Fracture treatment

The days when all broken bones were plastered are long gone.

...there are several reasons for this:

On the one hand, surgical techniques and implants (plates, nails, etc.) have improved considerably, and on the other hand, we now know that it is better to move joints as soon as possible than to keep them in plaster casts for a long time, as this keeps the joints mobile, protects the articular cartilage and reduces muscle atrophy during fracture healing.

Patient comfort is also significantly higher following surgical treatment of fractures. Patients are more mobile, personal hygiene is easier and integration into working life is quicker. These are advantages that hardly anyone wants to do without today.

A basic distinction is made between intramedullary and extramedullary surgical methods.
Intramedullary techniques involve the use of TENS, nails or similar.

TENS (titanium-elastic nails) are used almost exclusively in children. The advantage is that the fracture can usually be closed in children. A hole can then be drilled into the bone through a small skin incision of approx. 2 cm in length under X-ray control and the TEN inserted into the long bone (e.g. radius, tibia), which is hollow on the inside.

Lower leg nail

This means that only an approx. 2 cm long scar remains on the outside. After 2-3 months, this 2 to 5 mm thick titanium wire can be removed over the old scar under a short anesthetic.
In adults, the TEN is usually too "weak" and not suitable for fracture treatment. In this case, intramedullary nails (especially on the upper arm and shin) are used. These are inserted through 5-6 cm long skin incisions, if necessary after drilling out the hollow bones. Before or during the procedure, the fracture is set up under X-ray control. To prevent the bone from twisting or shortening again in the fracture area, the nail, which has drill holes in its upper and lower ends, must be fixed to the bone with screws. The nail can be removed again after approx. 1 ½ years.

IMC under image control

For humeral fractures just below the humeral head, we are one of the few hospitals to use a special implant, the IMC (intramedullary claw).

It can be used to set up and stabilize the fracture with minimal effort and without damaging important soft tissue (tendon cap of the shoulder = rotator cuff).

However, a 4-week period of immobilization is then required. Exercise therapy with a physiotherapist can begin after 3 weeks. The IMC should be removed after 12 weeks, as otherwise it will grow in strongly and subsequent removal may be difficult.

In the case of other bones (such as ulna, radius, metacarpus, fingers, ankle...), special fracture types or localizations (e.g. close to the joint), fractures must be set open.

This means that a longer skin incision has to be made, muscles are detached, tendons and vessels such as nerves are held aside, the fracture is set up under direct vision and stabilized with a plate through whose holes screws are inserted. Nowadays, in addition to conventional implants, we also have so-called angle-stable plates available for this purpose. This means that the screw head also has a thread with which the screw is firmly fixed in the plate hole and therefore cannot loosen in the plate hole and cannot change the angle to the plate.

This ensures significantly more stability in the fracture treatment and a reduction in the complication rate, such as failure of the fracture to heal or loss of reduction (tilting of the set fracture again). The plates can be removed again after approx. ½-1 year, depending on the localization and X-ray findings.

All of these different fracture treatment options are offered in our clinic, meaning that fractures are treated at the highest level and according to the latest scientific standards.