Thursday, February 14, 2008

Broken bones start to fix themselves almost immediately

The playground at your local park probably has a conveniently spongy surface perfect for cushioning young bones upon the inevitable tumble from the jungle gym. But back in the days of monkey bars and concrete slabs, playgrounds were notorious hotbeds of bone fractures. One consolation of such a painful mishap was a cool cast signed by everyone in your class. Aside from that, a good thing about broken bones is that they start to fix themselves almost immediately. How do they do it?

Although they may appear dry and lifeless, bones are just as alive as the tissue that surrounds them. Inside the hard outer part of a bone is a spongy center filled with blood vessels and special cells that constantly tear down and rebuild the bone from the inside out. Bone cells called osteoclasts are like a demolition crew, breaking down old bone material while cells called osteoblasts are like a construction crew, building up new bone material as the old stuff is demolished.

So how do these cells help broken bones heal? When a bone breaks, a blood clot forms and bone demolition cells near the site of the break immediately begin clearing away the rubble. Meanwhile, the bone creates a sort of patch called a bone callus to replace the blood clot and hold the broken bone together. At the same time, bone construction cells near the break start to produce new bone material to repair the damage. Depending on the bone and the severity of the fracture, after several weeks its hardworking cells can repair a broken bone as good as new.

Source: http://amos.indiana.edu/library/scripts/brokenbones.html



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Tuesday, February 5, 2008

New treatment lets patients use broken bones immediately

Jewelry designer Eve Alfille, 72, sought medical attention for a wrist fracture just 10 days before she was to show a new collection of work at her gallery in Evanston.

She thought her show would be ruined because she would be unable to finish hand-crafting her jewelry with a clunky cast on her wrist.

She went to one doctor who told her he wouldn’t perform surgery – the wrist would just have to heal on its own. Without the surgery she faced permanent displacement, and might not have been able to twist her wrist ever again, she said.

“They weren’t really interested in my needs,” Alfille said. “I am a jewelry designer and there is a certain use of my hand that I just need – I wouldn’t be able to work.”

She was devastated and sought a second opinion. That’s when Dr. Mark Cohen, an orthopedic surgeon at Rush University Medical Center who specializes in hand, wrist and elbow surgery, told her that using the latest technology he could fix her wrist and have her back to work in just a few days.

“It was remarkable,” Alfille said. “There was no pain, before or after, and I was able to do work that same day.”

Alfille is but one of many patients who will find wrists fractures less of an inconvenience than in years past. New technology, which attaches small plates to the bone, has been tested over the past five years and has now had enough trials to be proved very effective at getting patients up and running months faster than before without risk of reinjuring the bone, Cohen said.

Wrist fractures are the most common type of broken bones, which means many people could potentially be incapacitated by the injury. Cohen said in the winter with slippery sidewalk and ice-crusted parking lots he treats three to four broken wrists a week. In addition to being of use on the wrist, the plates can also be used in ankle, leg, hip and other types of fractures.

“These small little locking plates have revolutionized the way we treat broken wrists,” Cohen said. “Patients experience less pain, fewer problems after surgery, recover quicker and rapidly recover their mobility and function.”

The small locking plates are secured internally with small screws placed directly into the bone. Once in place the plates are extremely secure and permanent. The patient can almost immediately enter rehabilitation therapy and start to return to normal activities, Cohen said. Using old technology, including casts, to set the wrist -- or external screws fixed into place with metal bars -- the patient would not enter therapy until about two months after the fracture occurred.

The process is much faster because the body is essentially tricked into thinking it is healed because it has been bolted back together internally, said Dr. John Fernandez, Cohen’s partner in orthopedics at Rush University Medical Center.

“We have a couple of students who were treated the old way versus the new way and the difference is dramatic,” Fernandez said. “Patients are able to use the hand immediately rather than waiting for the fracture to heal.”

This surgery will be most influential for seniors who are the most common victims of falls that result in broken or fractured bones, Cohen said.

“Many older people live alone and their independence is very important to them,” Cohen said. “To be able to make somebody independent within a few days is a huge difference than having someone rely on only one hand for all of their activities.”

Source: http://news.medill.northwestern.edu/chicago/news.aspx?id=76077



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Thursday, January 24, 2008

Osteoporosis Myth: Broken Bones From Falls Are Not Related to Osteoporosis

Reality: Fractures in individuals over the age of 50 can be the first sign of weak bones from osteoporosis or low bone mass. Each year, 1.5 million older Americans suffer a bone fracture due to osteoporosis. Half of all women over 50, and a quarter of all men, will suffer an osteoporosis-related fracture sometime in their remaining life. And the problem is increasing: the surgeon general estimates that by 2020, half of all Americans over 50 will be at risk for bone fractures from osteoporosis and low bone mass.

If you are over 50, any broken bone should be taken very seriously. You may think to yourself, "Anyone would have broken a bone after taking a fall like that," but a break after a fall in people over 50 may be a critical sign of osteoporosis. Talk with your doctor about whether you should have a bone density test to determine if your fracture could be due to osteoporosis.

There are many medications currently available to treat osteoporosis, and they have been shown to substantially reduce the risk of bone fractures for the people who take them. If your doctor prescribes an osteoporosis medication, it's important to keep taking it even if you don't see improvements on your next bone density scan. Osteoporosis drugs can be reducing your risk of bone fracture in ways that don't show up on a bone density scan. And as always, you should continue to eat a diet rich in calcium and vitamin D.

SOURCES: Department of Health and Human Services: "Bone Health and Osteoporosis: A Report of the Surgeon General, 2004." National Osteoporosis Foundation. American Academy of Orthopaedic Surgeons.
Source:
http://www.webmd.com/solutions/Osteoporosis-Myths-Facts/broken-bones

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Wednesday, January 23, 2008

Frequently Asked Questions About Casts

Getting a cast often comes with plenty of questions. Here are answers to some frequent inquiries many parents - and kids - may have about casts:

What are the different kinds of casts?
A cast, which keeps your child's bone from moving so it can heal, is essentially a big bandage that has two layers - a soft cotton layer that rests against the skin and a hard outer layer that prevents the broken bone from moving. These days, casts are made of either:

plaster of paris - a heavy white powder that forms a thick paste that hardens quickly when mixed with water. Plaster of paris casts are heavier than fiberglass casts and don't hold up as well in water.


synthetic (fiberglass) material - made out of fiberglass, a kind of moldable plastic, these casts come in many bright colors and are lighter and cooler. The covering (fiberglass) on synthetic casts is water-resistant, but the padding underneath is not. You can, however, get a waterproof liner. The doctor putting on your child's cast will decide if he or she should get a fiberglass cast with a waterproof lining.

How is a cast put on?
First, several layers of soft cotton are wrapped around the injured area. Next, the plaster or fiberglass outer layer is soaked in water. The doctor wraps the plaster or fiberglass around the soft first layer. The outer layer is wet but will dry to a hard, protective covering. Doctors sometimes make tiny cuts in the sides of a cast to allow room for swelling.

Can plaster of paris casts get wet?
Absolutely not! A wet cast may not hold the bone in place because the cast could start to dissolve in the water and could irritate the skin underneath it, possibly leading to infection. So your child shouldn't swim and should use a plastic bag or special sleeve, which is available online or sometimes at pharmacies, to protect the cast from water. And instead of a shower, your child may need to take a sponge bath.

Can synthetic (fiberglass) casts get wet?
Although the fiberglass itself is waterproof, the padding inside a fiberglass cast is not. So it's still important to try to keep your child's fiberglass cast from getting wet. If this is a problem, talk to your child's doctor about getting a waterproof liner. Fiberglass casts with waterproof liners allow children to continue bathing or even go swimming during the healing process. Although the liner allows for evaporation of water and sweat, it's still fragile. Also, only certain types of breaks can be treated with this type of cast. Your child's doctor will determine if the fracture may be safely treated with a waterproof cast.

Is it OK to have people sign and draw on my child's cast?
Definitely! That often makes the whole broken bone experience more bearable for kids. Permanent markers usually work best; washable ones can smear. Feel free to encourage siblings, family members, and classmates to sign it, draw pictures on it, or decorate it with stickers. Your child's doctor may even let your child keep the adorned cast as a souvenir.

What if my child has an itch in the cast?
Try blowing some air in the cast with a hair dryer - be sure to use the cool setting, though. And you should never pour baby powder or oils in the cast to try to relieve your child's itch, or try to reach the itch with long, pointed object such as a pencil or hanger - these could scratch or irritate your child's skin and can lead to an infection.

What if the cast gets a crack?
This can happen if the cast is hit or crushed, has a weak spot, or if the injured area begins to swell underneath. Call your child's doctor as soon as you notice a crack. In most cases, a simple repair can be done to the cast without needing to remove it or change it.

What if the cast is causing my child's fingers or toes to turn white, purple, or blue, or if the skin around the edges of the cast gets red or raw?
The cast may be too tight. Redness and rawness are typically signs that the cast is wet inside, from sweat or water. Sometimes, children pick at or remove the padding from the edges of fiberglass casts. They shouldn't do this, though, because the fiberglass edges can rub on the skin and cause irritation. Call your child's doctor to have the problem fixed right away.

Why aren't some types of broken bones put in casts right away?
Some kinds of fractures don't need casts to heal. Certain fractures of larger long bones, such as the femur (thighbone), are hard to keep straight in a cast. Although doctors used to commonly put many of these kinds of fractures in traction (a way of gently pulling the bone straight), these days, surgery is often used instead.

Do all broken bones need casts?
It's not practical to cast ribs and collarbones (clavicles). Even displaced collarbones (in which pieces on either side of the break are out of line) heal well with a sling or special strap called a "figure-of-eight clavicle strap," which the child wears like a vest. Some non-displaced finger and toe fractures (in which the pieces on either side of the break line up) that don't involve the joint or the growing part of a child's bone (called the growth plate) may heal well with a splint or buddy taping (taping the injured digit to the adjacent unaffected finger or toe).

Will my child feel pain when the broken bone is in a cast?
Some pain is expected for the first few days, but it's usually not severe. Your child's doctor may recommend acetaminophen or ibuprofen to ease your child's pain.

How are casts taken off?
The doctor will use a small electrical saw to remove the cast. Although it may look and sound scary to your child, the process is actually quick and painless. The saw's blade isn't sharp - it has a dull, round blade that vibrates up and down. The vibration is strong enough to break apart the fiberglass or plaster, but shouldn't hurt your child's skin and may even tickle.

What will the injured area look and feel like when the cast is removed?
Once the cast is off, the injured area will probably look and feel pretty weird to your child: The skin will be pale, dry, or flaky; hair will look darker; and the area (muscles especially) will look smaller or weaker. Don't worry, though - this is all temporary. And depending on the type and location of your child's fracture, the doctor may also give your child special exercises to do to get the muscles around the broken bone back in working order.

Source: http://www.kidshealth.org/parent/firstaid_safe/emergencies/cast_faq.html

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