Cleveland Clinic’s Department of Orthopaedic Surgery has released a downloadable guide for patients considering knee repair. Produced by the staff at Cleveland Clinic, the guide explains the causes of knee pain as well as the options for repairing and relieving pain in easy-to-understand terminology.

The Comprehensive Guide to Knee Pain and Repair focuses on the current solutions for knee pain. Downloadable here the guide covers the following methods of knee repair:

- Physical Therapy
- Viscosupplementation
- Support Systems (Braces)
- Arthroscopic Surgery
- Partial Knee Replacement
- Full Knee Replacement

“We feel it’s important that someone suffering from pain in the knees understands that there are options available to them,” says Wael Barsoum, MD, Vice Chairman, Orthopaedic Surgery. “We’re pleased to offer this guide to the public, explaining the different treatments that are available, ranging from simpler options like knee braces all the way to total knee replacement.”

The Cleveland Clinic’s Department of Orthopaedic Surgery has consistently ranked in the top five orthopaedic programs in the nation according to U.S.News and World Report. The physicians and surgeons are recognized as some of the best in the world for knee repair. Cleveland Clinic surgeons are currently taking part in a multi-center study on the effectiveness and viability of partial knee joint resurfacing.

clevelandclinic/

Patients who have undergone a single-level lumbar microdiskectomy for lumbar disk herniation experienced significant improvement in physical function following an intensive, progressive physical therapist guided exercise and education program, according to a research report published in the November issue of Physical Therapy (PTJ), the scientific journal of the American Physical Therapy Association (APTA).

Low back pain continues to be the most prevalent musculoskeletal problem, and one cause is lumbar disk herniation accompanied by sciatica – with many cases resulting in lumbar diskectomy. Up to 35 percent of patients continue to have pain and impaired function after surgery, which may be related to the type of postoperative care that they receive.

“An important goal of physical therapy interventions is to resolve functional deficits associated with low back pain,” said physical therapist and lead researcher Kornelia Kulig, PT, PhD, associate professor of clinical physical therapy in the Division of Biokinesiology and Physical Therapy at the University of Southern California in Los Angeles. “There is strong evidence that intensive exercise is effective in restoring functional status in patients who have undergone lumbar diskectomy. The exercise intervention in our study consisted of an intensive, graded strength and endurance training program targeting the trunk and lower-extremity musculature.”

In this study, 98 participants who had undergone a single-level microdiskectomy were randomly allocated to receive education only or exercise and education. The education-only group received one session of back care education 4-6 weeks after surgery. The education and exercise group received one back care education session followed by a 12-week USC Spine Exercise Program initiated 2-3 days after the education session. The exercise program consisted of back extensor strength (force-generating capacity) and endurance training as well as mat and upright therapeutic exercises. The back extensor strength and endurance training portion was designed to load the back extensor muscles in a graded manner by varying the time and angle at which the trunk was held against gravity, using a variable-angle Roman chair.

The goal of the program was for participants to be able to maintain a horizontal body position for 180 seconds. The purpose of the mat and upright therapeutic exercise portion of the program was to progressively and dynamically develop strength, endurance, and control of movement by the trunk and lower-extremity musculature.

Testing on all outcome measures began 4-6 weeks after surgery, prior to intervention, and was repeated for comparison after the 12-week program. Participants showed improvement in their ability to engage in activities of daily living as well as performance on the Repeated Sit-to-Stand Test, the 50-Foot Walk Test, and the 5-Minute Walk Test. In addition, some participants opted out of their allocated intervention group to pursue physical therapy care outside of the study, but agreed to remain in the study. This allowed researchers to include a third group. The three-group analysis still showed greater improvement in activities of daily living scores, 5-minute walk distance, and 50-foot walk time in the exercise and education group.

“These results suggest greater effectiveness of the current exercise program in reducing disability and improving walking performance than that expected from usual physical therapy,” remarked Kulig. “An intensive 12-week strength and endurance training program of the trunk and lower-extremity musculature is safe and results in a greater reduction in disability and a greater increase in walking performance immediately following the intervention.”

This study was funded by a grant from the Foundation for Physical Therapy.

Source: Jennifer Rondon

American Physical Therapy Association

A new tool lets people with disabilities control a computer cursor without lifting a finger. Early tests suggest that an experienced user of Vocal Joystick would have as much control as someone using a handheld device.

The Internet offers wide appeal to people with disabilities. But many of those same people find it frustrating or impossible to use a handheld mouse. Software developed at the University of Washington provides an alternative using one of the oldest and most versatile modes of communication: the human voice.

“There are many people who have perfect use of their voice who don’t have use of their hands and arms,” said Jeffrey Bilmes, a UW associate professor of electrical engineering. “I think there are several reasons why Vocal Joystick might be a better approach, or at least a viable alternative, to brain-computer interfaces.” The tool’s latest developments will be presented this month in Tempe, Ariz. at the Assets Conference on Computers and Accessibility.

Vocal Joystick detects sounds 100 times a second and instantaneously turns that sound into movement on the screen. Different vowel sounds dictate the direction: “ah,” “ee,” “aw” and “oo” and other sounds move the cursor one of eight directions. Users can transition smoothly from one vowel to another, and louder sounds make the cursor move faster. The sounds “k” and “ch” simulate clicking and releasing the mouse buttons.

Versions of Vocal Joystick exist for browsing the Web, drawing on a screen, controlling a cursor and playing a video game. A version also exists for operating a robotic arm, and Bilmes believes the technology could be used to control an electronic wheelchair.

Existing substitutes for the handheld mouse include eye trackers, sip-and-puff devices, head-tracking systems and other tools. Each technology has drawbacks. Eye-tracking devices are expensive and require that the eye simultaneously take in information and control the cursor, which can cause confusion. Sip-and-puff joysticks held in the mouth must be spit out if the user wants to speak, and can be tiring. Head-tracking devices require neck movement and expensive hardware.

Vocal Joystick requires only a microphone, a computer with a standard sound card and a user who can produce vocal sounds.

“A lot of people ask: ‘Why don’t you just use speech recognition?” Bilmes said. “It would be very slow to move a cursor using discrete commands like ‘move right’ or ‘go faster.’ The voice, however, is able to do continuous commands quickly and easily.” Early tests suggest that an experienced user of Vocal Joystick would have as much control as someone using a handheld device.

In the laboratory, doctoral student Jonathan Malkin, who helped develop the tool, uses Vocal Joystick to play a game called Fish Tale. It takes two minutes to train the program for Malkin’s voice. He then moves the fish character easily around the screen, raising his voice slightly to speed up and avoid being eaten by a predator fish.

The newest development, which will be presented at the October meeting in Tempe, uses Vocal Joystick to control a robotic arm. The pitch of the tone moves the arm up and down; other commands are unchanged. This is the first time that vocal commands have been used to control a three-dimensional object, Bilmes said.

One initial concern, he said, was whether people would feel self-conscious using the tool.

“But once you try it you immediately forget what you’re saying,” Bilmes said. “I usually go to the New York Times’ Web site to test the system and then I get distracted and start reading the news. I forget that I’m using it.”

To test the device, the group has been working with about eight spinal-cord injury patients at the UW Medical Center since March.

“It’s a really exciting idea. I think it has tremendous potential,” said Kurt Johnson, a professor of rehabilitation medicine who is helping with the tests.

Bilmes said he hopes people will become more adept at using the system over time. Future research will incorporate more advanced controls that use more aspects of the human voice, such as repeated vocalizations, vibrato, degree of nasality and trills.

“While people use their voices to communicate with just words and phrases,” Bilmes said, “the human voice is an incredibly flexible instrument, and can do so much more.”

###

Video demonstrations and publications are available on the group’s Web site..

Source: Hannah Hickey

University of Washington

Patients who have undergone a single-level lumbar microdiskectomy for lumbar disk herniation experienced significant improvement in physical function following an intensive, progressive physical therapist guided exercise and education program, according to a research report published in the November issue of Physical Therapy (PTJ), the scientific journal of the American Physical Therapy Association (APTA).

Low back pain continues to be the most prevalent musculoskeletal problem, and one cause is lumbar disk herniation accompanied by sciatica-with many cases resulting in lumbar diskectomy. Up to 35 percent of patients continue to have pain and impaired function after surgery, which may be related to the type of postoperative care that they receive.

“An important goal of physical therapy interventions is to resolve functional deficits associated with low back pain,” said physical therapist and lead researcher Kornelia Kulig, PT, PhD, associate professor of clinical physical therapy in the Division of Biokinesiology and Physical Therapy at the University of Southern California in Los Angeles. “There is strong evidence that intensive exercise is effective in restoring functional status in patients who have undergone lumbar diskectomy. The exercise intervention in our study consisted of an intensive, graded strength and endurance training program targeting the trunk and lower-extremity musculature.”

In this study, 98 participants who had undergone a single-level microdiskectomy were randomly allocated to receive education only or exercise and education. The education-only group received one session of back care education 4-6 weeks after surgery. The education and exercise group received one back care education session followed by a 12-week USC Spine Exercise Program initiated 2-3 days after the education session. The exercise program consisted of back extensor strength (force-generating capacity) and endurance training as well as mat and upright therapeutic exercises. The back extensor strength and endurance training portion was designed to load the back extensor muscles in a graded manner by varying the time and angle at which the trunk was held against gravity, using a variable-angle Roman chair.

The goal of the program was for participants to be able to maintain a horizontal body position for 180 seconds. The purpose of the mat and upright therapeutic exercise portion of the program was to progressively and dynamically develop strength, endurance, and control of movement by the trunk and lower-extremity musculature.

Testing on all outcome measures began 4-6 weeks after surgery, prior to intervention, and was repeated for comparison after the 12-week program. Participants showed improvement in their ability to engage in activities of daily living as well as performance on the Repeated Sit-to-Stand Test, the 50-Foot Walk Test, and the 5-Minute Walk Test. In addition, some participants opted out of their allocated intervention group to pursue physical therapy care outside of the study, but agreed to remain in the study. This allowed researchers to include a third group. The three-group analysis still showed greater improvement in activities of daily living scores, 5-minute walk distance, and 50-foot walk time in the exercise and education group.

“These results suggest greater effectiveness of the current exercise program in reducing disability and improving walking performance than that expected from usual physical therapy,” remarked Kulig. “An intensive 12-week strength and endurance training program of the trunk and lower-extremity musculature is safe and results in a greater reduction in disability and a greater increase in walking performance immediately following the intervention.”

This study was funded by a grant from the Foundation for Physical Therapy.

Source
American Physical Therapy Association

Mary Agnes Carey, associate editor of CQ HealthBeat, discusses House Democrats’ efforts to override President Bush’s veto of SCHIP expansion legislation, a House hearing about tobacco regulation and disability benefits for veterans in this week’s “Health on the Hill from kaisernetwork and CQ.”

According to Carey, House Democrats and advocates are trying to sway House Republicans and Democrats who voted against legislation that would have reauthorized and expanded SCHIP to override Bush’s veto of the measure. An override vote is scheduled for Oct. 18. The SCHIP bill passed by a veto-proof majority in the Senate but not in the House. Carey says obtaining enough votes in the House to override the veto “will be a difficult task to achieve.” A Senate Republican proposal that would add about $14 billion to SCHIP over five years and restrict coverage to low-income children younger than age 19 and to pregnant women may prove to be a way to “break the logjam,” Carey says.

Carey also discusses a House Energy and Commerce Health Subcommittee hearing on legislation that would permit FDA to regulate tobacco, including flavorings and other additives used by cigarette manufacturers. According to Carey, proponents of the bill say it is needed because tobacco use is the leading cause of preventable death in the U.S. and costs the nation $96 billion annually in health costs. However, several Republicans on the panel expressed concerns that the bill would undermine FDA’s public health mission and that the government already has implemented efforts to reduce tobacco use.

In addition, Carey discusses recommendations by the Veterans’ Disability Benefits Commission to increase disability benefits by up to 25% until a new system is put in place to more adequately reflect the needs of veterans returning from the wars in Iraq and Afghanistan. The commission stated that not enough attention is being paid to such conditions as post-traumatic stress disorder and called for more frequent mental health examinations and compensation for PTSD patients, as well as a reduction in the backlog of disability claims, Carey says.


The complete audio version of “Health on the Hill,” transcript and resources for further research are available online at kaisernetwork.

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

GE Healthcare, a unit of General Electric Company (NYSE:GE), announced the installation of Russia’s first high-definition computed tomography (CT) scanner, GE Healthcare’s flagship Discovery CT750HD, at the Center of Medical Rehabilitation by the Russian Ministry of Health in Moscow led by Professor Konstantin V. Lyadov.

The Centre of Medical Rehabilitation is the first hospital in Russia to join leading hospitals around the globe in installing this powerful groundbreaking high-definition CT technology. The scanner sets a new standard for CT clarity, allowing clinicians to diagnose quickly and confidently using significantly less x-ray radiation than previous CT scanners.

“We are delighted to have the first Discovery CT750 HD in Russia as part of Center of Medical Rehabilitation’s investment in cutting edge technology. This exciting development of high definition CT improves our ability to see fine anatomical detail in what can be difficult to image diseases,” said Professor Valentin E. Sinitsyn, Moscow Medical Academy & Head of Diagnostic Centre in Federal Medical & Rehabilitation Centre.

Vyacheslav Grischenko, General Manager Russia & CIS, GE Healthcare said: “With this outstanding technology, high-definition image quality can be achieved without increasing the x-ray dose to which patients are exposed. For some cardiac patients, for example, this can mean a valuable alternative to the traditional invasive angiogram. It is less invasive and less expensive.”

The new scanner uses a breakthrough garnet gemstone CT detector, the first new CT detector technology in 20 years. The gemstone detector can improve image clarity by up to 33% for routine body imaging and up to 47% for cardiac imaging and helps improve doctors’ ability to see the difference between various types of tissue.

In addition to providing better image clarity, the new scanner is designed to reduce the amount of X-ray dose for patients by up to 50 % for full-body scans, and up to 83% for heart scans.

The Discovery CT750 HD improves image quality while reducing dose up to 50% across the entire body, maintaining GE Healthcare’s position as a leader in low dose technology.

Notes

- GE Healthcare’s proprietary GemstoneTM detector is the first new CT scintillator in 20 years and is based on a garnet gemstone.

- The Gemstone detector enables spatial resolution improvements of up to 33% for routine body imaging over today’s existing product.

- Gemstone Spectral Imaging enhances tissue characterization through its ability to derive images that separate materials such as calcium, iodine and water.

- The world’s first high definition CT scanner sets new standards for CT clarity and dose reduction and GE has now begun shipping Discovery CT750 HD scanners to customers around the world.

- Superior image quality at the lowest possible dose is a key priority for GE Healthcare. GE Healthcare follows the ALARA (As Low As Reasonably Achievable) principle for dose management and offers a variety of dose reduction and optimization features on its CT scanners.

About healthymagination

Healthymagination is GE’s global business strategy announced in May 2009. It aims to help healthcare providers deliver better healthcare to more people at lower cost. GE committed US$3 billion worldwide, for 100 innovations that lower cost, increase access and improve quality, as well as to $2 billion to finance IT and access rural & underserved areas, and to $1 billion for partnerships, content and services.

Source
GE Healthcare

Recent data from the Census Bureau that indicated a decrease in the percentage of elderly U.S. residents who live in nursing homes provide a “highly misleading picture of nursing home care in America today,” Alan Rosenbloom, president of the Alliance for Quality Nursing Home Care, writes in a USA Today letter to the editor (Rosenbloom, USA Today, 10/5). According to the data, 7.4% of residents ages 75 and older lived in nursing homes in 2006, compared with 8.1% in 2000 and 10.2% in 1990 (Kaiser Daily Health Policy Report, 9/27).

Rosenbloom writes that “based on our internal data, nursing homes today are caring for even more people than in the past,” although “ever-increasing numbers receive short-term rehabilitation and return home.” The “only accurate assessment” of nursing home care would “evaluate the total number of people served annually — not the number of people served at a specific point in time,” according to Rosenbloom.

He writes, “The good news is that more patients of nursing homes are returning home than ever, and the short-term rehabilitative care they receive is better than ever,” adding, “We should be celebrating the changing face of nursing homes and their place in a robust health care system for our aging baby boomers, rather than offering simplistic conclusions from misleading data” (USA Today, 10/5).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Constraint-induced movement therapy (CIMT) is a potentially effective form of intervention for children with hemiplegic cerebral palsy, but more research is needed, according to a new systematic review published in the November issue of Physical Therapy (PTJ), the scientific journal of the American Physical Therapy Association (APTA). The review, which analyzed 21 intervention studies and 2 systematic reviews, concluded that further research should focus on the frequency, duration, and type of constraint used to treat the affected limb. Similar gains may be achieved when both arms are used together during therapy, but there have not as yet been sufficient studies that compare these two types of physical therapy. Moreover, the review concluded that there is insufficient research on the impact of CIMT on a developing child’s undamaged brain regions and that more investigation is needed.

Hemiplegic cerebral palsy affects one arm and leg on the same side of the body. CIMT forces the use of the affected side, specifically the upper extremity, by gently restraining the unaffected side in a mitt, sling, or cast. The patient then practices moving the affected arm for varying durations of time and intensity. Previous studies showed support for the use of CIMT to improve the frequency of use of the affected arm for children with hemiplegia. In most studies, positive effects were demonstrated 6 to 8 months after intervention.

“Although previous studies reveal a marked increase in function of the affected limb, there is a strong need for more rigorous studies to determine what constitutes an adequate dose of CIMT for pediatric patients with hemiplegia,” said physical therapist Linda Fetters, PT, PhD, FAPTA, the holder of the Sykes Family Chair in Pediatric Physical Therapy, Health, and Development in the Division of Biokinesiology and Physical Therapy, and a professor in the Department of Pediatrics at the Keck School of Medicine at the University of Southern California.

This systematic review specifically focused on research involving children younger than 18 years of age, as the central nervous system in these young children is still in the early stages of development. One of the theories behind the success of CIMT in children is that the developing brain has the capacity to reorganize learning.

“What we don’t yet know is the impact of prolonged restraint on a child’s developing nervous system,” said first author Hsiang-han Huang, MS, OT, a ScD student in the Department of Physical Therapy and Athletic Training at Boston University. “Depending on the stage of development during which CIMT is applied, its potential impact may differ.”

Source
American Physical Therapy Association

Final preparations are being put in place for the opening of a brand new service which is set to be launched at Goole District Hospital.

The doors of the new Goole Neuro-Rehabilitation Centre will be open to patients from Monday October 22nd 2007. It is the result of Northern Lincolnshire and Goole Hospitals NHS Foundation Trust working in co-operation with The Brain Injury Rehabilitation Trust (BIRT).

The venture offers high quality care and support within an NHS setting, but operating independently of the NHS.

The 14-bedded facility provides post acute and community integration rehabilitation, for people with acquired brain injury, following BIRT’s well-established neuro-behavioural model. Under this model, each service user has an individual rehabilitation plan, which includes structured learning programmes, practising daily living skills, community access skills, behavioural management techniques, social skills training and vocational training and support.

In addition the unit offers a short term assessment and rehabilitation service for people with neurological disabilities, such as multiple sclerosis and Guillain Barre Syndrome.

The team of staff includes physiotherapists, occupational therapists, a speech and language therapist, a neuropsychologist and a number of rehabilitation support workers, all of whom will work alongside the existing Trust Community Rehabilitation Medicine Service to provide a continuous link for each individual through their pathway of care from in-patient through to re-integration into the community.

Trust Divisional Manager of Clinical Sciences Karen Griffiths said: “This is a long awaited development for the locality, as previously patients requiring neuro-rehabilitation programmes on discharge from hospital are required to access services out of the area – which brings difficulties for both patients, carers and their families.

“We look forward to receiving patients and supporting this new care pathway that joins both acute and social rehabilitation, enhancing outcomes of rehabilitation and delivers improved care.”

BIRT, and its parent charity The Disabilities Trust, will be able to draw on its existing representation in the North and North East to provide a continuum of care for people with brain injury or physical disabilities in residential settings or in its community supported houses or home support packages.

Mike McPeake, Services Manager for BIRT, said: “This is an exciting development, which could act as a forerunner for similar partnerships with other NHS Trusts in future. The project will enable people who need intensive one-to-one support to access our proven brain injury rehabilitation model at a much earlier stage and will have the added benefit of being located much closer to people’s homes in North Lincolnshire.”

For further information on the Northern Lincolnshire and Goole Hospitals Trust please visit nlg.nhs

For more information about the work of the Brain Injury Rehabilitation Trust (BIRT), please visit birt.

Source:
David Eggleston
The Disabilities Trust
The Disabilities Trust is a Registered Charity, No 800797

A fracture, also referred to as a bone fracture, FRX, FX, Fx or # is a medical condition where the continuity of the bone is broke. A significant percentage of bone fractures occur because of high force impact or stress; however, a fracture may also be the result of some medical conditions which weaken the bones, for example osteoporosis, some cancers or osteogeneris imperfecta. A fracture caused by a medical condition is known as a pathological fracture.

The word break is commonly used by lay (non-professional) people. Among health care professionals, especially bone specialists, such as orthopedic surgeons, break is a much less common term when talking about bones.

A crack (not only a break) in the bone is also known as a fracture. Fractures can occur in any bone in the body. There are several different ways in which a bone can fracture; for example a clean break to the bone that does not damage surrounding tissue or tear through the skin is known as a closed fracture or a simple fracture. On the other hand, one that damages surrounding skin or tissue is known as a compound fracture or an open fracture. Compound or open fractures are generally more serious than simple fractures, with a much higher risk of infection.

Most human bones are surprisingly strong and can generally stand up to fairly strong impacts or forces. However, if that force is too powerful, or there is something wrong with the bone, it can fracture.

The older we get the less force our bones can withstand. Approximately 50% of women and about 20% of men have a fracture after they are 50 years old (Source: National Health Service, UK).

Because children’s bones are more elastic, when they do have fractures they tend to be different. Children also have growth plates at the end of their bones – areas of growing bone – which may sometimes be damaged.

According to Medilexicon’s medical dictionary:

To fracture means “to break”.
A fracture (fx) is “a break, especially the breaking of a bone or cartilage.”

Some different types of fracture:

Avulsion fracture – a muscle or ligament pulls on the bone, fracturing it.
Comminuted fracture – the bone is shattered into many pieces.
Compression (crush) fracture – generally occurs in the spongy bone in the spine. For example, the front portion of a vertebra in the spine may collapse due to osteoporosis.
Fracture dislocation – a joint becomes dislocated, and one of the bones of the joint has a fracture.
Greenstick fracture – the bone partly fractures on one side, but does not break completely because the rest of the bone can bend. More common among children, whose bones are softer and more elastic.
Hairline fracture – a partial fracture of the bone. Often this type of fracture is harder to detect.
Impacted fracture – when the bone is fractured, one fragment of bone goes into another.
Longitudinal fracture – the break is along the length of the bone.
Oblique fracture – A fracture that is diagonal to a bone’s long axis.
Pathological fracture – when an underlying disease or condition has already weakened the bone, resulting in a fracture (bone fracture caused by an underlying disease/condition that weakened the bone).
Spiral fracture – A fracture where at least one part of the bone has been twisted.
Stress fracture – more common among athletes. A bone breaks because of repeated stresses and strains.
Torus (buckle) fracture – bone deforms but does not crack. More common in children. It is painful but stable.
Transverse fracture – a straight break right across a bone.

What are the signs and symptoms of a bone fracture?
A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.
The signs and symptoms of a fracture vary according to which bone is affected, the patient’s age and general health, as well as the severity of the injury. However, they may include some of the following:

Pain
Swelling
Bruising
Discolored skin around the affected area
Angulation – the affected area may be bent at an unusual angle
The patient is unable to put weight on the injured area
The patient cannot move the affected area
The affected bone or joint may have a grating sensation
If it is an open fracture there may be bleeding
When a large bone is affected, such as the pelvis or femur..

The sufferer may look pale and clammy
There may be dizziness (feeling faint)..
..as well as a feeling of sickness and nausea

If possible, do not move a person with a broken bone until a health care professional is present and can assess the situation and, if required, apply a splint. Obviously, if the patient is in a dangerous place, such as in the middle of a busy road, one sometimes has to act before the emergency services arrive.
What are the causes of bone fractures?
The majority of fractures are caused by a bad fall or automobile accident. Healthy bones are extremely tough and resilient and can withstand surprisingly powerful impacts. When people enter old age two factors make their risk of fractures greater; weaker bones and a greater risk of falling.

Children, who tend to have more physically active lifestyles than adults, are also prone to fractures.

People with underlying illnesses and conditions that may weaken their bones also have a higher risk of fractures. Examples include osteoporosis, infection, or a tumor. As mentioned earlier, this type of fracture is known as a pathological fracture.

Stress fractures, which result from repeated stresses and strains, commonly found among professional sports people, are also common causes of fractures.
How is a fracture diagnosed?
A doctor will carry out a physical examination, identify signs and symptoms and make a diagnosis. The patient will be interviewed – or friends, relatives or witnesses if the patient cannot communicate properly – and asked about circumstances that clearly caused the injury or may have caused it.

Doctors will often order an X-ray. In some cases an MRI (magnetic resonance imaging) or CT (computed tomography) scan may also be ordered.
What are the treatment options for a bone fracture?
Bone healing is a natural process which in most cases will occur automatically. Fracture treatment is usually aimed at making sure there is the best possible function of the injured part after healing. Treatment also focuses on providing the injured bone with the best circumstances for optimum healing (immobilization).

For the natural healing process to begin, the ends of the broken bone need to be lined up – this is known as reducing the fracture.

The patient is usually asleep under a general anesthetic when fracture reduction is done. Fracture reduction may be done by manipulation, closed reduction (pulling the bone fragments), or surgery.

Immobilization – as soon as the bones are aligned they must stay aligned while they heal. This may include:

Plaster casts or plastic functional braces – these hold the bone in position until it has healed.
Metal plates and screws – current procedures use minimally invasive techniques.
Intra-medullary nails – Internal steel rods are placed down the center of long bones. Flexible wires may be used in children.
External fixators – these may be made of metal or carbon fiber; they have steel pins that go into the bone directly through the skin. They are a type of scaffolding outside the body.

Usually the fractured bone area is immobilized for between two to eight weeks. The duration depends on which bone is affected and whether there are any complications, such as a blood supply problem or an infection.

Healing – if a broken bone has been aligned properly and kept immobile the healing process is usually straightforward.

Osteoclasts (bone cells) absorb old and damaged bone while osteoblasts (other bone cells) are used to create new bone. Callus is formed; callus is new bone which is formed around a fracture. It forms on either side of the fracture and grows towards each end until the fracture gap is filled. Eventually the excess bone smoothes off and the bone is like it used to be before.

The patient’s age, which bone is affected, the type of fracture, as well as the patient’s general health are all factors which influence how rapidly the bone heals. If the patient smokes regularly the healing process will take longer.

Physical therapy (UK: physiotherapy) – after the bone has healed it may be necessary to restore muscle strength as well as mobility to the affected area. If the fracture occurred near or through a joint there is a risk of permanent stiffness – the individual may not be able to bend that joint as well as before.

Surgery – if there was damage to the skin and soft tissue around the affected bone or joint, plastic surgery may be required.

Delayed unions and non-unions

Non-unions are fractures that fail to heal, while delayed unions are those that take longer to heal.

Ultrasound therapy – low-intensity ultrasound is applied daily to the affected area. This has been found to help the fracture to heal. Studies in this area are still ongoing.
Bone graft – if the fracture does not heal a natural or synthetic bone is transplanted to stimulate the broken bone.
Stem cell therapy – studies are currently underway to see whether stem cells can be used to heal fractures that do not heal.

What are the possible complications of a bone fracture?
Heals in the wrong position – this is known as a malunion; either the fracture heals in the wrong position or it shifts (the fracture itself shifts).

Disruption of bone growth – if a childhood bone fracture affects both ends of bones, there is a risk that the normal development of that bone may be affected, raising the risk of a subsequent deformity.

Persistent bone or bone marrow infection – if there is a break in the skin, as may happen with a compound fracture, bacteria can get in and infect the bone or bone marrow, which can become a persistent infection (osteomyelitis). Patients may need to be hospitalized and treated with antibiotics. Sometimes surgical drainage and curettage is required.

Bone death (avascular necrosis) – if the bone loses its essential supply of blood it may die.
Prevention of fractures
Nutrition and sunlight – the human body needs adequate supplies of calcium for healthy bones. Milk, cheese, yoghurt and dark green leafy vegetables are good sources of calcium. Our body needs vitamin D to absorb calcium – exposure to sunlight, as well as eating eggs and oily fish are good ways of getting vitamin D.

Physical activity – the more weight-bearing exercises you do, the stronger and denser your bones will be. Examples include skipping, walking, running, and dancing – any exercise where the body pulls on the skeleton.

Older age not only results in weaker bones, but often in less physical activity, which further increases the risk of even weaker bones. It is important for people of all ages to stay physically active.

The (female) menopause – estrogen, which regulates a woman’s calcium, starts to drop and continues to do so until after the menopause; levels never come back up to pre-menopausal levels. In other words, calcium regulation is much more difficult after the menopause. Consequently, women need to be especially careful about the density and strength of their bones during and after the menopause. The following steps may help reduce post-menopausal osteoporosis risk:

Do several short weight-bearing exercise sessions each week.
Do not smoke.
Consume only moderate quantities of alcohol, or don’t drink it.
Make sure you get adequate exposure to daylight.
Make sure your diet has plenty of calcium-rich foods. For those who find this difficult, talk to your doctor about taking calcium supplements.