Ulna and Radius are two main bones in the forearm. Ulna runs along the outside of the wrist and Radius runs along the inside. A bony projection at the end of the ulna is called the ulnar styloid process.

It fits into the cartilage of the wrist joint and plays an important role in the strength and flexibility of the wrist and forearm. A break if the bone in this area is called an ulnar styloid fracture.

The symptoms of Fracture:

The main symptom of an ulnar styloid fracture is immediate pain. This type of fracture is usually accompanied by a radius fracture. In such a case, the pain is felt more on the inside of the wrist than near the ulnar styloid process.

Additional symptoms include:

• swelling
• tenderness
• bruising

One may also notice the wrist and hand hanging at a different angle than the usual configuration.

Causes:

Hand and wrist fractures (the latter is basically an ulnar styloid fracture) are mostly caused by an injury sustained while trying to break a fall with an outstretched arm.

Other common causes include:

• Motor Vehicle accidents
• Hard falls
• Sports injuries

Further, osteoporotic conditions can also increase the risk of fractures. Such condition weakens the bones and makes them brittle. One needs to take extra precautions to avoid bone injuries.

Treatment

Options to treat broken bones include both with and without surgery.

Nonsurgical treatment

Mild ulnar styloid fractures often need a basic wrist cast. The doctor may have to realign bones before adding a cast. This process is called reduction and can sometimes be done without an incision (closed reduction).

Surgical treatment

For severe fractures, which may also involve other nearby bones, one would require surgery. This involves an open reduction: The doctor makes an incision near the fracture and uses the opening to reset the affected bones. Severe breaks may require using metal orthopedic bone screws or pins to keep the bones in place while they heal.

Following an open reduction, a durable cast is needed, which may be made from plaster or fiberglass.

Ankle fracture: Types, Symptoms & Causes

An ankle fracture happens when one or more than one bone that makes up the ankle joint- and probably its ligaments break at or close to the joint.

Every year, 184 persons out of every 100,000 withstand ankle fractures. Emergency rooms witness 1.2 billion visits in 2003 due to ankle fractures alone. This number has been increasing and the broken ankles have been getting more severe in the last few years.

Types of ankle fractures

Ankle fractures can be categorized into 5 main types:

• Lateral malleolus fracture– The lateral malleolus is the point situated on the outside of the leg where the fibula articulates with the talus. A lateral malleolus fracture is a broken distal fibula.
• Medial malleolus fracture– A medial malleolus fracture is a tibia fracture analogous to the lateral malleolus fracture of the fibula. It is a fracture of the distal tibia.
• Posterior malleolus fracture– It is very infrequent that only the posterior malleolus- the actual bony protrusion of the tibia is broken.
• Bimalleolar fracture– If two ankle bones are fractured, it is known as a bimalleolar fracture. This is usually a combination of a medial malleolus and lateral malleolus fracture. This kind of fracture will lead to an unstable ankle.
• Trimalleolar fractures– If all 3 of the malleoli (the medial, lateral and posterior) have been broken, it is a trimalleolar fracture. This kind of fracture will lead to a very unstable ankle.

Symptoms

The many common symptoms across all kinds of ankle fractures are:

• Extreme pain in the ankle that may “radiate” out to the foot and knee
• Swelling in the ankle and, sometimes leg
• A problem in walking or complete inability to walk (don’t use this as a test, as it can worsen the injury)
• Blistering
• Bruising

The symptoms of an ankle fracture may be mistaken for the symptoms of other medical situations (sprained ankle, talus fracture, etc.). Ensure you consult a doctor to know if you have an ankle fracture and get the suitable treatment. The treatment may include surgical intervention that requires orthopedic instruments used by the surgeons.

Causes

An ankle fracture is an outcome of too much stress being put on any or all the bones of the ankle joint. The causes of the ankle fractures are:

• Ankle twist– If your foot twists far to the side, turning around your ankle
• Ankle roll– If your foot rolls up on its side during you are putting substantial weight on it
• A fall or a trip- If you suddenly lose your balance and awkwardly try to catch yourself with your feet.
• Overextension of the ankle joint- If you try to swing your foot down too far in a parallel arc with your leg, as a may be ballerina
• Extreme impact– If the joint sustains a serious blow, as it may if are in an automobile accident or you come down on your feet from a height

Complications

Without suitable care and medical intervention, an ankle fracture can lead to arthritis. You have an especially high risk of ultimately getting arthritis if, after the injury, your ankle appears misshapen. If the break is serious, you might see a bone poking out of your skin. If this is the case, you must take immediate medical care, as this kind of ankle fracture can lead to severe infection.

Treatment for Ankle fracture will be decided by the Orthopedic Surgeon after proper examination of the injury using X-ray or CT scan or MRI. He may opt for Surgical Intervention and use of trauma Implants like Malleolar Screws, Wires, Plates and Screws if other options are not effective.

Surgery is followed by planned Post-Operative Care including Physiotherapy so that the patient regains proper movement of the ankle.

Injuries to children leading to fracture of femoral bone are quite common. Non-surgical treatment option has been effective for common Femur Fractures. Selecting treatment method for femur fractures is dependent on the age of the child since the displacement (separation of the bone ends) that can be accepted depends on the child’s age and even widely displaced fractures have healed in young children.

Infants

Usually, cast treatment is adopted for treating Femur fractures in infants and toddlers. A Pavlik harness may be preferred instead of a Spica cast in early infancy.

The rapid growth of bone in young children does not require the bone ends to be perfectly aligned. Over time, the bone remodels to a shape, where it may not be evident that the bone had been injured. Spica casting for about 4 to 6 weeks will be adequate for bone healing in case of most infants and toddlers.

Early Childhood

Spica casting is usually adequate for younger children (Up to the age of 6) to treat a femur fracture. As children get older, the duration of casting may be slightly longer, but the bone still has excellent potential for healing.

For children in the 5 to 7-year age bracket, Orthopedic Surgeon has to make a decision in consultation with the parents for applying the best technique to heal the bone injury. While a Spica cast is a popular option in treating children, Doctor may decide to insert flexible rods inside the bone. The pros and cons must be well understood from the treating Doctor.

In Later Childhood

While there is no clear cutoff for spica casting option becoming less practical, but one must evaluate options with the surgeon. The surgical treatment options commonly adopted for femur fractures are:

• Flexible Rods: A flexible intramedullary rod is the most common treatment option for older children (age 7 – 12). These flexible rods are inserted just above the knee into the medullary canal of the femur bone and easily removed after treatment. The rods do not cross the growth plate. As the rods are not rigid, they cannot support the child. These young children heal very quickly, and the rods do not cause problems.
• External Fixation: External fixation uses a rod outside the patient’s body which is attached to the bone with long pins or screws. The external fixators are often used with open fractures or when the fractured bone is in many pieces (comminuted). Due to good results with the flexible rods, the use of external fixators is limited.
• Standard Rods: In an adult, Intramedullary rod is the standard treatment for a femur fracture. Once a child’s growth plates have closed, only then this type of rod should be used. Around the ages of 11 to 14, most femur fractures will be treated is the same way as they are treated in an adult.

Above are general approaches for the treatment of common femur fractures but deciding the best treatment option in a situation depends not just on the age but on a number of factors of individual circumstances of the child, which may alter the treatment approach.

A bone, if fractured needs to be properly aligned and stabilized so that it unites and is strong enough to handle the body’s weight and movement. Earlier, Doctors relied on casts and splints from outside the body to support and stabilize the bone. The development of a surgical intervention to internally set and stabilize fractured bones using Implants is now widely practiced.

To treat a fracture, the bone fragments are first repositioned (reduced) into their normal alignment during the surgical procedure. Special implants Viz. plates, screws, nails, and wires hold them together.

Some of the advantages of such Internal fixation procedure are:

1. shorter hospital stays,
2. enables patients to return to his normal function faster, and
3. reduces the incidence of nonunion (improper healing) and malunion (healing in improper position) of fractured bones.

The implants are made from stainless steel and titanium, which are durable and strong. In the case of joint replacement, these implants can also be made of cobalt and chrome alloy. The Implant material is compatible with the body and rarely cause an allergic reaction.

IMPLANTS

Screws

Most often used an implant for internal fixation is Screws. Although it is a simple device, there are various designs depending upon the type of fracture and place of use. Screws different sizes are used with bones of varying sizes. Screws may be used alone to hold a fracture and is used with plates, rods, or nails. After the bone unites, screws may be either left in place or removed. 

A broken bone in this patient’s ankle is held in position with plates and screws.

Plates

Plates hold the broken pieces of bone together and work as an internal splint. Screws are used to fix it to the bone. After healing of the bone is complete, Plates may be left in place or may be removed.

In this x-ray, broken bones in a forearm are held in position with plates and screws while they heal.

Nails or Rods

Long bones in our body are hollow at its center. Inserting a rod or nail through the hollow center of the bone to hold the bone pieces together is adopted the technique in some fractures of the long bones. Screws at each end of the rod are used to keep the fracture from shortening or rotating and hold the rod in place until the fracture has healed. Rods and screws may be removed after healing is complete or left in the bone. This technique is commonly used to treat the fractures in the femur (thighbone) and tibia (shinbone) bone.

This x-ray shows a healed shinbone fracture treated with intramedullary nailing.

Wires/Pins

Wires are often used to pin the bones back together. They are often used to hold together pieces of bone that are too small to be fixed with screws. In many cases, they are used in conjunction with other forms of internal fixation, but they can be used alone to treat fractures of small bones, such as those found in the hand or foot. Wires are usually removed after a certain amount of time but maybe left in permanently for some fractures.

This x-ray shows a child’s elbow fracture that has been put into the correct position and held in place with two pins. The pins will be removed after healing has begun.

External Fixators

External fixation is often used to hold the bones together temporarily when the skin and muscles have been injured. An external fixator acts as a stabilizing frame to hold the broken bones in the proper position. In an external fixator, metal pins or screws are placed into the bone through small incisions into the skin and muscle. The pins and screws are attached to a frame outside the skin. Because pins are inserted into the bone, external fixators differ from casts and splints which rely solely on external support.

External fixation is often used to hold the bones together temporarily when the skin and muscles have been injured.

In many cases, external fixation is used as a temporary treatment for fractures. Because they are easily applied, external fixators are often put on when a patient has multiple injuries and is not yet ready for a longer surgery to fix the fracture. An external fixator provides good, temporary stability until the patient is healthy enough for the final surgery.

Other times, an external fixator can be used as the device to stabilize the bone until healing is complete.

There may be some inflammation or, less commonly, infection associated with the use of external fixators. This is typically managed with wound care and/or oral antibiotics.

Other Considerations

Sterile conditions and advances in surgical techniques reduce but do not remove, the risk of infection when internal fixation is used. The severity of the fracture, its location, and the medical status of the patient must all be considered.

In addition, no technique is foolproof. The fracture may not heal properly or the plate or rod may break or deform. Although some media attention has focused on the possibility that cancer could develop near a long-term implant, there is little evidence documenting an actual cancer risk and much evidence against that possibility. Orthopaedic surgeons are continuing their research to develop improved methods for treating fractures.

There are two bones in the forearm – radius and the ulna. When one or both the bones of the forearm have a fracture, we term it as Forearm Fracture. Both bones are important not only for proper motion of the elbow and wrist joints but also serve as important attachments to muscles of the upper extremity.

A most common reason for fractures is due to a fall on the hand, or a direct blow to the forearm (commonly seen in altercations, sports injuries, and car accidents). Pain, swelling, and deformity of the forearm indicate a forearm fracture. Proper diagnosis can be made with physical examination and x-ray studies.

Radial shaft fractures, ulnar shaft fractures, and fractures of both forearm bones are discussed below. Siora Surgicals has manufacture locking implants for hand fracture. Other Fractures that occur around the elbow (radial head fractures and olecranon fractures) and those that occur around the wrist (wrist fractures), will be covered separately.

Radial Shaft Fractures

It is not common to suffer an isolated fracture of the radial shaft. Most fractures of the radial shaft are associated with injury to the ulna (see ‘both bones forearm fracture’ below) or injury to one of the joints around the wrist (Galeazzi fracture).

An isolated radial shaft fracture, if it occurs, commonly requires surgery unless the fracture is non-displaced. If the fracture is out of position, then fracture is realigned to allow forearm rotation. Hence, surgery is the preferred treatment option to realign and hold the bones in the proper position.

Ulnar Shaft Fractures

An isolated fracture to the ulna is most often caused during an altercation and is called a “nightstick” fracture. Raising of the forearm in a protective posture exposes the ulna bone, which can be damaged by a blunt traumatic hit. The name is derived from the defensive gesture of people trying to shield themselves from a policeman’s nightstick leading to ulnar fractures.

If the fracture is well aligned, an isolated ulna fracture can be treated with immobilization in a cast. However, if the fracture is badly displaced, or the skin is broken causing an open fracture, then surgical treatment is advised.

Both Bones Forearm Fracture

Fracture of Both bones almost always require surgery in an adult patient. Without surgery, the forearm is generally unstable and to cast this type of fracture in a proper orientation is very difficult if possible. In younger children, nonsurgical treatment can be considered, but in adolescents, surgery may have to be carried out.

Fractures of both bones of the forearm are most commonly treated by fixing a metal plate and screws on both the radius and ulna bones. These bones have to be approached through a separate incision, necessitating, therefore, you will have two incisions on your forearm. Some surgeons may use a rod within the bone to maintain the position of the bone, but this cannot be done in fractures where rotational stability is required. Hence, both bones forearm fractures are mostly treated with plate and screws.

Complications of Forearm Fractures

The complications that are commonly encountered in such fractures include:

• Limited Motion: After the treatment of forearm fractures, decreased motion capability is common. It can be limited in the elbow and wrist joints but is most commonly noticed in forearm rotation (i.e. opening a jar or turning a door handle).
• Non-Healing Fracture: Due to inadequate healing of the bones of the forearm, there may be persistent pain. In open Fractures or where the bone is lost (i.e. many small pieces), this problem is more likely to occur. In such cases, repeat surgery for bone grafting may be necessary.
• Infection: Post-surgery, possibility of Infection is common. An infection in forearm fracture after surgery may require removal of the metal plate and screws to cure the infection.

Painful Hardware: Many times, the metal implants used during surgery can be felt under the skin and are painful. They can be removed, after the bone has properly united, usually at least a year after surgery.

Bone plates work like internal splints which hold together the fractured parts of a bone. These plates are available in all size, thicknesses, and shapes to suit the bone for which it is to be used. Over the years, developments in material science and engineering have led to the evolution of different shapes and size of the plates for clinical use.

In the initial phase of development of plates, surgeons such as Lane and Lambote used them to merely fix two bone fragments in approximate alignment. There were frequent Mechanical failures due to the metal reaction, inadequate design of screws and plates, etc.

The first use of interfragmentary compression by applying for plates under tension along the longitudinal axis of the bone was carried out by Danis, a Belgian surgeon in 1949. The concept was further explored and perfected thereafter by Muller and the AO group.

A bone plate has two mechanical functions. It transmits forces from one end of the bone to the other, bypassing the area of fractures and thus protecting them. Throughout the healing process, it also holds the fracture ends together while maintaining proper alignment of the fragment.

Classification –

The names given to bone plates can refer to the shape of the plates (semi-tubular or one-third tubular plate), or some time to the width of the plate (broad or narrow plate). A name may be derived from the shape of the screw holes (round hole plate), or from the surface contact characteristics of the plate (low contact), or from the intended site of application (condylar plate).

Regardless of their geometry, configuration, length, thickness, or types of holes, all plates may be classified into four groups according to their function.

1. Neutralization Plates
2. Compression Plates
3. Buttress Plates
4. Condylar Plates

Neutralization Plate –

A neutralization plate transmits various forces from one end of the bone to the other, bypassing the area of the fracture and acts as a ‘bridge’. Its main function is to maintain a mechanical link between the healthy segments of bone above and below the fracture. Such a plate does not produce compression at the fracture site.

A plate used in combination with a lag screw is also a neutralization plate, counteracting the torsional, bending and shearing forces that tend to disrupt the screw. The lag screw contributes to the interfragmentary compression and stability. The neutralization plate merely protects the lag screw, allowing mobilization of the extremity.

In exceptional circumstances, a neutralization plate can produce compression at the fracture site, if the geometry of the fracture permits it.

The most common clinical application of the neutralization plate is to protect the screw fixation of a short oblique fracture of a long bone, or for the fixation of a segmental bone defect in combination with bone grafting.

Open reduction and internal fixation (ORIF) are one of the treatment options to fix a broken bone. It puts the parts of a broken bone together, so that they can heal. Open reduction means the bones are put back in their place during a surgery. Internal fixation means that special hardware is used to hold the bone parts together. This helps to correct the bone accurately. The procedure is done by an orthopedic surgeon using orthopedic implants & instruments provided by the orthopedic instrument manufacturers in India.

How do I prepare for a clavicle fracture open reduction and internal fixation?

Before ORIF physical and X ray examination of the site of injury is necessary. Doctor would like to get even details like the medicines you take, including over-the-counter medicines such as Aspirin. Also, tell your doctor the last time you ate.

Doctors might preform your ORIF as a planned process. If this is the case, ask whether you should stop taking any medicines ahead of time, for example, blood thinners. You will need to avoid drink and food after midnight the night before the procedure.

What happens at the time of a clavicle fracture open reduction and internal fixation?

An orthopedic surgeon and a team of specialized healthcare professionals will perform the procedure with the help of orthopedic surgery instruments obtained from orthopedic instrument distributors in Jakarta. The whole operation may take two hours. In general, you can expect the following:

• You will receive general anesthesia to make you sleep through the operation so that you would not feel any discomfort or pain.
• A healthcare professional will carefully monitor your vital signs, such as your blood pressure and heart rate during the operation. You may have a breathing tube placed down your throat during the operation to help you in breathing.
• After cleaning the affected area, your surgeon will make an incision through the muscle and skin near your clavicle.
• Your orthopedic surgeon will bring the pieces of your clavicle back into alignment (reduction).
• Next, your surgeon will secure the clavicle pieces to each other (fixation). To do this, she or he may use one or more of the Orthopedic Implants viz. bone screws, orthopedic plates, wires, and pins.
• Your doctor may make other essential repairs.
• Locking Reconstruction Plate 3.5 MM Staright is used for the clavicle fracture
• After the team has secured the bone, your surgeon will surgically close the layers of muscle and skin around your clavicle.

What happens after a clavicle fracture open reduction and internal fixation?

You may have some pain after your procedure, but pain medicine may help to lessen the pain. You should be able to resume a normal diet as soon as possible. You will probably require an imaging procedure, like an X-ray, to ensure that your surgery was successful. Depending on the extent of your injury and your other medical conditions, you may be able to go home that same day.

For a while after your surgery, you will need to keep your arm immobile. Usually, this means that you will need to wear your arm in a sling for several weeks. You will get instructions about how you can move your arm.

Your doctor might give you other instructions about caring for your clavicle, such as applying ice. Your doctor might not want you to take certain over-the-counter medicine for pain, because some of these can interfere with healing of bone. your doctor may advise you to eat a diet high in vitamin D and calcium as your bone heals.

You might have some fluid draining from your incision. This is normal. Let your doctor know right away if:

• You see an increase in swelling, redness, or draining from your incision.
• You have a high chills or fever
• You have severe pain
• You have loss of feeling somewhere in your body

Make sure to have all your follow-up appointments. You may need to have your staples or stitches removed a week or so.

At some point, you may need physical therapy to restore flexibility and strength to your muscles. Doing your exercises as prescribed can improve your chances of a complete recovery. Most people can return to all their regular activities within a few months.