Broken Bone Re-break: Medical Question

Aerial · Mar 26, 2011

Hi all,

Just a quick question for the medically knowledgeable: I have a scenario where a person has suffered a severe break to their arm which has healed badly, i.e. with the bone ends not aligned. I'm assuming there would be both nerve damage and atrophying of the muscles due to not being able to use that arm much.

My question is, what would it take to re-break the bone and set it properly? Would the original break point be the weakest part of the bone or the strongest? Are there any common complications with the procedure?

Oh, and should the break be in the middle or near the end for it to make the most sense that it had been poorly set or not at all and had healed so badly?

(If it makes a difference, this is a fantasy novel so the rules are a tad different. There are no antibiotics or modern pharmaceuticals, but bone and nerve regeneration are both possible with magic and they have full-blown body imaging as good as or better than what we can do with CAT scans and the like.)

Thanks,

Aerial

sheadakota · Mar 26, 2011

Well it would depend what bone in the arm and what type of break.
it is more difficult to break the humurous (your upper arm) than it would be to break either your ulner or radius (the two bones in your lower arm)

There doesn't have to be nerve damage even with a complete break. If your are talking about the ulner (thats the one kind of near your pinky finger) and the radius(near your thumb) the most common fracture of these are mid-shaft and is caused by excessive torque to the bone(s)

If the fracture is complete(the ends of the bones are completely seperated then they might heal incorrectly with out proper treatment but nerve damage doesn't have to apply.

Whe the bone heals by itself the arm may appear bent and the place where the fracture occured would actially be the strongest part of the bone now- it would be very difficult to re-break the bone in rthat exact same spot.
And yes there would be atrophy of the muscle while it is healing and the person can not use it- but if this is a young person, that muscle should regain strength quickly once healing has occured.

Aerial · Mar 26, 2011

sheadakota said:
Well it would depend what bone in the arm and what type of break.
it is more difficult to break the humurous (your upper arm) than it would be to break either your ulner or radius (the two bones in your lower arm)

*Facepalm* Yes, I was thinking the humerus.

There doesn't have to be nerve damage even with a complete break.

If the fracture is complete(the ends of the bones are completely seperated then they might heal incorrectly with out proper treatment but nerve damage doesn't have to apply.

Okay, so nerve damage can happen? My MC is actually the healer, so I'm trying to figure out how she would go about healing an old physical injury that would prevent someone from using their arm. (It would be too contrived, imo, for it to be an injury that just happened to happen while she was in town.) That's why I thought of the broken bone scenario.

When the bone heals by itself the arm may appear bent and the place where the fracture occured would actially be the strongest part of the bone now- it would be very difficult to re-break the bone in rthat exact same spot.
And yes there would be atrophy of the muscle while it is healing and the person can not use it- but if this is a young person, that muscle should regain strength quickly once healing has occured.

How would resetting the bones be approached by doctors today? Would they break the bone as close to the original spot as possible or would it be a surgery situation, where they need to cut away the section where the bone healed improperly and use rods to reconnect them? Or am I way off?

Thanks for all the information!

Aerial

sheadakota · Mar 26, 2011

Sure nerve damage can happen. If that's what you need then that is feesable. But keep in mind in the real world nerve damage is permanent- in fantasy- anything is possible.

I'll bow to the docs on the board but if I am correct- and the arm is not usable because of deformity caused by the break, then they would re-break it- cut away the ends that are mishapen and place rods and screw the two ends together so the bone can regenerate correctly. I'm pretty sure that is correct (i'm a nurse not a doc) Hopefully one of the MDs will chime in and give you a more definitve answer.

50 Foot Ant · Apr 5, 2011

The old way to rebreak it was pretty brutal. They took a heavy hammer, and slammed it against the break point, then straightened the limb out.

Aerial · Apr 5, 2011

That's pretty much what I needed to have the character do. I just wasn't sure if it was realistic.

Thanks. I appreciate the input.

Aerial

Canotila · Apr 5, 2011

sheadakota said:
Sure nerve damage can happen. If that's what you need then that is feesable. But keep in mind in the real world nerve damage is permanent- in fantasy- anything is possible.

That depends on the nerves damaged. Spinal cord damage is permanent, but your peripheral nervous system does regenerate, albeit slowly. When I was in my accident the neurologist told me about 1/4 inch per year. There are therapies that can be done to stimulate nerve regrowth in some cases.

Whether it all comes back or not is situational though. Stuff like scar tissue getting in the way can make a nerve injury essentially permanent.

Broken Bone Re-break: Medical Question

Aerial

There is no spoon.

sheadakota

part of the human equation

Aerial

There is no spoon.

sheadakota

part of the human equation

50 Foot Ant

Aerial

There is no spoon.

Canotila

Sever your leg please.