X-rays play an important role in assessing success of fracture treatments
2 views are usually required to assess bone position following treatment
Materials used for immobilisation often obscure detail of injuries seen on X-ray
All fracture treatment starts with appropriate resuscitation and care of the patient with consideration of the full clinical context.
Immobilisation of a fracture is usually required to allow long term healing. If a fracture is displaced then 'reduction' (returning the bones to an anatomical position) may be required prior to immobilisation. Placement of metal stabilisation devices may be required if simple methods of immobilisation are unsuccessful.
X-rays play an important role in assessing bone position following the treatment of a fracture or dislocation. Two or more views are usually required to accurately assess bone position after any treatment procedure.
Immobilisation materials
Strapping, plaster or metal wires can be used to immobilise many fractures. Following the positioning of these materials X-rays are used to assess the position of bones. Comparison should be made with the pre-treatment X-rays.
Some immobilisation materials will obscure detail of bone injuries, but usually assessment of bone alignment can still be made.
Metal wires (roll over image) were required to immobilise this oblique phalangeal fracture
These wires - commonly known as Kirschner wires (or K-wires) - are placed through the skin under anaesthetic
Positioning is not perfect but immobilisation will allow healing
Reduction
Prior to immobilisation, reduction of a fracture can be achieved by manipulation under anaesthetic. X-rays are useful to assess the success of this procedure.
Bimalleolar fractures with lateral displacement of the talus with respect to the tibia - 'talar shift' (red arrow)
Medial joint widening is worse following manipulation and placement of the plaster cast (roll over image)
Open reduction and internal fixation
If manipulation and use of external immobilisation devices is not successful or not appropriate, then open surgical reduction with placement of internal fixation metalwork such as plates and screws may be required.
The roll over image shows internal fixation metalwork with good reduction of the fractures
Normal joint spacing and alignment are restored
Frame fixation
Complex bone injuries or injury to small bones may not be amenable to plastering or internal fixation. In these cases external fixation may be achieved with the use of a frame device.
