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Multiple Fractures

Unfortunately, when enough force is placed through your body to fracture a bone, there are usually a lot of other soft tissues and structures that will be damaged in the process. When you add surgery and immobilisation to this, you will likely have joint stiffness and considerable muscle weakness.

What causes fractures?
There are a few common causes of fractures that may be classified as traumatic or non -traumatic.

Traumatic:

  • Falls
  • Motor vehicle, motorbike or pedestrian accidents

Non-Traumatic:

  • Osteoporosis – decreased bone density resulting in fragile bones, often in elderly people.
  • Pathological fractures – weakened bone from disease or tumours.
  • Osteomyelitis (bone infection)
  • Cancers that spread to the bone
Types of Fractures

Healing and treatment of fractures depends on the type of fracture. These can be classified as:

1. Complete

  • Transverse – the fragments remain in place
  • Oblique or spiral – tend to slip
  • Comminuted – have numerous fragments and are usually unstable
  • Impacted – the fragments are jammed together

2. Incomplete

  • Greenstick – mostly in children when the bone has buckled

3. Compression – when the bone is crumbled

Some are shown below:

Medical Management

The initial medical management is to relieve pain, achieve and maintain good bone alignment and allow healing. Part of this is known as reduction of a fracture i.e. restoring bone fragments to a normal alignment. This can be achieved with:

1. Closed reduction – manipulation to improve the position of fragments and then stabilizing fragments so that they can unite. The fracture can be stabilized with a cast, traction (pull on the bone) or a brace.

2. Open Reduction Internal Fixation (ORIF) – Surgery to align fragments

  1. Internal fixation – involves placement of pins, screws, plates, nails or an intramedullary rod to stabilize the bone fragments but allows for early movement.
  2. External fixation – involves the placement of screws through the bone above and below fracture to stabilize the bone and then the attachment of these to an external frame, which can be adjusted to re-align the bone.
How do bones heal?

The bones undergo a series of changes or events during the healing process to “remodel/ remould” the new bone.

1. Haematoma – This is bleeding from the tissue damage that happens at the time of the fracture.
2. Inflammation – This is a reaction from the body to protect itself and to absorb the haematoma (bleeding). It results in swelling of the area.
3. Callus – Dead bone is “mopped up” or removed by the body and new / woven bone develops.
4. Consolidation – The new bone changes that occur, which result in the fracture being solidly united.
5. Remodeling – New-formed bone resembles normal structure of the bone and extra callus is removed by the body over a period of time.

How Long Does it take for Bone to Heal?

Healing time of fractures depends on several factors e.g.:

  • Type of bone
  • Type of fracture
  • State of blood supply (cardiac condition/diabetes)
  • Age (children heal faster than adults)
  • General health (smoking may delay healing)

General healing times are summarized below:

Upper Limb Lower Limb
Callus visible in x-ray 2-3 weeks 2-3 weeks
Union / firm fracture 4-6 weeks 8-12 weeks
Consolidation / secure bone 6-8 weeks 12-16 weeks
What about rehabilitation?
Following the initial medical management, you will need to participate in a guided medical and
therapeutic programme which aims to reduce any complications that may occur. These include:

  • Stiffness in joints
  • Infection
  • Non-union or delayed union (bone does not heal)
  • Malunion (poor alignment)
  • Nerve injury
  • Damage to blood vessels
  • Osteoarthritis

1. Physiotherapy

The physiotherapist will focus on a guided exercise programme and help you to mobilise within the limitations set by the doctor or surgeon.

Exercise helps to reduce swelling, maintain or improve joint range and improve muscle strength.
Initially, you may not be allowed to put full weight or any weight on the fractured limb. It is important to follow the guidelines set by the doctor and methods taught by the physiotherapist
to prevent complications and ensure correct healing.

Briefly, some of the descriptions used may include:

  • Non-weight bearing (NWB) – No weight can be taken through the limb. This involves holding the affected limb off the floor.
  • Toe-touch weight bearing (TTWB) – Limb can touch the floor for balance only.
  • Partial Weight Bearing (PWB) – 50% of one’s body weight may be taken through the affected limb.
  • Weight bearing at tolerance (WBAT) – Weight may be taken through the limb within pain limits.
  • Full weight bearing (FWB) – 100% normal weight bearing.

You may initially require assistive devices to walk and get around. The type of device you use may change during your rehabilitation e.g. first using a wheelchair, then a walking frame and later, crutches.

2. Occupational therapy

The occupational therapist will assist you to ensure that you can perform self- care tasks e.g. dressing, bathing, toileting, bathing and domestic tasks e.g. cooking at your highest level of independence.

They may recommend assistive devices to optimize your independence. In addition, they will assist with ordering of a wheelchair if it is required. The rehabilitation process will also address your ability to return to work and evaluate other vocational abilities if necessary. At a later stage, if appropriate, they will assist with the process of returning to driving.

3. Psychological support services

Rehabilitation does not only address the physical aspects of your injury. Psychological support is available from the social workers and psychologists who can assist with supportive counselling.

4. Medical follow up

Follow up with your initial treating doctor is important during the rehabilitation process to monitor your healing, monitor wounds and advise on how the therapy programme can proceed.
We aim to have open communication with the referring doctors to ensure that the best outcome possible is achieved.

5. Outpatient services

The initial rehabilitation will take place as an inpatient, but depending on your progress, you may still require outpatient therapy and continue with a home exercise programme.

How can we help?