It is a dictum in orthopedics that no two fractures are alike. Every fracture behaves differently from other. In the same part fractured, there could be different types of treatment depending on many factors other than fracture geometry.
Treatment of fractures takes various things into consideration -age of the patient, fracture pattern, type of bone fractured, part of the bone fractured, any other associated injury any chronic problem and sometimes your expectation the treatment. We discuss it one by one.
Patient age is an important consideration in the treatment of a fracture. Most of the pediatric fractures can be treated by nonoperative methods. There are many few indications for use of surgical treatment for children as compared to an adult.
An undisplaced fracture at any age would require just a plaster application (there are exceptions to this statement though).
A displaced fracture would always require closed or open reduction (open reduction is a term used to treat the fractures by surgically opening the fracture fragments.
Area of the bone fractured
Metaphyseal fractures (Fractures near to bone ends) are more amenable to closed reduction & splintage than shaft fractures in case of long bones. Intra-articular fractures (fractures in which break also occurs at the end of the bone that takes part information of joint) require strict anatomical reduction when compared to nonarticular fractures.
Type of bone fractured
This is a very important consideration because biomechanics of each bone & joint are different, there tend to occur different kind forces on fractured fragments in different bones.
Accordingly, the primary & surgical treatment varies.
The pressure of large wound along with fracture is an indication for wound cleaning, debridement (removal of dead tissue) and fixation.
Associated multiple fractures in other bones is also an indication for surgery. The aim is to stabilize all the bones so that patient can be made mobile.
Chronic problems if any also make an important factor in kind of treatment that can be given to the patient.
Choice of patient
This too has an important bearing on treatment. Some people would accept plaster application for a long time but will not take the risk to undergo surgery.
All said and done, the basis of both nonoperative, operative treatment is same.
To align the fractured fragments into anatomically acceptable position and hold it there till union between fractured fragments occurs.
This simple principle is the guiding factor in all complex modes of treatment.
These are main factors which form the basis of treatment in case of fractures. A physician would always choose from one of the available choices and thus there could be variations in treatment from one doctor to another.
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