What is a refracture?
In the context of a refracture, a repeated bone fracture at the same or nearby fracture site of a previous fracture, several factors have to be considered. Thus, the doctors must determine whether the refracture has occurred due to an incomplete healing of the fracture or sometimes an inadequate trauma was the reason for a refracture.
If the patient has not completed the last phase of the healing (modeling or even remodeling phase), so that not enough callus or bone replacement tissue has formed in the fracture site, there is an automatically increased risk of a refracture. Therefore, if the patient puts the previously injured region too early, the fracture line may well break again or the fracture may arise above or below the fracture line.
In unfinished fracture healing, however, recent fractures of the incompletely healed fracture line are common. The physician then speaks of an inadequate trauma if the bone had withstood no preload and the effects of violence.
Typical causes, which sometimes cause a refracture, are too early stress after a fracture. Especially if the last healing processes (sufficient callus formation) are not fully awaited and the injured region is loaded too soon, the breakage point can break again. But too early removal of osteosynthesis materials can cause the bone - because of the lack of support - does not "hold".
This often causes the fracture line at the same or nearby to break again. Occasionally, fractured fracture healing (such as osteoporosis or osteogenesis imperfecta) can lead to refracture, as the healing process has been slow or absent, so surgical procedures (osteosynthesis materials) must be used. Occasionally, however, the physician may misjudge the fracture healing, so that a refracture occurs.
Symptoms, complaints & signs
The patient complains - as with all other fractures - about increasing pain, restricted mobility; Swelling and bruising are visible or may develop later. Depending on the location, refractures cause the same symptoms and symptoms as corresponding fractures.
Diagnosis & disease course
The physician will first perform a clinical examination and then have an X-ray taken. Through the imaging process, it is possible that it can be very well recognized whether the fracture line is actually broken again or sometimes a fracture has arisen above or below the fracture line.
Above all, if the X-ray images of the old fracture are placed on the new recordings, the physician immediately recognizes whether a refracture is present or not. The course of the disease and prognoses vary and are also related to the cause of the refracture. If too much or too much stress was responsible for the fracture line being broken again, care must be taken after the refracture to ensure that the healing process is actually tolerated patiently.
However, if the physician diagnoses any fracture-disturbing causes (such as osteoporosis, osteogenesis imperfecta, etc.) or if the fracture is so severe that "normal healing" does not produce the desired results, bone-supporting materials must be used. These ensure that the bone is supported and stabilized.
As a rule, the materials are removed over time; However, if they were surgically used for bone support in the course of fracture healing disorders, they usually remain in the bone if they do not cause discomfort and are not surgically removed.
The symptoms and complications of a refracture are usually very similar to the symptoms of a common fracture. The sufferers suffer primarily from very severe pain. The pain often spreads to neighboring areas of the body and can lead to insomnia, and thus irritability of the affected person, especially at night.
Also, depression or mental discomfort may occur due to the refracture. Furthermore, many suffer from swelling or bruising. As a rule, a bone fracture also significantly restricts the patient's movement, resulting in various restrictions and complaints in everyday life. If the refracture is not treated, the bones can in the worst case also grow together wrongly or ignite.
In the worst case, the patient may die from blood poisoning. The treatment of the refracture occurs in most cases without complications by the rest position of the affected region. After a few weeks the bone fracture is usually healed. However, in some cases patients may need different therapies to restore joint movement. The life expectancy of the patient is usually not negatively affected by the refracture.
When should you go to the doctor?
A refracture must always be treated by a doctor. It can not come to a self-healing in this disease, so the person is always dependent on medical treatment. Only by a medical treatment, the refracture can be completely cured. A doctor should be consulted if the person suffering from the healing of his fracture still suffers from severe pain or restriction of movement.
It can also lead to effusions or excessive swelling at the respective site, so that the patient also suffers from a significantly reduced quality of life. The movements are clearly limited and the person concerned is usually dependent on the help of other people in his everyday life. If these symptoms occur and persist for an extended period, a doctor must be consulted in any case. As a rule, the refracture is treated by an orthopedic surgeon or by an accident surgeon.
Therapy & Treatment
The therapy of a refracture is based on the already existing fracture. If, for example, the cause is too early, the fracture site is again immobilized or a plaster cast is applied. However, the physician must subsequently enlighten the patient before the healing process, so that any refractures can be prevented.
However, if the physician realizes that it was a cure, sometimes resulting from the patient suffering from bone disease, other methods than the first fracture must be chosen for the cure to produce the desired outcome. Thus, bone stabilizing materials can be surgically incorporated into the bone.
By means of intramedullary nails or plates, the bone can be assisted in its healing and on the other hand stabilized in such a way that refractures can almost be ruled out. Since the treatments of the refractures are usually handled on the basis of the already existing first fracture line, there are individual therapies and treatment options here.
It is important that - so that the musculature is strengthened again after the resting phase - the patient takes physiotherapeutic measures. Physiotherapy can also help to prevent refracture, as it strengthens the muscles.
If there are no fracture-healing disorders that are based on any underlying diseases, refractures should generally be prevented. Since many refractures occur due to too early a stress, the secondary fracture can be prevented if the patient has enough patience and waits for the complete healing process. Sometimes also physiotherapeutic measures can help; The muscles are strengthened by the exercises, so that further fractures near the fracture line can be almost completely excluded.
The aftercare of the refracture can be designed longer term than the follow-up of a normal fracture. Here, above all, the cause of the refracture is crucial. It must be differentiated, whether it is a refracture due to too early stress on the bone or an insufficient stabilization or the refracture underlying other diseases that need to be treated with in order to achieve a complete healing of the bone fracture.
In many cases, this can be, for example, osteoporosis, which should be treated by a specialist doctor in accordance with medical treatment. Depending on the cause, the practical aftercare is designed primarily to control and ensure the healing process of the refracture. An orthopedist uses X-rays to check the condition of the refracture at appropriate intervals.
Overall, a longer healing and after-care phase is to be assumed than with a single bone fracture, even if the forms of therapy do not differ per se. However, in some cases surgical treatment may have been required in the acute treatment of the refracture, and the healing of the surgical wound should be considered in the aftercare. It is also important to educate and guide the patient's behaviors to avoid further complications in healing the fracture, such as premature loading.
You can do that yourself
If there has been a new one in the area of an older fracture, there may be several reasons. For the patients, it is important to know these reasons in order to avoid complications or even a new fracture.
For example, if too early a strain on the old fracture was the cause of the new fracture, it is important that the patient heal this new fracture more carefully. It is also possible that the doctor misjudged the fracture healing or the osteosynthesis material was removed too soon. In these cases, perhaps a change of doctor would be advisable or a second opinion to obtain.
If the refracture is due to a disturbed wound healing, unrecognized illnesses could be behind it. Here we recommend a conversation with the family doctor. Also osteoporosis or other bone diseases may have caused the refracture. These diseases must be recognized and treated. For the refracture they usually mean that materials are introduced, which should support the bone permanently in the future.
Cooling is helpful against the pain and swelling commonly associated with bone fractures. The patients supply the corresponding places either with cooling pads (cold / warm compresses) or make cold rolls, for example with Quark. If the cooling cushions are stored in the freezer, they must not be placed directly on the skin, as otherwise it can lead to cold burns.