Doctor Biehl

Broken Bones

Doctor Biehl is an expert when it concerns bones. When a bone breaks it is called a fracture. There's more than one way to break or fracture a bone. A break can be anything from a hairline fracture (a thin break in the bone) to the bone that's completely snapped into two pieces. broken_bone
Dr. Biehl describes fractures in the following ways:
A complete fracture is when the bone has broken into two pieces.
A greenstick fracture is when the bone cracks on one side only, not all the way through.
A single fracture is when the bone is broken in one place.
A comminuted fracture is when the bone is broken into more than two pieces or crushed.
A bone may become bent but doesn't break. This is called a bowing deformity and usually occurs in children's bones.
An open fracture is when the bone broke through the skin. This carries a much higher risk of infection.

What Happens When You Break a Bone?
It hurts to break a bone! It's different for everyone, but the pain is often like the deep ache you get from a super bad stomachache or headache. Some people may experience sharper pain - especially with an open fracture. And if the fracture is small, a kid may not feel much pain at all. Sometimes, a kid won't even be able to tell that he or she broke a bone!


Breaking a bone is a big shock to your whole body. It's normal for you to receive strong messages from parts of your body that aren't anywhere close to the fracture. You may feel dizzy, woozy, or chilly from the shock. A lot of people cry for a while. Some people pass out until their bodies have time to adjust to all the signals they're getting. And other people don't feel any pain right away because of the shock of the injury.

If you think you or someone else has broken a bone, the most important things to do are to:
stay calm- make sure the person who is hurt is as comfortable as possible.
tell an adult- if there are no adults around, call 911 or the emergency number in your area.
The worst thing for a broken bone is to move it. This will hurt the person and it can make the injury worse! In the case of a broken arm or leg, a grown-up may be able to cushion or support the surrounding area with towels or pillows.
CALL DOCTOR BIEHL!!!! This is what he specializes in!!!!

One super-important tip: If you're not sure what bone is broken or you think the neck or back is broken, do not try to move the injured person. Wait until a trained medical professional has arrived!

What Does Doctor Biehl Do?
To treat the broken bone, Doctor Biehl needs to know which kind of fracture it is. That's where X-rays come in handy. X-rays gives Doctor Biehl a map of the fracture so that he or she can set the bones back in their normal position.

With breaks in larger bones or when a bone breaks in more than two pieces, Doctor Biehl may need to put in a metal pin - or pins - to help set it. For this operation, you'll get some medicine so you'll be asleep and unable to feel any pain. When your bone has healed, the Doctor Biehl will remove the pin or pins.

After your bone has been set, the next step is usually putting on a cast, the special bandage that will keep the bone in place for the 1 to 2 months it will take for the break to mend. Casts are made of bandages soaked in plaster, which harden to a tough shell (that's why they last so long!).

Sometimes casts are made of fiberglass or plastic - and some are even waterproof, which means you can still go swimming and get them wet! And sometimes they come in cool colors or patterns that you can choose.

How Do Broken Bones Heal?
Your bones are natural healers. At the location of the fracture, your bones will produce lots of new cells and tiny blood vessels that rebuild the bone. These cells cover both ends of the broken part of the bone and close up the break until it's as good as new.

What Should You Do When the Cast Comes Off?
Can you believe they use a saw to remove your cast? The funny thing is this saw doesn't hurt your skin at all. It might even tickle! Once the cast is off, the injured area will probably look and feel pretty weird. The body part that was in a cast might look strange at first. The skin might be pale, dry, or flaky. Body hair might look darker and the body part itself might look smaller because you might have lost some muscle while it was healing.

Don't worry. This is all temporary. Kids are great healers, so you'll be back to normal soon. In some cases, your doctor might suggest you do special exercises to improve your strength and flexibility. You'll want to go slow and ask the doctor if there are any activities you should avoid, such as hanging from the monkey bars. If you want to return to a sport, ask the doctor how soon you'll be able to do it.

How can you be sure you don't break any more bones? Accidents happen, but you often can prevent injuries by wearing safety helmets, pads, and the right protective gear for your activity or sport.

It's also a smart idea to do what you can to build strong bones. How do you do that?

Get a lot of physical activity, especially stuff like jumping and running.
Feed your bones the calcium and vitamin D they need to stay strong. That means getting your share of milk and other calcium-rich foods and drinks, such as broccoli and calcium-fortified orange juice.

Fractures: An Overview

Fractured means broken. Whether you have a complete or a partial fracture, you have a broken bone. A bone may be completely fractured or partially fractured in any number of ways (cross-wise, lengthwise, in the middle).

How do fractures happen?
Fractures can happen in a variety of ways, but there are three common causes:
1) Trauma accounts for most fractures. For example, a fall, a motor vehicle accident or a tackle during a football game can all result in a fracture.
2) Osteoporosis also can contribute to fractures. Osteoporosis is a bone disease that results in the "thinning" of the bone. The bones become fragile and easily broken.
3) Overuse sometimes results in stress fractures. These are common among athletes.

Diagnosing fractures:
Usually, you will know immediately if you've broken a bone. You may hear a snap or cracking sound. The area around the fracture will be tender and swollen. A limb may be deformed, or a part of the bone may puncture through the skin. Doctors usually use an X-ray to verify the diagnosis. Stress fractures are more difficult to diagnose, because they may not immediately appear on an X-ray. However, there may be pain, tenderness and mild swelling.

Types of fractures:
Closed or simple fracture. The bone is broken, but the skin is not lacerated.
Open or compound fracture. The skin may be pierced by the bone or by a blow that breaks the skin at the time of the fracture. The bone may or may not be visible in the wound.

Particular types of fractures are:

Transverse fracture. The fracture is at right angles to the long axis of the bone.

Greenstick fracture. Fracture on one side of the bone, causing a bend on the other side of the bone.

Comminuted fracture. A fracture that results in three or more bone fragments.

The healing process:
As soon as a fracture occurs, the body acts to protect the injured area, forming a protective blood clot and callus or fibrous tissue. New "threads" of bone cells start to grow on both sides of the fracture line. These threads grow toward each other. The fracture is closed and the callus is absorbed.

Treatment for fractures:
Doctors use casts, splints, pins or other devices to hold a fracture in the correct position while the bone is healing.
External fixation methods include plaster and fiberglass casts, cast-braces, splints and other devices.
Internal fixation methods hold the broken pieces of bone in proper position with metal plates, pins, or screws while the bone is healing.

Recovery and rehabilitation:
Fractures take several weeks to several months to heal, depending the extent of the injury and how well you follow your doctor's advice. Pain usually stops long before the fracture is solid enough to handle the stresses of normal activity.Even after your cast or brace is removed, you may need to continue limiting your activity until the bone is solid enough to use in normal activity. Usually, by the time the bone is strong enough, the muscles, for instance in your leg or arm, will be weak because they haven't been used. Your ligaments may feel "stiff" from not using them. You'll need a period of rehabilitation that involves exercises and gradually increasing activity before those tissues will perform their functions normally, and the healing process is complete.


What bones are made of

"Thank goodness it's only a fracture. I thought it might be broken." People often think that a fracture is less severe than a broken bone, but fractures are broken bones.

To understand why bones break, it helps to know what bones do and what they are made of. The bones of the body form the human frame, or skeleton, which supports and protects the softer parts of the body. Bones are living tissue. They grow rapidly during one's early years, and renew themselves when they are broken.

Bones have a center called the marrow, which is softer than the outer part of the bone. Bone marrow has cells that develop into red blood cells that carry oxygen to all parts of the body and into white blood cells that help fight disease. Bones also contain the minerals calcium and phosphorus. These minerals are combined in a crystal-like or latticework structure. Because of their unique structure, bones can bear large amounts of weight.

How fractures occur

Bones are rigid, but they do bend, or "give" somewhat when an outside force is applied to them. When this force stops, bone returns to its original shape. For example, if you fall forward and land on your outstretched hand, there's an impact on the bones and connective tissue of your wrist as you hit the ground. The bones of the hand, wrist and arm can usually absorb this shock by giving slightly and then returning to their original shape and position. If the force is too great, however, bones will break, just as a plastic ruler breaks after being bent too far.

Types of fractures:
The severity of a fracture usually depends on the force that caused the fracture. If the bone's breaking point has been exceeded only slightly, then the bone may crack rather than breaking all the way through. If the force is extreme, such as in an automobile collision or a gunshot, the bone may shatter. If the bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone, the fracture is called an "open" fracture. This type of fracture is particularly serious because once the skin is broken, infection in both the wound and the bone can occur.

Treating your fracture:
Because fractures hurt and make it difficult if not impossible to use the part of the body that is injured, most people call a doctor or seek emergency care quickly. In some cases, however, a person can walk on a fractured bone in the leg or foot, or use a fractured arm. Just because you can use your hand or foot does not mean that you do not have a fracture. If you think a bone may be broken, you should seek medical help immediately. A medical examination and x-rays are usually necessary to tell for sure and to ensure proper treatment. It is very important to control the movement of a broken bone. Moving a broken or dislocated bone can cause additional damage to the bone, nearby blood vessels, and nerves or other tissues surrounding the bone. That's why people giving first aid or emergency treatment may splint or brace your injury before medical treatment is given. Also, if there is an open wound it should be covered by a clean cloth or bandage on the way to further medical treatment. At the emergency room, clinic or doctor's office, the physician usually applies a splint to prevent further damage, to lessen the pain and to help stop any bleeding. The patient is usually asked to recline and elevate the injured part. Elevation helps to reduce bleeding and swelling. X-rays can help the physician determine whether there is a fracture, and if so, what type of fracture it is. If there is a fracture, the doctor will "reduce" it, by restoring the parts of the broken bone to their original positions. "Reduction" is the technical term for this process. All forms of treatment of broken bones follow one basic rule: the broken pieces must be put back into position and prevented from moving out of place until they are healed. Broken bone ends heal by "knitting" back together with new bone being formed around the edge of the broken parts. The specific method of treatment depends on:
The severity of the break.
Whether it is "open" or "closed".
The specific bone involved--a broken bone in the spine (vertebra) is treated differently from a broken leg bone or a broken rib.

Types of treatment:
The following treatments are used for various types of fractures.

Cast immobilization-A plaster or fiberglass cast is the most common type of fracture treatment, because most broken bones can heal successfully once they have been repositioned and a cast has been applied to keep the broken ends in proper position while they heal.
Functional cast or brace-The cast or brace allows limited or "controlled" movement of nearby joints. This treatment is desirable for some but not all fractures.
Traction-Traction is usually used to align a bone or bones by a gentle, steady pulling action. The pulling force may be transmitted to the bone through skin tapes or a metal pin through a bone. Traction may be used as a preliminary treatment, before other forms of treatment.
Open reduction and internal fixation-In this type of treatment, an orthopaedist must perform surgery on the bone. During this operation, the bone fragments are first repositioned (reduced) into their normal alignment, and then held together with special screws or by attaching metal plates to the outer surface of the bone. The fragments may also be held together by inserting rods down through the marrow space in the center of the bone. These methods of treatment can reposition the fracture fragments very exactly. Because of the risks of surgery, however, and possible complications, such as infection, they are used only when the orthopaedic surgeon considers such treatment to be the most likely to restore the broken bone to normal function.
External fixation-In this type of treatment, pins or screws are placed into the broken bone above and below the fracture site. Then the orthopaedic surgeon repositions the bone fragments. The pins or screws are connected to a metal bar or bars outside the skin. This device is a stabilizing frame that holds the bones in the proper position so they can heal. After an appropriate period of time, the external fixation device is removed.
Each of these treatment methods can lead to a completely healed, well-aligned bone that functions well. Remember that the method of treatment depends on the type and location of the fracture, the seriousness of the injury, the condition and needs of the patient, and the judgment of the orthopaedist and the patient.
Successful treatment of a fracture also depends greatly on the patient's cooperation. A cast or fixation device may be inconvenient and cumbersome, but without one a broken bone can't heal properly. The result may be a painful or poorly functioning bone or joint. Exercises during the healing process and after the bone heals are essential to help restore normal muscle strength, joint motion and flexibility. Help your broken bone heal properly-follow your orthopaedist's advice.

Preventing broken bones

Even though healthy bones are very strong, any bone will break if the force applied against it is great enough. Bones that are weakened by disease or misuse may break more easily than healthy bones. To develop and maintain healthy bones, a person needs adequate amounts of calcium and proper exercise. Because of the way bones are made, calcium is very important in the growth, development, and maintenance of strong bones. Adequate amounts of calcium are necessary as a child grows and for the adult as well. Women, in particular, must have enough calcium in their diet. The female hormone estrogen regulates the use of calcium in women's bodies. Following menopause, when women produce far less estrogen, calcium regulation is more difficult. So it is very important that women make their bones as strong as possible before menopause, through weight-beating exercise and adequate calcium in their diets. In some women after menopause, bones fracture very easily because they have been weakened by calcium depletion.Because of the way bones are made, they also get stronger with regular but not excessive exercise. If a person is active, bones will become stronger and more dense. The bones of an inactive person are often not as strong and may fracture more easily than those of an active person. For this reason, older people should try to remain physically active.Proper diet and exercise, along with an understanding of what bones are made of and how they break, may help in preventing some fractures. If you do break a bone, seek medical treatment and remember-follow Doctor Biehl's advice.


| ©2007 Doctor Biehl LLC