FRACTURES

A fracture is a break in the continuity of a bone. Most fractures result from a single, significant force applied to normal bone.

TYPES:

Fractures may be either

Open: The overlying skin is disrupted, and the broken bone is in communication with the environment via a skin wound.

Closed: The overlying skin is intact.

Pathologic fractures occur when mild or minimal force fractures an area of bone weakened by a disorder (eg, osteoporosis, cancer, infection, bone cyst). When the disorder is osteoporosis, these fractures are often called insufficiency or fragility fractures.

Stress fractures result from repetitive application of moderate force, as may occur in long-distance runners or in soldiers marching while carrying a heavy load. Normally, bone damaged by microtrauma from moderate force self-repairs during periods of rest, but repeated application of force to the same location predisposes to further injury and causes the microtrauma to propagate.

CLINICAL FEATURES:

The mechanism (eg, the direction and magnitude of force) may suggest the type of injury. However, many patients do not remember or cannot describe the exact mechanism

A perceived snap or pop at the time of injury may signal a fracture (or a ligament or tendon injury). Fractures and serious ligamentous injuries usually cause immediate pain; pain that begins hours to days after the injury suggests minor injury. Pain that is out of proportion to the apparent severity of the injury or that steadily worsens in the first hours to days immediately after injury suggests compartment syndrome or ischemia.

Certain findings may indicate a fracture or another musculoskeletal injury.

Deformity may indicate a fracture, but it may also indicate dislocation or subluxation (partial separation of bones in a joint).

Swelling commonly indicates a fracture or other significant musculoskeletal injury but may require several hours to develop. If no swelling occurs within this time, fracture is unlikely.

Tenderness accompanies nearly all musculoskeletal injuries, and for many patients, palpation anywhere around the injured area causes discomfort. However, a noticeable increase in tenderness in one localized area (point tenderness) suggests a fracture.

Crepitus (a characteristic palpable and/or audible grinding produced when the joint is moved) may be a sign of fracture.

DIAGNOSIS:

• Plain x-rays 
• CT SCAN
• MRI -  In cases where fracture is not visible on plain x-rays but is strongly suspected clinically (common with scaphoid fractures and impacted femoral neck [subcapital] hip fractures).
•  CT angiography to check for suspected arterial injuries (commonly done to evaluate the popliteal artery when the knee is dislocated)

MANAGEMENT:

INITIAL TREATMENT –

PRICE (protection, rest, ice, compression, elevation) may be beneficial.

Protection helps prevent further injury. It may involve limiting the use of an injured part, applying a splint or cast, or using crutches.

Rest may prevent further injury and speed healing.

Ice and compression may minimize swelling and pain. Ice is enclosed in a plastic bag or towel and applied intermittently during the first 24 to 48 hours (for 15 to 20 minutes, as often as possible). Injuries can be compressed by a splint, an elastic bandage, or, for certain injuries likely to cause severe swelling, a Jones compression dressing.

Elevating the injured limb above the heart for the first 2 days in a position that provides an uninterrupted downward path; such a position allows gravity to help drain edema fluid and minimize swelling

Immobilization- Immobilization decreases pain and facilitates healing by preventing further injury and keeping the fracture ends in alignment. Joints proximal and distal to the injury should be immobilized.

HOMEOPATHIC MANAGEMENT FOR FRACTURES

1. Symphytum Officinale - Also known as knit-bone, it is widely recommended as the first line of treatment of fractures. Symphytum Officinale is a natural and highly effective medicine that boosts the activity of fibroblasts cells and helps in healing the fractured bone. It also helps with the production of callous and treats irritability and pricking pains at the point of the fracture site. It is also a suitable medicine for hairline fractures.
   
   
2. Arnica Montana: - immense swelling and pain at the site of the fracture. The affected site is sore to touch and bruised. Fractures that occur from a fall or those caused as a result of an injury by a blunt instrument are treated with Arnica. This medicine is also used to treat old bone injuries.
3. Calcarea Phos - is a medicine for fractures that are slow to heal. It is used to treat remote fractures and helps hasten the bone repair process in cases where the bone has not joined for a long time. Calcarea Phos provides calcium and phosphate, two elements required for quick union of the bone. It also promotes the formation of callus.
4. Silicea – It is a medicine for fractures of brittle bones that get fractured often. Silicea strengthens weak bones and prevents them from getting fractured frequently. It is commonly used to treat and manage osteoporosis and other bone problems such as caries, necrosis, and exostosis.
5. Calendula Officinalis -  is a medicine for fractures where the skin covering the fractured site becomes raw, red and inflamed. There may be a copious discharge of pus along with stinging pains. This medicine is used to treat compound fractures (where the broken bone pierces the skin) and also to prevent gangrene.

6. Hypericum: Spasms after every injury. Traumatic neuralgia and neuritis.