Complex Fracture Guide
Complex fracture is a term used to describe multiple fractures in a segment of the bone along with the injury to the surrounding tissues and ligaments, frequently injuring the adjacent joint too.
It can be the result of accident, fall from height, etc. Complex fracture can often cause joint dislocation or the loss of fragments of the fractured bones.
Risks of Complex Fracture
The young/growing adults (victims of vehicle accidents), athletes (activities they perform might be too tremendous), women over the age of 45 (due to hormonal changes there are high chances of developing osteoporosis), old age (bones are already weak) are at high risk of getting complex fractures.
Types of Complex Fracture
Complex fracture can either be open or closed fracture.
- Open fracture means that the surrounding tissue is pierced by the fractured bone and there is an increased risk of infection.
- In close fracture there is no break in the surrounding tissue, even though they are affected.
In open fracture the fractured bones cuts through the skin tissue creating an open wound too. Open fractures are mostly caused by road traffic accidents, becomes difficult to treat and takes more time to heal as compared to closed fractures. This is because open wounds are more prone to infections and there is additional need to provide wound coverage (plastic surgery in upto 50% cases).
In closed fracture there is no break in the skin tissue hence, the treatment is easier but, being a complex fracture one has to undergo surgical procedure to restore bony continuity.
Treatment of Complex Fracture
Complex fractures are not so easy to treat. The surgeon does a meticulous pre-operative assessment and planning. As per the requirement and affected area implants like plates, screws, rods, nails maybe needed.
The treatment includes :
STAGE 1 :
- Fracture fixation :
It is a procedure in which the affected limb is stabilized for transfer or reconstruction by using metallic implants.
- Debridement :
It is the term used for surgical removal of the dead tissue/ debris and foreign material from the wound.
- Soft tissue coverage :
The surgeons take a small amount of skin or graft of the patient’s own skin to cover the injured area or major reconstruction by flap may be needed.
- Revascularization :
It is a procedure done to restore the blood supply of the injured tissue in case of severe trauma.
STAGE 2
- Fracture reconstruction :
In fracture reconstruction the affected fragments of the bone is fixed either using internal fixators like screws, plates and bone grafts or external fixators like pins and screws, as required.
Healing Period with Complex Fracture
The healing period of the complex fracture varies from that of the other fracture as not only bones but nearby soft tissues are affected also.
Also the healing depends on the age and gender of the patient.
Healing might be faster in a pediatric bone, because they are at a growing stage making it easier for the bones and soft tissue to heal. Whereas, it would be difficult to heal in old and osteporetic bones as the bone is already weak and healing is slower in elderly due to medical illnesses, poor nutrition and lack of certain good hormones. Hence, a proper healing time should be given to the fractured area depending on the age and gender of patients, as it may vary from 6 weeks to 6 months.
Once the healing has taken place completely one should strictly follow the exercise treatment plan as designed by the orthopedic team, this phase is often term as the rehab phase.
Rehabilitation with Complex Fracture
The rehabilitation phase treatment plan is designed as per the affected site hence, varies from patient to patient. The plan typically consist of :
- Pain relief methods (if required)
- Achieving full range of motion of the affected joint
- Strengthening of the muscles of the affected area
- Preventing wasting of other nearby muscles in absence of motion
- Getting back to the activities of daily living