Concept of Clinical Management in fractures |
Posted: September 21, 2019 |
Functional activity in the fractured limb must be introduced at the right time for proper healing. Being a leading orthopedic implants manufacturer in the world, we bring to you the concept of the clinical management of fractures and the importance of timing in the introduction of functional activity to the fractured limb. In order to achieve complete comfort of the patient, it is necessary to soothe the fracture and adjacent joints in conventional casts or splints (rigid or flexible orthopedic implants). However, the process of stabilization should be discontinued as soon as the acute symptoms settle. The function is then slowly introduced in a step by step way. It is equally important to finding the position at which the fragments tend to discover mechanical equilibrium within the soft tissues. Once this position is fixed, the integral soft tissues provide a center that stops any further kind of irregularity from occurring due to the functional activity. When pressure is applied these soft tissues provide an elastic groundwork upon which motion of the fractured fragments can occur. However, as stress is gone, the soft tissues return the fragments to their initial positions. Continuing protective function results in a steady reduction of symptoms which further contributes to an ordinary recovery. Gradual achievement of progressive function is often connected to the rising levels of stress in the healing tissues and in the optimization of their internal architecture and involuntary properties. Resisting against the establishment of function and weight-bearing activity particularly in the case of the fractures of lower extremity has been the profoundly rooted belief that fractured extremities experience the phenomenon of shortening if subjected to weight-bearing pressure. As the top orthopedic products manufacturers in India, we have found clinically that this assumption is incorrect especially in the case of closed fractures. The shortening that occurred immediately after the accident remains essentially unaffected in spite of the early introduction of function and weight-bearing. Even if the initial shortening is fixed but the correction is not made stable, it is expected that it will recur. However, this continuation of shortening will not take place beyond the initially experienced one. Our experience in the orthopedic implants and instruments business indicates that in plentiful cases of closed tibial and forearm fractures, the initial shortening that occurs from overriding of the fragments is very small. Such length inconsistencies, if corrected by means of orthopedic implants or manipulation cannot necessarily be maintained unless the fracture is of a type that is not subjected to shearing stresses, or in medical language a transverse type. Thus, it is a general practice to accept the early overriding of slanted, spiral, or minute fragments of fractures if it is minimal because we expect that it will not progress further. For example, the closed fracture of the tibia (the shinbone or shankbone) is usually followed by an initial shortening of 0.5 cm. In very few cases, a shortening of 1 cm is witnessed and an even lesser percentage experiences > 1 cm shortening. The permanent continuation of this shortening does not represent a cosmetic or functional insufficiency. The initial overriding of the fragments that occur at the time of an accident or injury is the result of a specific amount of damage caused to the soft tissues that further bind the fragments in place. Further augment in shortening would occur if there is an increase in the extent of soft tissue damage that generally does not occur under protected weight-bearing. However, once the piece of the bone is restored, the soft tissues will not be able to maintain the length of the limb through their inherent power. There is a greater possibility that the fragments will move back to their original degree of shortening and in such cases, the soft tissues will again stabilize the fragments in that initial position. The incompressible fluid flow (flow in which fluid density is constant) effect of the soft tissues, primarily contributes in maintaining the alignment of the fragments and not in controlling shortening (as people initially and mistakenly thought). However, this outcome on the soft tissues cannot be relied upon for a continuous period of time in a brace which is nonadjustable. This is because of the change in the volume of the soft tissues that occur in the most severe and early stages of repair. This is generally the reason why adjustable braces (if used prior to the growth of inherent stability at the fracture site) are preferable to rigid cylindrical casts. Our unit of orthopedic implants manufacturers design fractures braces that help to stabilize rotary and certain angular deformities. Load that occurs due to any weight-bearing activities are supported by the incompressible fluid effect of the soft tissues and division that occurs within the limb. The soft tissues prevent any additional damage and thus further progression of any abnormal deformities. In the treatment of many fractures of long bones of the appendicular skeleton(skeletal elements within the limbs) using orthopedic implants like functional braces, medical practitioners have experienced an overall low nonunion rate of In cases of two-bone limb segments for reasons not yet understood, one bone generally heals faster than the other. As a top ortho implants producer, we have witnessed many absurd cases. There are times when we were astonished to see that the introduction of function to limbs that have been immobilized for a long time and have shown no signs of fracture union heal automatically. Thus, it is not vague to say that the late introduction of function and weight-bearing maybe only the needed stimulus to restart the healing process.
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