| when we think about an injury or fracture, we | | | | often treated without surgery, but those same |
| immediately think about surgery being required to | | | | injuries might require surgery in an adult. |
| repair the problem. The fact is that the majority of | | | | 2. Conversely, a fairly common fracture that occurs in |
| fractures commonly seen in orthopedic offices can | | | | the older population is called a Colles fracture. This is |
| be treated without surgery. The question then is: | | | | fracture of the distal radius at the wrist. When this |
| “What types of fractures typically will require | | | | fracture is seen in the elderly population, operative |
| surgery and what types of fractures can be treated | | | | intervention probably will not be required. Oftentimes, |
| without surgery?” This discussion will deal with | | | | these fractures can be reduced in the office or the |
| the fractures that are most commonly seen in the | | | | operating room and placed in a cast. Once the |
| office, which involve the hand, wrist, and shoulder. | | | | fracture heals, the patient will have most of the |
| You might think that sustaining a simple fracture as a | | | | normal function required for daily activities. However, |
| young person would automatically be more easily | | | | in a teenager who is approaching skeletal maturity, a |
| treated than treating that same fracture when | | | | similar fracture would probably require operative |
| sustained as senior, however; this is not always the | | | | intervention, since the patient is younger and would |
| case. Much depends on the location of the fracture | | | | have higher expectations for use of the wrist. In |
| as well as the expected activity level of the individual. | | | | addition, after closed reduction (alignment of the |
| Consider these three scenarios: | | | | bone without surgery), the bone would not remodel |
| 1. A mildly-displaced forearm fracture in a 7-year-old | | | | adequately to allow the patient to have a |
| youngster can often be treated with simple cast | | | | normally-functioning wrist. |
| immobilization because, in the ensuing months after | | | | 3. The one area of the body where older patients |
| the cast is removed, the bones will continue to | | | | can often sustain fractures that do not require |
| remodel. Up until about the age of 15 in females and | | | | surgery is the shoulder. Why? Because of the many |
| 16 in males, the bones are constantly undergoing | | | | joints in the body, the shoulder has the largest range |
| changes or “remodeling” as an | | | | of motion. If the articular portion of the shoulder joint |
| individual matures. Oftentimes, an x-ray taken six | | | | is still reasonably aligned, the fracture involves the |
| months after a mildly-angulated fracture in a | | | | portion of the shoulder near musculature attachments |
| 7-year-old will show no evidence of a previous | | | | and is not significantly displaced, most of these |
| fracture and will show that the bone has returned to | | | | fractures can be treated simply by wearing a sling for |
| its normal alignment and shape. A similar fracture | | | | a few weeks, followed by physical therapy So, for |
| involving an adult or someone who is | | | | an elderly patient who sustains a fracture that heals |
| skeletally-mature will behave quite differently. These | | | | reasonably well-aligned, they may lose a few degrees |
| fractures must be reduced anatomically; or in | | | | of motion, but are left with enough motion remaining |
| layman’s terms, put back together in exact | | | | within the joint to accomplish their activities of normal |
| alignment, without any angulation. The reason for this | | | | daily living. In a child, a fracture near the growth plate |
| is that the fracture, once it heals, will not undergo | | | | in the shoulder will probably heal without surgery and |
| any kind of remodeling process. If an adult angulated | | | | continue to remodel, resulting in full recovery. |
| forearm fracture was treated by simple cast | | | | As you can see from the above discussion, every |
| immobilization, there would be long-term | | | | fracture needs to be evaluated by an experienced |
| consequences after the fracture healed, such as a | | | | orthopaedic surgeon. They understand how patient |
| deformity in the forearm and lack of full motion of | | | | age, fracture location and patient activity levels will |
| the forearm and the wrist. These outcomes certainly | | | | impact future bone healing and remodeling. They are |
| are not acceptable. Thus, an adult who sustains a | | | | also best-qualified to make the determination of |
| fracture of the forearm will probably require an | | | | when surgical reduction and possible bone structure |
| operation in which plates are placed over the fracture | | | | reinforcement (plates, pins, cages, etc.) may be |
| site, once the fracture has been reduced in the | | | | necessary for optimal bone healing and recovery of |
| operating room. Likewise, fractures involving the hand | | | | the patient. |
| and the wrist in skeletally-immature patients are | | | | |