Broken bones are less than common injuries in the sports arena. But when they do happen they are painful and require immediate medical attention. Stress fractures are injuries that aren’t really fractures at all but rather a splitting of the bone through overuse and stress.
Let’s examine the treatment of both compound fractures (in which the bone is protruding from the skin) and stress fractures.
Compound fractures aren’t common sports injuries. More commonly athletes suffer from stress fractures or simple fractures. In a compound fracture the bone isn’t only broken but it is exposed to the air. The bone must be broken and exposed to air but it doesn’t have to the object that caused the open area to be called a compound fracture. For this reason these bone breaks are sometimes called open fractures.
Compound fractures are a break in the bone that usually results from a high impact stress to the bone but they can also be a result of weakened bones from certain treatments, cancer, or illnesses. However, in the case of sports injuries athletes have generally been cleared of illnesses or conditions that would weaken the bones before playing.
Diagnosis of a compound fracture is fairly simple. There is an open area that goes down to bone and the bone is broken. And because it’s open there is the opportunity for dirt and bacteria to enter the wound.
Compound fractures are most likely to happen during events that include body contact and high impact stress to the bone. During a sports event there are several first aid treatment factors that can be applied to decrease the risk of infection and help physicians treat the fracture.
The area should be splinted carefully to keep the bone from further movement. This will help to decrease pain for the sufferer and decrease the risk that movement of the bone could sever an artery causing even more damage. The splinting should be done without touching the area that is open to air. If you are in an area where the paramedics are imminent then leaving the extremity until they arrive is probably best. Leave the person in the position in which he fell, or gently help him straighten the rest of his body to a more comfortable position until help arrives.
Try to stop them from viewing the break since it can cause even more stress to the patient and even initiate a shock reaction. Keep their head down and eyes from the wound.
The area is at a very high risk for infection of not only soft tissue but also the bones. Bone infections are a difficult problem to solve. Treatment of infections can require multiple surgeries, long term hospitalization, prolonged antibiotic treatment and other complications to the ultimate healed results.
Every effort is made to prevent the potential complication of bone infections with early treatment starting in the emergency room. Even with the early treatment at the scene of the accident and in the emergency room patients who experience a compound fracture are more susceptible to bone infections and the subsequent complications that follow.
Treatment of open fractures or compound fractures includes prophylactic antibiotic treatment and surgical reduction of the fracture. This means that in order to realign the broken bones the patient is taken into surgery where pain from motion at the site of the injury and cleaning of the open wound is managed.
These fractures heal more slowly than other types of bone fractures. Once the bone breaks and there is an open wound the muscles contract and move the bones side by side making realigning them difficult. Once the surgery is completed patients find that regaining full function, the goal of treatment, takes weeks longer than with a simple fracture. Muscles, tendons, soft tissue, skin and bone are all affected and require time to heal effectively.
Many times the surgical procedure performed is called an open reduction with internal fixation. These terms mean that the reduction — or pulling the bones together appropriately — is done as an open procedure under surgery. The internal fixation appliances are rods or plates used to give stability to the bones while they heal.
While compound fractures aren’t as common as simple fractures they require more immediate attention, more intense treatment and often develop other complications that can change the ultimate results. Knowing what to expect and how treatment may go will help patients to understand the length of time that is involved in the process. Compound fractures have been known to end careers such as Quarterback Joe Theismann whose career ending fracture happened on the playing field on national television.
Stress fractures are a whole other ball of wax, so to speak. Stress fractures are caused by undue stress being placed on the bone through the mechanical stressors of tendons and ligaments and not through impact with an immovable object.
Many times a stress fracture will be the final result of shin splints that aren’t cared for. Athletes who ignore the pain and discomfort of shin splints, believing that they can continue to work through the pain, will often end up with a split in the tibial bone that is a stress fracture.
The pain of stress fractures can be immediate or increase over a short period of time. These fractures aren’t visible on x-ray because of the positioning of the fracture but do become apparent as they begin to heal as new calcium is laid down.
Stress fractures aren’t career ending but they can be season ending injuries for an athlete. They often require several weeks of immobilization to heal successfully. To diagnose a stress fracture the physician will recommend either a bone scan with contrast or an MRI with and without contrast to visualize the fracture in the bone. This gives the doctor an immediate answer as to whether the pain is caused from a stress fracture, the size of the fracture and the expected time of healing.
Once the initial bone scan is performed where the stress fracture can be visualized the physician can order x-rays to follow up on the healing process in expected time periods. Knowing the size of the fracture or split in the bone and the approximate time of the injury the doctor will be able to estimate how long it will be before healing begins to take place.
Athletes who don’t show the expected healing process may be evaluated for other problems or metabolic issues that are increasing the time needed to heal the fracture. These can include calcium shortage in the body, lack of Vitamin D and other essential nutrients.
Some physicians use a removable cast that patients can wear during the day, are able to walk using them, and can remove them to sleep or shower. At other times, if the physician feels the patient may not comply with the recommendations or the fracture is significant, they will recommend a solid cast. These casts are removed every two weeks to inspect the skin beneath and evaluate the healing process.
The physician may begin with a recommendation of 6-8 weeks in a cast and use their evaluation of the healing process through cast removal to determine how long the cast will remain in place.
Once the cast is removed the doctor will likely recommend several appointments with the physical therapist to evaluate why the injury happened and help the legs and joints to strengthen after weeks of immobilization.
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