Broken bones or bone fractures occur whenever a force is placed on a bone that is greater than the bone can handle. Beyond this basic definition, not much else about fractures is basic.
“There are a lot of different types of broken bones,” explained Avera Orthopedics trauma surgeon Michael Devish, DO. A fracture can be displaced or non-displaced. It can be a closed fracture (the broken bone has not pierced the skin) or open (compound) where the broken bone juts out through the skin. It can be subtle break or multiple breaks resulting in many pieces and fracture lines. “A fracture is a thousand different things that generally mean a bone is no longer in one piece,” Devish added.
And fractures can happen anywhere, at any time ― walking barefoot in your home you stub your toe on a piece of furniture and it begins to swell, you trip on a curb while running and suddenly you can’t apply weight to your ankle, or you fall and simply cannot get up.
When Fractures Happen, What Next?
Severity of the fracture symptoms will determine your next steps. Because a fracture is a traumatic injury that impacts muscle as well as bone, there is often pain and swelling involved.
Making a same-day appointment at your primary care clinic may be a good first step for a stubbed toe, or moderate wrist or ankle pain, but if symptoms are more extreme, Devish said a visit to orthopedic urgent care, or the emergency room is necessary.
“Where you go for evaluation is very dependent upon symptoms,” Devish said. “If your swelling is extreme or you have something grossly unstable, it is important you get to urgent care or to the emergency room so that you don’t have complications – like interruption of blood flow to the limb.”
For patients’ convenience, Avera offers orthopedic urgent care at its Dawley Farm and Avera Specialty Hospital locations in Sioux Falls.
If a fracture is diagnosed during an evening or weekend visit to urgent care, the urgent care doctor may determine your injury can wait to be evaluated by an orthopedic specialist and you do not need to go to the emergency room. They will help connect you to Avera Orthopedics for an appointment
Should I Go to the Emergency Room?
An emergency room visit is necessary when:
- Limb is flopping
- Bone is visibly out of place
- Limb movement is not possible
- Extreme swelling
- Extreme pain
Avera Orthopedics provides 24-hour trauma coverage by orthopedic surgeons. The trauma surgeon will recommend if and when surgery is necessary in the near future – or even immediately.
Is it OK to Ask for an X-ray? Yes.
Determining if an injury is a sprain or a fracture can sometimes be challenging. X-ray can most often answer this question, but not always on the first scan, Devish explained.
“Perfectly, non-displaced fractures can be very, very hard to see. A handful are so perfect they are very hard to see. So, I recommend follow-up images in seven to 10 days if the first X-ray was negative, and symptoms persist – especially in children, to confirm it is not a growth-plate injury.”
If you or a loved one have symptoms, but an X-ray has not been ordered, Devish said it is OK to request one.
“I don’t think many physicians will disagree with the need for a screening X-ray for something that hurts. Especially if there is a history of trauma, like a fall, it is important to get an X-ray.”
And sometimes, in cases of hip fractures, Devish said often a CT scan is necessary. “More than occasionally, hip fractures will not be seen on the initial X-ray.”
Treatment of Fractures
Treatment varies depending on the type of fracture, age and bone health.
A broken bone needs surgery when:
The fracture is displaced. In other words, the injury to your bone caused your bone to move. Surgery often involves the placement of rods, screws or plates to set the bone in place and ensure it grows back together properly.
A broken bone can heal without surgery when:
The bones are still in place and the fracture isn’t as severe. The orthopedic specialist will ensure the fracture is immobilized using a cast, splint, brace or boot, and let you know what activities are safe and what activities you should avoid to ensure proper healing.
“Lots of non-displaced fractures are often treated conservatively, with a cast or brace. A sling may be enough if the fracture is stable thanks to surrounding structures. Many fractures in children are treated with casts because kids have an amazing ability to remodel,” Devish said. “I sometimes joke, ‘they still have a lot of magic inside them from God.’”
In the case of hip fractures, Devish said nearly all require surgery, but they do not all require a hip replacement. Surgery for a hip fracture is recommended within the first 24-hours following injury.
“It’s been shown that outcomes are much better when hip fractures are treated as expeditiously as possible,” Devish said.
Devish knows a lot about hip fractures, because repairing them is his focus.
“Hip fractures are the most common fracture I fix,” he said. “I appreciate the ability to specialize because by doing something over and over, you become really good at what you do, and your patients have excellent outcomes.”
Devish said he initially chose to focus on orthopedic surgery because he appreciates the challenge it presents, and the way he feels after caring for a patient.
“I love my job,” he said. “I get to restore anatomy by utilizing power tools I hold in my hands, and using state-of-the-art techniques and technology to stabilize a fracture for them, which restores their mobility and function so they can continue to live the life they want.”
Learn more about orthopedic care and sports medicine at Avera.
