Fractures are relatively common orthopedic injuries, and anyone providing primary patient care is likely to encounter them. Although a complete and thorough treatment of this subject would require an entire textbook in and of itself, a chapter explaining the basic principles of fracture care seems appropriate for any textbook that covers office orthopedics.
WHY TREAT FRACTURES?
What are the goals of fracture treatment? What do we aim to accomplish when we treat these injuries? The best way to answer these questions is to imagine what would happen if we left the fracture untreated. Without some form of stabilization, fractures can be excruciatingly painful, and pain control is front and center among the goals of fracture treatment. A splint, a cast, traction, or surgical fixation, all of these options for fracture treatment stabilize the injured skeleton and significantly reduce the pain associated with it. Treating the fracture also reduces the deformity. Most fractures result in some degree of deformity. Sometimes, the deformity is significant; sometimes it is not. If the deformity is significant, leaving it uncorrected would have negative consequences in terms of musculoskeletal function. Furthermore, deformed bones transmit abnormal forces to the joints above and below them, which can cause premature wear of articular cartilage and early arthritis. A primary goal in the treatment of fractures with significant deformity is to correct the deformity so that these adverse consequences can be avoided. Also, it is usually the case that placing the fractured bone fragments in close apposition and then limiting the motion of the fracture increases the chances that the fracture will heal and achieve a bony union. When fractures don’t heal with a solid bony union, we call them nonunions. When they heal, but heal in abnormal alignment, we call them malunions. So, the basic goals of fracture management are to decrease pain, correct deformity, and increase the chances of fracture healing.
One of the oldest treatments for fractured extremities is traction. If you throw a pearl necklace onto the floor, it can come to rest in about any shape or configuration you can imagine. But if you pull the two ends of that necklace in opposite directions, the necklace will automatically assume the shape of a straight line. That is the principle behind the use of traction to treat long-bone extremity fractures. Applying traction to the foot, for example, will pull an angulated fracture of the femur or tibia straight. For decades, extremity fractures, especially those in the tibia and femur, were treated in traction.
Successful fracture treatment requires that we accomplish two things: (1) put the fractured bone(s) in the proper position (a step orthopedists call reducing the fracture or obtaining a reduction) and (2) maintain that reduction until the fracture has healed. Traction is capable of accomplishing both goals, and it was used to do so with good results for a large part of the history of orthopedics. In the 1940s ...