Can skin ever grow together

Surgeon warns: "The bone needs time to heal"

Whether on the slopes or on the icy sidewalk - a fall can happen quickly. If the impact is very strong, a bone can break. Surgeon Adrian Schwaller answers the most important questions about bone fractures.

Mr. Schwaller, have you ever broken a bone?

Yes. But luckily only one toe and the nasal bone when sailing.

How can I, as a layperson, recognize a broken bone?

On the one hand there is severe pain. The bone itself hardly has any nerves, but the periosteum that surrounds the bone contains nerves and blood vessels and is therefore very sensitive. On the other hand, movements are restricted and, depending on the type of fracture, an abnormal misalignment is visible.

How can I help if someone breaks their leg on the ski slope?

The break point should not be moved because of the severe pain. At most you can stabilize it with a rolled up jacket. It is very important that you reassure the victim and make sure that he does not freeze until the emergency services arrive.

Nowadays, skiers are often out and about very quickly and sometimes with different techniques than in the past, such as carving. Does this have an impact on the type of broken bones?

Dislocations can occur during carving, often in connection with fractures in the shoulder area. A rupture of the anterior cruciate ligament in the knee area, often in connection with a fracture of the head of the tibia, is possible.

What happens to the patient in the hospital?

The patient is given painkillers there and checked for additional injuries. Then a targeted x-ray will be taken to analyze the fracture. If necessary, computed tomographic recordings must follow. Then the fracture is stabilized, either with a plaster splint, special bandages or with a metal frame, i.e. a so-called external fixator.

And then do you have an operation?

An operation is not always necessary. In some cases, immobilization, for example with a plaster cast, helps. Whether an operation is necessary depends on various factors: Is there a misalignment and would the bone grow together incorrectly without an operation? Is it a so-called comminuted fracture, in which the bone is broken into several pieces? In these cases, an operation creates the possibility of stabilizing the bone so that it can heal in the anatomically correct position. Even with an open fracture, in which the bone penetrates outward through the skin, surgery usually has to be performed.

How do you go about such an operation?

First, the broken bone is brought into the correct anatomical position. This is done under general or partial anesthesia. Then it is fixed. For this purpose there is now a large selection of implants such as nails, screws, plates and prostheses made of stainless steel or titanium alloys.

What has changed compared to before?

In the past, you made a large incision at the break point and injured the soft tissue a second time. However, skin, muscles, nerves and blood vessels must be spared. The periosteum, for example, is essential for the healing process because it provides the basis for new bone formation. Today, therefore, minimally invasive work is often used.

What does that mean in concrete terms?

The surgeon arrives at the bone with the appropriate implants via small access points that are placed in healthy tissue away from the fracture. The plates are designed in such a way that they can be guided to the fracture site through small incisions in the skin and with the help of aiming devices. If the metal plate or nail fits perfectly, screws are inserted into the plate or nail through further small incisions in the skin. The operation can be followed on screens that transmit a type of X-ray film and the implant can be optimally placed.

How long does such an operation take?

You can't say that across the board. The duration of the procedure depends on the injuries, the complexity and the measures required.

Are there any risks?

Like any surgical procedure, this also involves certain risks. The small incisions in minimally invasive operations have the advantage that there are fewer infections, fewer discomforts and faster recovery.

What happens after the operation?

Now it is very important that the patient becomes active again as soon as possible. With the exception of the broken bone, all joints of the injured limb and the rest of the body must be moved - be it on your own under the guidance of a therapist or with the help of movement splints. The fracture must be treated in such a stable manner that the casualty can move at least with partial weight bearing.

Why is it so important?

Man is not made to lie down. Lying down for a long time harbors considerable health risks. These include bedsores, thromboses and pneumonia. Especially with older people, lying down for long periods of time from the need for care to death can result, for example, from pulmonary embolism.

"Carpal bones take longer to heal."

Surgery or plaster - what heals a broken bone faster?

It doesn't matter, because the bone simply needs time to heal in any case. And the duration depends on various factors. Which bone is affected? How good are the soft tissues and blood circulation? Does the patient suffer from diabetes mellitus? Does he smoke? Depending on which bone is affected, it heals so stably within four to six weeks that it can be fully loaded.

Are there bones in the human body that grow together particularly well or particularly poorly?

Certain carpal bones take longer to heal. And, more generally, the child's growing bones heal much faster than those of the adult.

Sometimes you can see a thickening at the break point during the healing process. How does this happen?

This is the so-called callus. Special bone cells temporarily grow more bone material in the area of ​​the fracture so that stability is created. This callus is broken down again when the bone healing process is complete, so that after a few years you can hardly see that there was a break.

Which bones break most often?

The bones in the wrist area. It is the typical fracture that occurs when trying to catch a fall with an outstretched hand. All the force of the impact is transferred to the wrist. In the elderly, fractures near the hip joint are common.

Do you have any tips on how to minimize the risk of a broken bone?

Bones need a certain amount of stress. Movement is required to maintain the bone substance. Last but not least, the hormonal situation plays a role in women. With age, the female hormones decrease, which has a negative effect on the bones. Fall prevention is certainly important for women as well as for men of advanced age.

Last question: You have completed initial training as a machine mechanic. How does this benefit you in your work as a surgeon?

As a machine mechanic, I learned three-dimensional thinking and how to use screws and plates, drills and torque wrenches, and I also know the different materials. This knowledge and the craft also come into play in my surgical work.

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