Spiral Fractures

This is an xray image of a distal tibia fracture. This person sustained a GLF (healthcare shorthand for "ground level fall"). They were coming out of a McDonald's, stepped off a curb funny, and sustained a spiral fracture, probably due to torsion.

Many difficulties associated with this type of fracture.

This particular fracture isn't something that can simply be casted up and sent home. Due to the displacement of the two ends of the bone, it can't simply be popped back into place and stabilized. Without surgical intervention, the smaller broken off part would probably die due to lack and blood flow and the associated lack of oxygen to the cells. If the section of bone were to die, I can guarantee that at some point gangrene would occur. At that point, the only option would be amputation of the entire limb.

Also, this type of fracture hurts like a bitch. The muscles are displaced and cramping occurs. Imagine the worst charlie horse ever and multiply that by 10 and then have it last all night. Next the ligaments are not happy either. Also as inflammation sets in, the pain level will continue to increase. In cases like this, pain control is extremely tricky. Oftentimes people will walk the line between being oversedated (and close to respiratory failure) due to narcotics and not having their pain at a tolerable level. Then there are the whole host of side-effects that opiates bring but that's for a different post some other day.

So at the least, the person would never be able to walk again. At the most, they would die from gangrene. So what to do?

Fortunately, what you're looking at is a fairly clean break for a spiral fracture (although it is impossible to tell from this xray - you'd need to see the CT scan version). Therefore this break is something that can be repaired by a decent specialist in an hour with the use of a rod and a few bone screws.

Basically, what the surgeon does; First they get the bone back in alignment using a "C-Arm" (or fluoroscope). Its called a C-Arm because it is shaped like a giant letter C. Basically it is a real-time Xray that allows the surgery team to see underneath the skin to the bone while they work.

Next, the surgeon makes three incisions. The first one is the largest. The surgeon uses this to run a (stainless steel or titanium) rod the length of the fracture. Next, using two smaller incisions the surgeon screws the rod in; above and below the fracture. These screws stabilize the bone to the rod. The C-Arm is utilized throughout the procedure to ensure everything is where it needs to be (the bone, the screws, and the rod).

The entire time, throughout the procedure, there is a salesman that sells the rods/screws from the medical device company making recommendations as to the size and length of the rods and screws (we're talking about the human body here, and you need to make sure you get the right product the first time!).

This procedure is known as an Open Reduction External Fixation (or ORIF for short). In this case, the patient had an ORIF of the Tibia. Open, because an incision was made (the skin was opened). Reduction, because the space between the fractured bone was reduced. Internal Fixation, the fixators of the bone (or rod and screws in this case) are located on the inside.

Each bone screw costs nearly $400 USD, and the rod itself is nearly $8000 (or more, depending on the size). So there is quite a bit of money involved. Add the cost of the materials, the surgeon's time, the anesthesthia, the support team, the drugs, the hospital bed. You're easily looking at a $40,000+ hospital bill.

The next phase after surgery involves keeping the injured leg immobilized. Usually using some kind of brace when up and walking. While in bed, ice and pillows are used to elevate the leg above the heart to help prevent swelling. Rest is a huge part of the recovery process and I can't stress this enough.

The injured leg will not tolerate any weightbearing whatsoever for the first 4-6 weeks. The length of time varies based on a person's age and overall physical condition. Keeping weight off the leg is a major challenge. Early physical therapy, good pain control, and lots of exercise are required to strengthen the upper extremities to get used to carrying the weight of the body when up and walking (this is especially true for obese people).

The next phase, after weight bearing can resume, centers around exercising the leg that was injured. Since it has been out of use for several weeks, it will be extremely weak. So in a way, it is like learning how to walk again.

All in all, take care of yourselves. Eat healthy. Take your vitamins. Exercise your muscles. Don't do stupid stuff. This type of injury could easily put you out of work for several months; especially the people who have physically active jobs. Not to mention the risk for infection that any type of implant carries.

Science and medicine these days are truly amazing. 200 years ago, this injury would have killed someone within a year. Now it can be taken care of. For $40,000, barring complications. :)