The times when all fractures were put in plaster are long gone.
There are several reasons for this:
• First, surgical techniques and implants (plates, screws…) have improved significantly and secondly, we know today that rapid reintegration of movement to the joints – compared to long periods of immobility in a plaster cast – keeps the joints flexible, protects the articular cartilage and reduces muscle wastage in the context of fracture healing.
• Patient comfort is also significantly improved after surgically treated fractures. Patients are more mobile, personal hygiene is easier to manage and people are able to return to their working lives faster. Advantages that hardly anyone would want to forgo.
There are basically two types of surgical methods; the so-called intramedullary and extramedullary procedures.
Intramedullary techniques involve the use of TENS, nails or similar.
TENS (titan elastic nails) are used almost exclusively on children. The advantage is that these injuries on children do not generally need to be opened up. Via a small incision of around 2cm in length, performed under x-ray guidance, a small hole can be drilled into the bone and the TEN inserted into the long bone (e.g. tibia), which is hollow inside anyway.
An external scar of only ca. 2cm will be all that remains. After 2-3 months, this 2 to 5 mm thick titanium wire is removed via the old scar under a short anaesthetic.
TEN is generally to weak for use in fracture treatment in adults. Intramedullary nails are used in this instance (especially for the upper arm and tibia). This is performed using a 5 – 6 cm incision, after which a hole is drilled into the hollow bone and the nail inserted. Before, or even during the procedure, the broken bone is realigned using x-ray guidance. To prevent renewed twisting or shortening of the bone in the fracture region, the nail must be fixed by screws to the upper and lower ends of the drill hole. These screws can be removed after approximately 1½ years.
IMC under image control
For humeral fractures just below the humeral head, we are one of few medical institutions that actually use a special implant, the IMC (intramedullary claw).
This allows, with minimal impact and without significant soft tissue injury (= rotator soft cuff tendons of the shoulder cap) the fracture to be realigned and stabilised.
However, this necessitates 3 weeks of immobilization before rehabilitative therapy can begin with a physiotherapist. The IMC should be removed after 10-12 weeks, otherwise is will integrate too strongly into the tissue and make subsequent removal difficult.
Other bones, (e.g. ulna, radius, metacarpals, fingers, ankles…), specific fractures or locations (e.g. close to the joint) are subject to open surgery.
That effectively means, a longer incision will be required, muscles will be detached, tendons blood vessels and nerves held to one side, the fracture is opened up and worked on under direct view of the surgeon; a plate will be screwed into place, thus stabilising the fracture. Nowadays, in additional to conventional implants, we also use so-called angle-stable plates. This involves use of a locking screw which can be anchored into the plate, thus enhancing angular stability and reducing risk of the plate becoming loose.
This provides significantly enhanced stability in the treatment of fractures and a reduction in complications, such as non-healing of the fracture, loss of reduction (re-tilting of the corrected fracture). The plates can be removed after ca. ½ -1 year.
All these various procedures for the treatment of fractures are offered at our hospital, ensuring that fractures are given the highest level of treatment possible in accordance with the latest developments of science and technology.