A fracture refers to a disruption in the integrity or continuity of a bone. Causes of fractures include direct trauma, indirect trauma, muscle traction, cumulative strain, and bone diseases.
Classification of Fractures
Classification Based on Whether the Fracture Site Is Open to the Outside Environment
(1) Closed Fracture: The skin or mucous membrane at the fracture site remains intact, and the fracture is not open to the outside environment.
(2) Open Fracture: The skin or mucous membrane near the fracture site is ruptured, and the fracture site communicates with the outside environment.
Classification Based on Severity and Morphology
(1) Incomplete Fracture: The integrity or continuity of the bone is only partially disrupted, such as hairline fractures and greenstick fractures.
(2) Complete Fracture: The integrity or continuity of the bone is completely disrupted; a fracture line is visible on X-rays. Based on the direction of the fracture line, these are classified as transverse fractures, oblique fractures, spiral fractures, comminuted fractures, impacted fractures, compression fractures, and epiphyseal separation.
Local Manifestations of Fractures
Specific Signs of Fractures:
(1) Deformity: Following a fracture, the shape of the injured body part changes;
(2) Abnormal mobility: In areas without joints, abnormal mobility may occur after a fracture.
(3) Crepitus or sensation of bone rubbing: When the fracture ends rub against each other, crepitus may be heard or a sensation of bone rubbing may be felt.
Other manifestations of fractures: ① Pain and tenderness; ② Localized swelling and bruising; ③ Functional impairment.
Complications of Fractures
After a patient sustains a violent impact, in addition to a fracture, various systemic or local complications may occur, such as shock, infection, visceral injury (visceral rupture and hemorrhage), neurovascular injury, joint stiffness, ischemic necrosis, or ischemic contracture. Therefore, if a fracture, contusion, or fall occurs, the patient should seek medical examination and treatment at a hospital.
Treatment of Common Types of Fractures
I. Fractures of the Distal Radius
Fractures of the distal radius are most commonly of the Colles type, typically caused by landing on the palm of the hand during a fall. The risk of slipping and falling is particularly high in icy or snowy weather, making such fractures more likely to occur. Patients present with a “fork-like” deformity of the wrist, localized swelling, marked tenderness, and a palpable crepitus; movement of the wrist joint and rotation of the forearm are restricted. X-rays can confirm the fracture type and direction of displacement.
Treatment: These fractures are generally closed fractures. After manual reduction, the wrist is immobilized with a small splint for 4 to 5 weeks.
Traditional Chinese Medicine Treatment
(1) Early stage of the fracture: Swelling and pain in the wrist, with the patient reluctant to move it. The treatment principle is to promote blood circulation, remove blood stasis, reduce swelling, and relieve pain. The formula “Blood-Activating, Pain-Relieving, and Calming Decoction” is used.
(2) Middle stage of the fracture: Swelling and pain have subsided, but finger movement is restricted. The treatment principle is to strengthen tendons and bones while promoting blood circulation and removing blood stasis. The formula “Bone-Healing and Blood-Activating Decoction” is used for treatment.
(3) Late stage of the fracture: Stiffness in the wrist, possibly accompanied by pain, muscle atrophy, and limb weakness. The treatment principle is to promote blood circulation, relax tendons, and improve joint mobility. The formula “Blood-Activating and Tendon-Relaxing Decoction” is used for treatment.
Functional Exercises: During the immobilization period, actively perform flexion and extension exercises for the finger joints and metacarpophalangeal joints, as well as range-of-motion exercises for the shoulder and elbow. This promotes blood circulation and helps reduce local swelling. After the cast is removed, herbal steam baths should be used to relax the tendons, invigorate the meridians, improve joint mobility, and restore normal function to the hand and wrist.
II. Clavicle Fractures
Clavicle fractures are most commonly caused by indirect trauma and frequently occur in the middle third of the clavicle. In adults, they are typically oblique or transverse fractures, while in children, they may present as greenstick fractures. Clavicle fractures resulting from direct trauma to the shoulder are often comminuted and are clinically rare.
Following a fracture, the proximal fragment is pulled upward and backward by the sternocleidomastoid muscle, while the distal fragment is pulled downward, forward, and inward by the pectoralis major, trapezius, and latissimus dorsi muscles, compounded by the weight of the upper limb; as a result, the two fracture ends may overlap.
Patients present with the affected shoulder dropping downward and tilting forward and inward. There is limited movement of the affected upper limb. Since the entire length of the clavicle lies beneath the skin, local swelling and tenderness are present after a fracture, and the displaced fracture ends may be palpable. X-rays reveal the fracture and the extent of displacement.
Treatment
(1) For greenstick fractures in children or infants, simply suspending the affected limb with a triangular sling for 3 to 4 weeks is sufficient.
(2) For displaced fractures, manual reduction should be performed first, followed by immobilization with a transverse “8” bandage.
(3) Administration of Traditional Chinese Herbal Medicine
① In the early stage, when the injured shoulder is swollen, painful, and has limited function, administer herbs that promote blood circulation, dispel blood stasis, reduce swelling, and relieve pain. The Fuyuan Huoxue Decoction, with appropriate modifications, may be used for treatment.
② In the middle stage, when the patient experiences reduced pain and swelling and the bone has regained continuity, treatment should focus on mending bones and tendons. Administer Jiegu Dan to promote fracture healing.
Formula Composition: Tu Yuan, Xuejie, Chuan Shan Jia, Calcined Natural Copper, Di Long, Dang Gui Wei, Processed Ma Qian Zi, Ji Gu, Gu Sui Bu, Ma Huang.
Grind the above herbs into a fine powder and form into tablets weighing 0.3 grams each. Adults should take 5 tablets three times daily by mouth; dosage for children should be reduced appropriately.
③ In the late stage, patients experience no pain and the swelling has subsided, but shoulder joint function remains partially restricted, with stiffness and discomfort in the muscles and tendons, or localized muscle atrophy. Treatment should focus on relaxing the tendons, activating the meridians, and improving joint mobility. The Shujin Huoxue Decoction may be administered for treatment.
④ Functional Exercises: During the immobilization period, patients may practice clenching their fists and flexing and extending the elbow and wrist joints. After the cast is removed, they should gradually perform full-range shoulder joint movements to facilitate early recovery of shoulder function.
An X-ray should be taken before removing the cast to assess fracture healing. If healing is inadequate, removal of the cast should be postponed.
III. Femoral Neck Fractures
Femoral neck fractures are most common in the elderly. The typical mechanism of injury involves slipping on level ground, with the lower limb adducted and the buttocks striking the ground first, resulting in a femoral neck fracture. Because this type of fracture frequently occurs in “elderly women,” it is sometimes referred to as an “old lady’s fracture.” In young and middle-aged adults, femoral neck fractures are typically caused by traffic accidents or significant trauma.
Patient Presentation: After a fall, elderly patients experience hip pain and are reluctant to stand or walk. Movement of the affected limb in any direction causes pain, and the foot of the affected limb may exhibit an external rotation deformity or shortening. X-rays can clearly identify the type of fracture and the extent of displacement.
Treatment of Femoral Neck Fractures
(1) Manual Reduction and Splinting: Suitable for hairline fractures and abduction-embedded fractures.
(2) Traction: Traction may be used to treat displaced adductor-type femoral neck fractures. Traction methods include adhesive tape skin traction and bone traction, continued for 6 to 8 weeks.
(3) Internal Fixation: If displacement is significant and traction is not suitable, internal fixation may be performed. There are many methods of internal fixation, primarily involving the use of steel pins or three-bladed screws.
(4) Traditional Chinese Medicine (TCM) Treatment: TCM formulas are prescribed based on the patient’s syndrome differentiation to promote bone healing.
① In the early stage, due to hip swelling and pain, abdominal distension, nausea and vomiting, difficulty with urination and defecation, restlessness, and insomnia, treatment should focus on promoting blood circulation to remove stasis and clearing heat from the bowels. Da Cheng Qi Tang combined with Fu Yuan Huo Xue Tang may be used.
② In the middle stage, the patient experiences reduced hip pain and subsiding swelling, but muscle atrophy is present and bone union is difficult. Treatment should focus on tonifying the kidneys and strengthening the bones, as well as promoting blood circulation and removing blood stasis; Bu Shen Huo Xue Decoction with appropriate modifications may be used.
③ In the late stage, due to prolonged bed rest, the patient suffers from osteoporosis, restricted joint mobility, and weakness in the limbs. Treatment should focus on tonifying qi and blood, as well as relaxing tendons and activating meridians; Shi Quan Da Bu Decoction may be used.
(5) Functional Exercises: During bed rest, perform full-body exercises and practice deep breathing at regular intervals each day to prevent pulmonary complications. Simultaneously, perform ankle and toe joint movements, as well as contraction and relaxation exercises for the lower limb muscles, to prevent muscle atrophy or joint stiffness. Additionally, undergo regular X-rays to monitor fracture healing.