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WHAT IS A FRACTURE?

Our skeleton is made up of bones. Bones are a type of connective tissue, reinforced with calcium and bone cells. There are about 206 bones in our body, supporting our muscles and making movement possible. Bones have a softer center, called marrow, where blood cells are made. The main functions of our skeleton are supporting our body, enabling movement and protecting our internal organs.

A fracture is a broken bone and it occurs when an external force exerted against a bone is stronger than the bone can bear, for e.g. in case of a fall, Injury or accident. This especially happens if the bone hits a hard surface Causes of bone fractures can include:
• Traumatic incidents such as sporting injuries, vehicle accidents and falls
• Conditions such as osteoporosis and some types of cancer that cause bones to fracture more easily as even minor trauma and falls can become serious.
The fracture disturbs the structure and strength of the bone, and leads to pain, loss of function and sometimes bleeding and injury around the site. Broken bones take around four to eight weeks to heal, depending on the age and health of the person and the type of fracture. In these cases, you immediately need to contact an experienced orthopedic surgeon like Dr Arunava Lala, who has a series of successful treatment history for fractures and related surgeries.

The symptoms of a fracture depend on the particular bone and the severity of the injury, but may include:
• Pain
• Swelling
• Bruising
• Deformity
• Inability to use that part of the body/limb
Different types of fracture include:

• Closed (simple) fracture – the broken bone has not pierced the skin
• Open (compound) fracture – the broken bone juts out through the skin, or a wound leads to the fracture site resulting in Infection and external bleeding.
• Hairline fracture – often occurring in the foot or lower leg as a result of repeated stress from activities such as jogging or running
• Complicated fracture – structures surrounding the fracture are injured. There may be damage to the veins, arteries or nerves, and there may also be injury to the lining of the bone (the periosteum)
• Comminuted fracture – the bone is shattered into small pieces. This type of complicated fracture tends to heal more slowly
• Avulsion fracture – muscles are anchored to bone with tendons, a type of connective tissue. Powerful muscle contractions can wrench the tendon free and pull out pieces of bone. This type of fracture is more common in the knee and shoulder joints
• Compression fracture – occurs when two bones are forced against each other. The bones of the spine, called vertebrae, can have this type of fracture.
Trauma to the head, chest, spine or pelvis can fracture bones such as the skull, hipbone, ribs are complicated as they protect vital organs and there are chances of heavy blood loss, Injuries to organs, tissues or surrounding structures.
TREATMENT FOR FRACTURES:
Good first-aid care of fractures is vital and needs immediate immobilizing (limiting movement of) the injured area as moving the broken bones can increase pain and bleeding and can damage tissues around the injury. This can lead to complications in the repair and healing of the injury later on. Doctors can diagnose bone fractures with X-rays or CT scans (computed tomography) and MRI scans (magnetic resonance imaging).

Depending on where the fracture is and how severe, treatment may include:
• Splints – to stop movement of the broken limb
• Braces – to support the bone
• Plaster cast – to provide support and immobilize the bone
• Surgically inserted metal rods or plates – to hold the bone pieces together
• Pain relief.

Depending on the location and severity of the fracture, the operation procedures can include:

• Closed or simple fractures – the two ends of the broken bone are lined up and held in place. The limb is thoroughly bandaged and then the wet plaster is applied. Sometimes, once the plaster is dry, the cast is split into two and the two halves are re-bandaged on the outside. This allows for any swelling that may occur.
• Open or compound fractures – these are thoroughly cleaned in the operating room to remove debris before being set, because a broken bone exposed to the open air may become infected
• Long bones – long bones such as the bone of the thigh (femur) are difficult to keep aligned. In adults these are often treated by internal nailing. A child may need traction for a couple of days before setting the bone in a cast. Once the two ends of bone start to show signs of healing, the leg and hip joint are immobilized in plaster of Paris. In other cases, pins are inserted above and below the fracture and secured to an external frame or ‘fixator’. This is done under a general anesthetic.
After surgery, your doctor will check that you have full sensation in the area; like – if you have a broken arm in plaster, they may ask you to wiggle your fingers. They will also check your limb for tingling, pallor (pale color) or coolness. These tests check whether the splint is affecting your limb’s nerve and blood supply. The injured part is kept as still as possible in the first few days and pain-relieving medication is prescribed. Your doctor will determine the difference between the pain of your fracture and any pain that could be caused by the splint, traction, plaster cast, poor alignment of the limb or swelling of the limb.
Blood clots that form on the broken ends of bone are the start of the healing process. Over about five to six weeks, the body joins the two bone portions together with a combination of fibrous cells and cartilage. This temporary bone (callus) is not as strong as real bone. It can break easily until it is slowly replaced with real bone. For this reason the doctor may remove your cast or splint after a few weeks, but you still need to treat the bone with care for at least one more month.

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