The word “fracture” refers to the pathological condition in which there is damage in the continuity of the bone (when “the bone breaks”).
Fractures can be caused by traumas (car accidents, sports accidents, falls, etc), or can be spontaneous, following illnesses that can be more or less severe (pathological fractures).
Low energy traumas can cause fractures when the conditions and the quality of the bone are not optimal, for various reasons, the most common being osteoporosis.
In order for a fracture to heal, it needs good stability and adequate vascularization.
The stability of the fracture is guaranteed by the type of fracture as well as the internal or external containment methods.
If in a fracture the two bone parts do not move and therefore maintain their original anatomical axis, it is a composite fracture. Usually composite fractures have an adequate intrinsic stability that ensure proper healing; they are thus treated conservatively, or rather with a simple cast or external brace.
A fracture where both (or more) bone fragments have moved, is referred to as a compound fracture. In this case a reduction maneuver to reestablish the proper anatomical axis is required.
The reduction maneuver, applying manual traction to the fractured segment, will allow for the correct alignment of the bone. If this maneuver is not effective or if the fracture remains instable even with a cast or brace, a surgical intervention will be necessary to realign the fracture and stabilize it.
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Osteosynthesis
Fractures that require surgical fixation can be stabilized with different types of synthesis; referred to as osteosynthesis.
During the osteosynthesis intervention, the bone fragments are realigned with special instruments and are fixed with metal wires, screws, plates, nails, external fixtures, etc).
Each of these has specific peculiarities with advantages and disadvantages. The choice of synthesis method is made by the surgeon on the basis of many considerations (type of fracture, conditions of the patient, bone quality, etc).
The majority of synthesis methods are made up of metal alloys, normally in titanium, that are perfectly biocompatible. These can, therefore, remain in place without creating problems. In young patients, or if the synthesis methods are bothersome because they are too superficial or limit movement, they are normally removed after an adequate time has passed from healing (normally 18-24 months from the time of the fracture).
Fractures need between several weeks and several months to heal definitively and, even if the pain has completely gone, the callus is often not sufficiently solid to allow for normal activity. For this reason it may be necessary to continue to limit the load or physical-sports activities until complete healing is confirmed by x-ray.
New instruments and surgical techniques allow for minimally invasive osteosynthesis which has the advantage of limiting surgical exposure and thus accelerating functional recovery.
After a fracture, whether treated surgically or conservatively, it is fundamental to carefully and meticulously re-educate the nearby structures (joints, muscles and tendons, vascular structures), which, due to the trauma, immobility or the surgery itself, are involved, resulting in pain, rigidity, loss of muscle mass and vascular problems. Specific exercises will help restore normal muscular strength, joint mobility and flexibility.
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Non-unions (pseudoarthrosis)
When a fracture does not heal, it is called pseudarthrosis. It is referred to in this way because the unhealed fracture makes the segment movable (sometimes with no pain), forming a new joint.
Pseudarthrosis can be atrophic, with little chance of healing, or hypertrophic, in which stabilization of the fracture site leads to bone healing.
Pathological conditions or lifestyles that increase the risk of pseudarthrosis include smoking, diabetes and infections and severe traumas that lead to necrosis of soft tissues near the bone (muscles, tendons).
The treatment of pseudarthrosis calls for complex interventions, using advanced technologies for both the instruments and surgical devices, both in the bioengineering field and in regenerative medicine (stem cells, biostimulators/modulators, etc).