Bones Fractures and Dislocations

What fractures and dislocations are

Bone is living tissue, and it fails when the force applied to it exceeds what it can absorb, whether from a fall, a collision on the field, a car accident or, in weakened bone, an ordinary stumble. Fractures are described as closed, where the skin remains intact, or open, where a wound connects the broken bone to the outside. Open injuries are treated more urgently because exposed bone can be contaminated.

Surgeons also describe the pattern of a break: transverse across the bone, oblique at an angle, spiral after a twisting injury, impacted where one segment is driven into another, and compression, seen most often in the spine. Hairline and stress fractures are incomplete breaks that develop gradually under repeated loading, which is why they appear in runners and other athletes. A dislocation is a different problem: the bone ends forming a joint separate, stretching or tearing the ligaments that hold them together. Shoulders, fingers, elbows, kneecaps and hips can all dislocate, and some injuries combine both.

Symptoms that often bring people in

• Sudden pain after an injury that does not settle
• Swelling and bruising, sometimes appearing quickly
• A change in the shape, angle or length of a limb, or a joint that looks out of place
• Inability to put weight on a leg or to use an arm normally
• Numbness, tingling, coldness or color change beyond the injury
• Pain that builds over weeks of training rather than starting with one event

How these injuries are evaluated

Evaluation usually begins with how the injury happened, since the direction and energy of the force suggest what may have been damaged. Examination follows, including circulation, sensation and movement beyond the injury. Plain X-rays are the usual first study, and CT or MRI may be added when the pattern is complex, involves a joint surface, or is not clearly visible. Certain stress fractures are difficult to see early and may need repeat imaging.

Treatment options in general terms

Many of these injuries are managed without an operation, depending on the bone involved and the stability of the joint.

• Immobilization. A cast, splint, boot, brace or sling holds bone or joint in a protected position while healing takes place.
• Closed reduction. A dislocated joint or displaced fracture may be guided back into position without an incision.
• Rehabilitation. Graduated loading and supervised therapy may be used to restore motion and strength once healing allows.

Surgery may be discussed when fragments cannot be held in acceptable position, when a joint surface is involved, when a fracture is open, or when a joint remains unstable.

• Internal fixation. Plates, screws, rods or wires hold the bone in corrected position from the inside.
• External fixation. A frame outside the limb, connected by pins or wires, can stabilize injuries with severe swelling, soft tissue damage or bone loss.
• Joint stabilization. Torn ligaments or fractured joint surfaces may be repaired when instability persists.

What to expect when you consult Dr. Wolfson

Dr. Wolfson is board certified in the United States and Canada, and his practice covers acute injuries as well as the problems that can follow them. A consultation typically covers your imaging, the options that apply to your injury, and the reasoning behind each. Our pages on fracture care, nonunion and malunion cover what happens when healing does not go to plan.

This page provides general information about fractures and dislocations and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]