Can break bones steel

Doctor's letter : Broken bones

EXPLANATION From the little toe to the skull, around 200 bones support the human body, giving it its shape and posture. However, if these struts are stressed too much during sport or in an accident, they can break. If the bone breaks into only two parts with smooth fracture surfaces, doctors speak of a simple break. If it bursts into several parts, this is called a splinter or debris fracture. With open fractures, the bone shifts so much that it rips an open wound through the surrounding tissue and skin and often protrudes from it.

Accident statistics show that one in four people by the age of 18 has suffered at least one broken bone. This means that the number of fractures is significantly higher than in adults. However, young patients have to undergo surgery much less often. Around 43,000 children under the age of 15 are treated in hospital for a broken bone every year, by far the most common for a fracture of the forearm.

SYMPTOMS The symptoms of a fracture are usually clear: an audible crack can often be heard - the word bone is probably an onomatopoeic derivative of this sound. The affected area hurts immediately and persistently, the part of the body can no longer be stressed. If, for example, the ankle joint is broken, the victim is no longer able to step on this foot without pain. Fractures in the extremities often show up through misalignments such as a bent forearm or a deformed leg.

The blood leaking from inside the broken bone may also cause the surrounding tissue to swell more. Later on, tissue fluid, i.e. the lymph fluid, can also accumulate to form edema.

CAUSES The most common causes are twisting of the limbs or an external force of violence, for example through a fall or through trauma, as can happen, for example, in certain, more violent team sports. Depending on age and physical health, the bones have different levels of resistance to external violence. In children, the bones are still quite elastic. Accidents therefore often lead to what is known as green wood breakage - in this case the periosteum bends and only the inside breaks. "As with a fresh twig, the shell remains intact on one side," says Henning Giest, chief physician for pediatric surgery and urology at St. Joseph Hospital in Berlin Tempelhof. In older people, however, the bone slowly decalcifies, becomes brittle and splinters more easily. Doctors call this natural decalcification process osteoporosis.

DIAGNOSIS A broken bone is usually easily recognizable from the outside because it has clear symptoms. If a fracture is suspected, doctors X-ray the affected part of the body. Because bones are easy to see on X-rays. Computed tomography (CT), magnetic resonance tomography (MRT) or ultrasound are also used less frequently.

THERAPY "Treatment suitable for children differs from treatment for adults," says pediatric surgeon Giest. Operations are rare because simple hernias do not have to be operated on. The self-healing powers and the growth of the bone are still strong and for healing it is sufficient to immobilize the affected extremities, for example with a plaster cast or a splint. The organism does the rest on its own. This is especially true for fractures in which the bone is not splintered or displaced and the joint is not affected.

In addition to the classic plaster of paris, doctors also use plastic bandages as an alternative. Although these weigh less than the plaster of paris, when they are put on, they can also form wrinkles on the underside, which can then cause pressure points and irritation on the skin below.

Open fractures, on the other hand, in which the muscle and connective tissue have also been injured, or bones that have been shattered into many parts must be operated on. Injuries near the growth zone of unstable fractures, in which the bones threaten to slip again, should be fixed surgically, says Giest. Surgeons then work their way up to the break and connect the broken pieces with plates, screws, nails. The oldest and at the same time most frequently used method, however, is the fixation of the fragments with wires made of steel or titanium (so-called Kirschner wires), which are drilled through the bone splinters and then connect them. However, this fixation is not firm, so that the affected limb must also be immobilized with a plaster cast until the splinters have grown together again.

Fractures that have to be operated on but in which the skin has not been damaged can often also be treated in a minimally invasive manner, i.e. through only a few small openings in the skin. The benefits of this procedure are faster healing of the tissues around the bone and smaller scars.

"For child-friendly therapy, however, it can also make sense to operate even on simple fractures," says Henning Giest. Because the bones fixed by metal could be subjected to greater stress - and above all earlier. A normal fracture that does not actually require surgery is usually immobilized in a cast for three to four weeks. “But a child's natural urge to move is reluctant to be immobilized for such a long time in a cast.” Children can hardly stand that. After an operation, however, the child can follow his urge to move again within a few days. And that replaces physiotherapy at the same time. "The natural urge to move is the best aftercare," says Giest.

The operation has another advantage: X-ray controls of the healing process - with the corresponding radiation exposure - can be avoided.

After the break has healed, the wires and screws used must be removed from the body, otherwise they could disrupt the child's bone growth. Screws and nails must be surgically removed, wires can be pulled without surgery.

The editors of the magazine "Tagesspiegel Kliniken Berlin 2016" compared the Berlin clinics that treat this disease. For this purpose, the treatment numbers, the hospital recommendations of the outpatient doctors and the patient satisfaction were compiled in clear tables to make it easier for the patient to choose a clinic. The magazine costs 12.80 euros and is available in the Tagesspiegel shop.

To home page