Treatment of Fractures

Dr. Pretorius is an experienced orthopaedic surgeon and can treat most fractures.

Healthy bones are strong and able to absorb the force of falls or impact on bone, if the forces are not extreme. When the force is stronger than the bone, the bone will break or fracture. Bones can heal by making new bone. If the bone is bent or displaced, the bone might not heal straight or might not heal at all.

Most fractures can be diagnosed on x-rays. Sometimes it is necessary to do further investigations like computer tomography (CT scan), magnetic resonance imaging (MRI) or sometimes a nuclear bone scan.

Types of fractures:

  • Greenstick fracture: The bone is fractured on one side. This is a typical childhood fracture.
  • Torus fracture: Also known as a buckle fracture – one side of bone is buckled from a force along the length of bone. This is also a childhood fracture.
  • Growth plate fracture: Another childhood fracture, occurring in children with open growth plates. This is located close to the end of the bones where growth happens. They normally heal within half the time of a fracture of the same bone.
  • Closed fracture: This means that the skin is intact over the broken bone.
  • Compound fracture: Also known as an open fracture, where the broken bone has pierced the skin.
  • Simple fracture: The bone has only one fracture line.
  • Segmental fracture: The bone has two separate fractures.
  • Comminuted fracture: This means that the bone is fractured into at least 3 pieces.
  • Extra-articular fractures: The fracture does not involve the joint surface.
  • Interarticular fractures: The fracture involves the joint line.
  • Non-displaced fractures: The broken bone remains in position.
  • Displaced fractures: The bone fragments have moved and is not in position.
  • Pathological fractures: Pathological fractures is a fracture in bone that has been weakened because of a disease process and therefore cannot withstand normal forces. This can be because of osteoporosis or because of bone tumours or cancer.

After your fracture is diagnosed and final diagnosis has been established, Dr. Pretorius will discuss the proposed treatment in detail.


Non-operative treatment:

Non-displaced and simple fractures can often be treated without surgery. If the broken bones are not displaced or well aligned, one can use a splint or an orthosis to immobilise the fracture. Most of these orthotics are commercially available and is made of plastic and / or metal.

Sometimes it is not possible to splint the fracture like the fracture of a collarbone, in which case the fracture can be immobilised in a sling while the fracture heals.

Some displaced fractures can be treated by closed reduction of the fracture. This is normally done using either a local or a general anaesthesia. The broken pieces of bone is moved into the correct position. Once the fracture has been “reduced”, the affected limb is then placed in a splint / cast.

Surgical treatment:

When a fracture cannot be reduced (moved into the correct position) or the reduction cannot be held with a splint or a cast, surgery might be needed to reduce the fracture and keep it in position.

Numerous surgical treatments are available and depends on:

  • The location of the fracture.
  • Type of fracture.
  • The severity of the fracture.
  • The presence of other fractures.
  • The age and general health of the patient.
  • The quality of the bone.

Types of surgery:

Internal fixation: With this, the fracture is reduced and held in position by wires, plates and screws or metal rods inserted along the length of the bone.

External fixation: An external fixator is normally applied by placing metal pins in bone above and below the fracture(s). These pins are then connected outside the body by metal rods. External fixators are normally used for open fractures or serious injuries with bone, muscle and nerve injuries, that carries a high risk of infection. It is also used in cases where there is severe swelling. In some cases, the external fixator is removed later on to repair the bone fragments.

Serious complications following surgery are very uncommon, but surgical procedures carry some risks. Although extreme care is always taken to minimise the incidence of complications, there’s always a possibility it may occur and it may even have permanent effects.

General risks of surgery:

  • Risk of the anaesthetic.
  • Antibiotics are routinely used during surgery to prevent infection – some patients may have an allergic reaction or anaphylaxis.
  • Wound infection.
  • Bleeding in the wound with haematoma (big collection of blood) formation.
  • Pain / numbness around the incision.
  • Allergies to antiseptic solutions used to clean the surgical site.
  • Allergies to sutures and / or dressings.
  • Deep vein thrombosis – there is always an increased risk of DVT with surgery of the lower limb.
  • Nausea and vomiting after surgery.


Specific Risks with Surgery for Fractures

Specific risks with surgery for bone fractures will largely depend on the fracture and the surgery performed. This will be discussed with you in detail by Dr. Pretorius.

The risks may include the following:

  • Infection in bone – more common in open fractures.
  • Injury to nerves.
  • Injury to blood vessels.
  • With large / long bone (thigh and shin bones) fractures, there is a risk of fat embolism (fat molecules in blood causing blockage of blood supply to lungs – appears 12 – 72 hours after injury.
  • Complications from bed rest- pneumonia / pressure sores.
  • Compartment syndrome – a dangerous and serious condition where swelling inside the cast / muscle compartments lead to decreased blood flow causing death of muscle and other tissue. Associated with severe pain / swelling / pins and needles, numbness and pain in the fingers or toes.
  • Non-union of fractures which is a greater risk for patients that smoke.
  • Loss of reduction if plate or screws break.
  • Growth plate injuries can cause bone to grow at an angle or to stop growing.
  • Intra articular fractures may never return to normal and can also continue to cause pain, stiffness and eventually degenerative arthritis.


Recovery after fracture surgery:

Following your surgery, you will wake up in the recovery room. The nurses in the recovery room will monitor your recovery by regularly checking vital signs (pulse, blood pressure etc), pain and consciousness levels.

The limb may be completely numb from a nerve block. It may take anything from 12 – 16 hours for the feeling to return.

It is better to stay on top of the pain by taking the prescribed pain medication as soon as feeling returns, as the nerve block wears off.

Oftentimes with lower limb surgery, you will not be able to put weight on the foot / leg. You will be going home on crutches and should be familiar with the use of crutches, before you do. If not, please inform us.

If you are allowed to go home on the same day, it is important to arrange for somebody collect you from the hospital and drive you home as it is illegal to drive a motor vehicle within 24 hours of having an anaesthetic.

If your surgery is overnight however, you will be transferred to the ward.

It is important to keep the injured limb elevated and to apply ice / cold packs to help for pain and swelling.

A physiotherapist will assist you with exercises and instruct you in the use of crutches if necessary. This might happen on the same day of your surgery depending on what time it takes place.

Depending on the procedure done, you may be discharged the same day or the next. Please arrange for somebody to collect you from the hospital. A follow-up appointment will be arranged for you, which is normally around 10 days after the surgery.

Try to only use the stronger pain medication if normal pain medication like Paracetamol is not effective.

It is important to keep the surgical area clean and dry and to keep the wound dressings intact.

Recovery after surgery is different for every patient. Usually when there is good bony healing, the cast is removed – between 6 and 18 weeks. Once the cast is removed, it is quite normal to have stiffness, pain and discomfort, limited movement, and swelling. Depending on the type of fracture and the severity of the fracture, it can take more than a year to recover from the injury. The rehabilitation process is as important as the surgery. Your effort and motivation are important to ensure an effective recovery and an optimal outcome.

Please contact the surgery immediately if you have any of the following:

  • Any redness, swelling, bleeding or drainage from your incision site.
  • Any fever or chills.
  • Any increase in pain around the incision site.
  • Any pain in your calf or thigh with increased swelling in the leg.
  • Loss of movement or function.
  • Any other concerns you may have.


Please find links to some useful information: