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With prompt treatment, particularly open reduction, and early mobilisation the outcome is generally good. High energy injuries and associated fractures worsen the outcome.
If the coccyx fracture is severe enough, short-term hospitalisation may be required, although this is extremely rare. More often, self-care at home is administered.
Sitting on soft surfaces is recommended, as this reduces pressure on the coccyx. A 'donut' or 'wedge' cushion may be purchased – these are simply cushions with a hole in them to ensure that no weight is placed in the injured tailbone. Painkillers such as ibuprofen are also recommended, as is a diet high in fibre to soften stools and avoid constipation.
Doctors will not usually attempt to correct a bad alignment, as muscles in the area are powerful and can pull the bone back into the 'bad' position. The bone is also very difficult to immobilise simply due to the sheer number of muscles attached to it, as well as the position.
Following a coccyx fracture, surgery is not usually required; however, if the pain continues even after the fracture has healed, and is severe enough to cause disability, a coccygectomy may be required. Coccygectomy is the surgical removal of the coccyx.
The treatment of FAI varies. Conservative treatment includes reducing levels of physical activity, anti-inflammatory medication and physiotherapy. Physical therapy may optimize alignment and mobility of the joint, thereby decreasing excessive forces on irritable or weakened tissues. It may also identify specific movement patterns that may be causing injury.
Due to the frequency of diagnosis in adolescents and young adults, various surgical techniques have been developed with the goal of preserving the hip joint. Surgery may be arthroscopic or open, peri-acetabular or rotational osteotomies being two common open surgical techniques employed when an abnormal angle between femur and acetabulum has been demonstrated. These primarily aim to alter the angle of the hip socket in such a way that contact between the acetabulum and femoral head are greatly reduced, allowing a greater range of movement. Femoral sculpting may be performed simultaneously, if required for a better overall shape of the hip joint. It is unclear whether or not these interventions effectively delay or prevent the onset of arthritis. Well designed, long term studies evaluating the efficacy of these treatments have not been done.
A 2011 study analyzing current surgical methods for management of symptomatic femoral acetabular impingement (FAI), suggested that arthroscopic method had surgical outcomes equal to or better than other methods with a lower rate of major complications when performed by experienced surgeons.
Galeazzi fractures are best treated with open reduction of the radius and the distal radio-ulnar joint. It has been called the "fracture of necessity," because it necessitates open surgical treatment in the adult. Nonsurgical treatment results in persistent or recurrent dislocations of the distal ulna. However, in skeletally immature patients such as children, the fracture is typically treated with closed reduction.
In children, the results of early treatment are always good, typically normal or nearly so. If diagnosis is delayed, reconstructive surgery is needed and complications are much more common and results poorer. In adults, the healing is slower and results usually not as good.
Complications of ORIF surgery for Monteggia fractures can include non-union, malunion, nerve palsy and damage, muscle damage, arthritis, tendonitis, infection, stiffness and loss of range of motion, compartment syndrome, audible popping or snapping, deformity, and chronic pain associated with surgical hardware such as pins, screws, and plates. Several surgeries may be needed to correct this type of fracture as it is almost always a very complex fracture that requires a skilled orthopedic surgeon, usually a 'specialist', familiar with this type of injury.
Medication can be prescribed to ease the pain. Antibiotics and tetanus vaccination may be used if the bone breaks through the skin. Often, they are treated without surgery. In severe cases, surgery may be done.
Nonsurgical treatment of tibia shaft fractures is now limited to closed, stable, isolated, minimally displaced fractures caused by a low-energy mechanism of injury. This treatment consists of application of a long-leg cast.
Surgical treatment is typically indicated for high-energy trauma fractures. Intramedullary nailing is a common technique, but external fixation may have equivalent outcomes.
Undisplaced fracture can usually be treated by casting. Even some displaced fractures can be treated with casting as long as a person can straighten their leg without help. Typically the leg is immobilized in a straight position for the first three weeks and then increasing degrees of bending are allowed.
Treatment of this fracture depends on the severity of the fracture. An undisplaced fracture may be treated with a cast alone. A fracture with mild angulation and displacement may require closed reduction. Significant angulation and deformity may require an open reduction and internal fixation. An open fracture will always require surgical intervention.
Most hip fractures are treated surgically by implanting an orthosis. Surgical treatment outweighs the risks of nonsurgical treatment which requires extensive bedrest. Prolonged immobilization increases risk of thromboembolism, pneumonia, deconditioning, and decubitus ulcers. Regardless, the surgery is a major stress, particularly in the elderly. Pain is also significant, and can also result in immobilization, so patients are encouraged to become mobile as soon as possible, often with the assistance of physical therapy. Skeletal traction pending surgery is not supported by the evidence. Regional nerve blocks are useful for pain management in hip fractures.
Red blood cell transfusion is common for people undergoing hip fracture surgery due to the blood loss sustained during surgery and from the injury. Adverse effects of blood transfusion may occur and are avoided by restrictive use of blood transfusion rather than liberal use. Restrictive blood transfusion is based on symptoms of anemia and thresholds lower than the 10 g/dL haemoglobin used for liberal blood transfusion.
If operative treatment is refused or the risks of surgery are considered to be too high the main emphasis of treatment is on pain relief. Skeletal traction may be considered for long term treatment. Aggressive chest physiotherapy is needed to reduce the risk of pneumonia and skilled rehabilitation and nursing to avoid pressure sores and DVT/pulmonary embolism Most people will be bedbound for several months. Non-operative treatment is now limited to only the most medically unstable or demented patients, or those who are nonambulatory at baseline with minimal pain during transfers.
The disease can be treated with external in-situ pinning or open reduction and pinning. Consultation with an orthopaedic surgeon is necessary to repair this problem. Pinning the unaffected side prophylactically is not recommended for most patients, but may be appropriate if a second SCFE is very likely.
Once SCFE is suspected, the patient should be non-weight bearing and remain on strict bed rest. In severe cases, after enough rest the patient may require physical therapy to regain strength and movement back to the leg. A SCFE is an orthopaedic emergency, as further slippage may result in occlusion of the blood supply and avascular necrosis (risk of 25 percent). Almost all cases require surgery, which usually involves the placement of one or two pins into the femoral head to prevent further slippage. The recommended screw placement is in the center of the epiphysis and perpendicular to the physis. Chances of a slippage occurring in the other hip are 20 percent within 18 months of diagnosis of the first slippage and consequently the opposite unaffected femur may also require pinning.
The risk of reducing this fracture includes the disruption of the blood supply to the bone. It has been shown in the past that attempts to correct the slippage by moving the head back into its correct position can cause the bone to die. Therefore the head of the femur is usually pinned 'as is'. A small incision is made in the outer side of the upper thigh and metal pins are placed through the femoral neck and into the head of the femur. A dressing covers the wound.
Most olecranon fractures are displaced and are best treated surgically:
Treatment may be with or without surgery, depending on the type of fracture.
The treatment of Pilon fractures depends on the extent of the injury. This includes the involvement of other bones such as the fibula and the talus, involvement of soft tissue, and the fracture pattern. Treatment strategies and fixation methods used include internal and external fixation, as well as staged approaches, with the aim of reducing the fracture, reconstructing the involved bones and restoration of articular surface congruence, with minimal insult to soft tissues. Appropriate wound management is important to reduce the high rate of infectious complications and secondary wound healing problems associated with open Pilon fractures. Vacuum-assisted wound closure therapy and using a "staged protocol" (awaiting soft-tissue recovery before extensive reconstructive efforts) may play a positive role.
Available evidence suggests that treatment depends on the part of the femur that is fractured. Traction may be useful for femoral shaft fractures because it counteracts the force of the muscle pulling the two separated parts together, and thus may decrease bleeding and pain. Traction should not be used in femoral neck fractures or when there is any other trauma to the leg or pelvis. It is typically only a temporary measure used before surgery. It only considered definitive treatment for patients with significant comorbidities that contraindicate surgical management.
Depending on the stability achieved via initial treatment, the patient may be allowed to stand and walk with help of support within about six to eight weeks. Full function may return in about three months.
Single intramedullary screws can be used to treat simple transverse or oblique fractures. Plates can be used for all proximal ulna fracture types including Monteggia fractures, and comminuted fractures.
External fixators can be used to prevent further damage to the leg until the patient is stable enough for surgery. It is most commonly used as a temporary measure. However, for some select cases it may be used as an alternative to intramedullary nailing for definitive treatment.
Minor nasal fractures may be allowed to heal on their own provided there is not significant cosmetic deformity. Ice and pain medication may be prescribed to ease discomfort during the healing process. For nasal fractures where the nose has been deformed, manual alignment may be attempted, usually with good results. Injuries involving other structures (Types 2 and 3) must be recognized and treated surgically.
If the femur head is dislocated, it should be reduced as soon as possible, to prevent damage to its blood supply. This is preferably done under anaesthesia, following which, leg is kept pulled by applying traction to prevent joint from dislocating.
The final management depends on the size of the fragment(s), stability and congruence of the joint. In some cases traction for six to eight weeks may be the only treatment required; however, surgical fixation using screw(s) and plate(s) may be required if the injury is more complex. The latter treatment will be called for if bone fragments do not fall into place, or if they are found in the joint, or if the joint itself is unstable.
Rest, Ice, Compression and Elevation (RICE) are standard treatments in the first 48 hours of an injury to the hip pointer. After 48 hours, patients can begin gently stretching, strengthening exercises, flexibility and coordination. For the first 7–10 days, patients can take anti-inflammatories such as ibuprofen and apply ice. Since this injury is very painful, recovery is usually very slow. When the person is without pain, sports massage and range-of-motion activities may reduce tension and swelling and prevent scar tissue buildup. Furthermore, an injection of corticosteroids into the affected area may reduce symptoms in the short term and accelerate rehabilitation. Operative treatment is rarely indicated and is reserved for patients suffering from significant displacement or fractures of the bones.
To prevent hip pointer, the equipment must be adequate in the sport and be well positioned and good size. It should also maintain excellent flexibility, strength and endurance of the hip, pelvis and lower back muscles.
Pelvic fractures that are treatable without surgery are treated with bed rest. Once the fracture has healed enough, rehabilitation can be started with first standing upright with the help of a physical therapist, followed by starting to walk using a walker and eventually progressing to a cane.
Rehabilitation has been proven to increase daily functional status. It is unclear if the use of anabolic steroids effects recovery.