usually not. Implants are designed to stay. They come out when they cause irritation, when they stick out under thin skin, or occasionally in younger patients. Otherwise there is no need, and removing them is an operation with its own risks.
Why does my fracture still hurt months later?
Aching for several months after union is common, particularly with weather changes and at the end of an active day. Pain that is getting worse instead of better, or that stops you using the limb, is different and should be reviewed.
Can I get a second opinion on a fracture already being treated?
Yes. It makes sense if you are unsure about the plan, if the position looks to be slipping on repeat X-rays, or if healing seems to have stalled. Bring all the imaging, including the films taken on the day of the injury, because the starting position matters.
I broke a bone falling from standing height. Should I be worried about my bones?
It should be checked. A fracture from a fall at standing height or less, particularly over the age of fifty, is a recognised signal of osteoporosis. A bone density scan and blood tests can identify it, and treating it substantially reduces the chance of the next fracture.
Related procedures
Where an operation does turn out to be the right answer, these are the ones this problem most often leads to.
Not sure what is causing it?
Finding out is what a consultation is for. Bring any imaging you already have, and any plan you have been given elsewhere. He sees patients by appointment only, in Kharar, Mohali, and on set days each month in Solan.