Fracture & Trauma Surgeon in Surat

Not all fractures are equal

The most useful distinction in fracture care is whether the break runs into a joint surface.

A fracture through the shaft of a bone needs to heal in good alignment, but the bone has some tolerance — a small residual angle is often compatible with normal function. A fracture that enters a joint has almost no tolerance. A step of even a couple of millimetres in a joint surface concentrates load on a small area, and that reliably produces arthritis over the following years.

That is why injuries such as acetabular and pelvic fractures are treated as a different category, and why the quality of the first operation matters so much. Reconstructing a joint surface accurately at the outset is far easier than salvaging one that healed badly.

Injuries treated

• Pelvic fractures — usually from high-energy injury such as a road traffic accident or a fall from height.
• Acetabular fractures — breaks of the hip socket, where restoring the joint surface determines whether the hip survives long term.
• Hip fractures in older adults — where prompt surgery and early mobilisation matter as much as the fixation itself.
• Complex and multi-fragment fractures around the knee, ankle, shoulder and elbow.
• Non-union and malunion — fractures that failed to heal, or healed in a poor position.
• Joint dislocations, including recurrent instability after a first dislocation.

How fractures are treated

1. 01.

   Assessment

   The injured limb, the circulation and nerves beyond it, and — in high-energy injury — the patient as a whole before the fracture.

2. 02.

   Imaging

   X-rays in at least two planes. CT where the fracture involves a joint surface, since a plain film understates the pattern.

3. 03.

   Decision

   Cast, or fixation with plates, screws, nails or an external frame — chosen by fracture pattern, bone quality and soft-tissue condition.

4. 04.

   Rehabilitation

   Restoring movement and strength once the fracture is stable, which decides how the limb actually functions.

Why some fractures do not heal

Most fractures heal given alignment, stability and blood supply. When one fails to heal — a non-union — there is almost always a reason, and treating the non-union without addressing the reason repeats the failure.

• Inadequate stability — movement at the fracture prevents bone bridging across it.
• Poor blood supply, either from the original injury or from surgical stripping of the bone.
• Infection, which must be eradicated before union can occur.
• Gap between the fragments too large for bone to cross without graft.
• Patient factors — smoking is a significant and reversible one; diabetes and poor nutrition also matter.

What to do after an injury

Seek assessment the same day for any injury with obvious deformity, inability to bear weight, numbness or coldness beyond the injury, or a wound over a suspected fracture. An open fracture — where the skin is broken over the break — is a surgical emergency because of the infection risk.

For lesser injuries, the immediate measures are rest, ice, elevation, and avoiding loading the limb until it has been examined. A fracture that is only diagnosed weeks later is considerably harder to treat well.