Traumatology is the part of medicine that is dedicated to the diagnosis and treatment of injuries of the musculoskeletal system. Being integrated not only the four limbs and their anchor waists, but the entire osteoarticular system, including the spine and the muscular and tendon elements.
Treatment may be without surgery (orthopedic treatment or conservative treatment) or by surgery. The decision between one or the other depends on the patient (general condition), the location of the fracture or the existence of conditions that justify one treatment over another.
These types of fractures are common in older people and more frequently in women.
In most cases these are elderly patients so it is best that they can be mobilized early. For this, surgical treatment is of choice either stabilizing the fracture by nails or plates and screws or replacing the affected part of the femur with a prosthesis.
The hip fracture should be operated on as soon as possible once the patient has been medically stabilized and there are no risks secondary to medical treatments.
The treatment of fractures is based on two procedures:
1- “non-operative or conservative by means of which external maneuvers are performed to accommodate the óseos displacements, and then external immobilizing devices such as plaster casts, splints, bandages, or simply rest are applied.
2-“surgical treatments”, also called “osteosynthesis”, through which through some form of surgery the displaced bone fragments are accommodated, and to keep them immobilized, internal implants are used, almost always metallic; in this way the reduction achieved is sustained.”
The objective of the traumatologist is that the consolidation of the fracture occurs in the most anatomical position possible and compatible with a maximum functional recovery.
For this, a knowledge of the fundamental biological and biomechanical principles is essential to indicate the best treatment at the most opportune time.
The modern techniques of stabilization and fixation of fractures, with which we have, favor the consolidation, reducing the immobilization times and facilitating the return of the patient to his usual activity.
Fractures of long bones (upper and lower extremities).
Fractures of the shoulder, collarbone, and elbow.
Wrist and hand fractures.
Fractures of the pelvis.
Fractures of the proximal and distal femur.
Fractures of the proximal tibia.
Fractures of the ankle and foot.
Extraction of osteosynthesis material.
Fractures of the proximal third of the humerus can occur at any age, although it frequently affects young patients, in high-energy accidents (sports accidents, traffic accidents, etc.), and elderly patients, related to osteoporosis.
Treatment will depend on the displacement of the fragments that occur in the fracture.
Thus, non-surgical treatment (i.e., conservative treatment) will be performed on those fractures that are not displaced, and surgical treatment will be chosen on those fractures where their fragments are displaced and may cause a difficulty in consolidation or consolidation in a bad position, resulting in a malfunction of the limb.
It is very important, then, that it is a traumatologist specializing in shoulder surgery who solves these fractures since the complexity of this surgery means that whoever performs it must have experience in this field.
Your surgeon specializing in shoulder surgery will have to choose between the different options to find the best option to treat your problem:
To achieve an optimal result after surgical treatment, your traumatologist will prescribe rehabilitative treatment to achieve the best functional result to cope with activities of daily living, as well as to return to your work and sports activity is the best conditions.
It is the non-surgical option, that is to say that due to the characteristics of the fracture the best option is not to operate, since the final result will probably be the same as if an intervention were performed but without the risks involved in going to the operating room.
This treatment consists of having the affected arm immobilized by means of an immobilizing bandage, which should not be removed throughout the day and all night, until a total of three weeks.
From the three weeks a series of passive exercises are started that will teach you in the consultation in order to begin the recovery phase of your shoulder. These exercises should be performed for a period of three weeks and from six weeks from the fracture will begin assisted rehabilitation until your final recovery.
This is a surgical option, that is to say that due to the characteristics of the fracture the best option is to operate, since the final result would probably not be the same as if an intervention were not performed. This implies that we will assume some risks that the operating room entails, but the benefits we obtain with the intervention are greater than the risks of going to the operating room.
With osteosynthesis the surgeon will try to reconstruct the normal shape of the fractured shoulder using the different techniques that currently exist. Among them are the endomedular interlocking and the plate, among others.
Clavicle fractures usually occur in young patients in connection with sports activities or traffic accidents.
It can also occur in children, infants and newborns as a result of obstetric maneuvers.
The most common treatment is conservative or non-surgical treatment, leaving the latter for those fractures that are displaced and that may give problems for consolidation.
It will be your traumatologist who will inform you if your clavicle fracture has to be operated on, since the most common form of treatment is usually by sling or another immobilization system, that is, without having to be operated on.
Surgical treatment of clavicle fracture is performed by reducing the fracture and placing a plate with screws that ensures reduction until consolidation.
It will be through clinical-radiological controls that you will perform in the consultation, when your traumatologist will inform you of how the fracture evolves until its healing.
Elbow fractures are usually very complex fractures, which requires a great deal of knowledge in the management of these injuries in both the child and the adult.
Fractures of the child’s elbow (supracondylele fractures) can be treated conservatively (without surgery) as long as they are not displaced and the surgical option will be decided in those that are displaced.
It will be the traumatologist on call who will inform you of the type of fracture and what is the most appropriate treatment.
When an intervention is performed, the fracture is usually stabilized by needles that must be removed after six weeks. During that time the arm will be immobilized with a splint for 2/3 weeks (depending on the fracture) to move to a softer immobilization allowing some degree of mobility of the elbow, and the elbow will be left free from six weeks when the needles must be removed.
When conservative treatment is performed, the immobilization regimen follows more or less the same as the surgical one but without the need for intervention.
They are usually always surgical.
Supracondyleal fractures of the adult have to be operated on in most cases. There are few occasions when we will decide to treat them conservatively (not surgically).
The intervention is performed by osteosynthesis with formed plates, that is, with plaques that adapt to the anatomy of the region. They are complex fractures that often leave some degree of sequel, so they require a surgeon with great knowledge of the region.
In elderly patients with great involvement of the joint area, it may be necessary to use an elbow prosthesis, if reconstruction becomes impossible.