PDA

View Full Version : Medical: untreated fracture



leahutinet
07-23-2017, 08:46 PM
I have a medical question: how long can a broken bone (in the leg) remain untreated until there is irreversible damage? I know this is a vague question and I don't know anything about broken bones, but I don't really know yet the circumstances for this character's situation, and actually, I thought your answers would help me decide how to write the story.
The character is female, 18, human, and she gets kidnapped. At some point, her leg gets broken (I don't know how badly, it will depend on your answers) and she's unable to get treatment until she's saved. So, what I'm asking is for you to tell me how long she could stay with an untreated broken leg, knowing that she'll be saved within a few weeks, and she's probably going to get surgery when she's out, but I want her to be able to walk again, whether it's weeks or months later. I hope you can help me with this and once again, I know it's very vague, but I'm going to write my story based on your replies.
If you need more details about the character or the situation or anything really, feel free to ask. Thanks!

Maryn
07-23-2017, 09:20 PM
I'm not a medical professional, nor have I ever broken a leg. However, I did break a rib and received no treatment. (I was a whiny kid already, so my complaints were not taken seriously.) What happened was that new bone surrounded the break over a period of months (or years, who knows?) until there's a literal knob of bone clearly visible on x-rays. One doctor said it appears the original break was out of alignment, or the knob would be much smaller.

I would guess that if your character stays off the leg, she, too, might develop a calcification that protects and strengthens the area of the break. I would further guess that if she can stay off it for long enough, she would walk again without treatment, although perhaps with a limp.

Do you need her to be mobile, or will she be able to stay in bed or use crutches or a wheelchair?

Brightdreamer
07-23-2017, 10:01 PM
What's the plot purpose of the break? Under what circumstances is she injured: falling while fleeing, car crash, deliberate injury by malicious party, etc.? Could a bad sprain or strain do the job? What resources does she have on hand for first aid, to possibly minimize long-term damage - can she improvise a splint or crutch? (Also, if this is a SF or fantasy setting, what medical tech is available for healing once she does get rescued? An injury that would permanently cripple someone today may be little more than an inconvenience with sufficiently advanced options.)

weekendwarrior
07-23-2017, 10:11 PM
new bone growth starts about 2 weeks after the break and lasts roughly 3 months. but this is assuming she's been able to stabilise it with a cast or a splint. With something like a leg fracture (unlike ribs or collarbones), unless she wasn't moving at all, it wouldn't grow back together as movement between the two bone ends would be too great and it wouldn't stay together long enough for the calcification to happen. so i think your best bet for duration for her to be missing is 1-2 months (and she definitely needs a splint)

leahutinet
07-23-2017, 10:26 PM
What's the plot purpose of the break? Under what circumstances is she injured: falling while fleeing, car crash, deliberate injury by malicious party, etc.? Could a bad sprain or strain do the job? What resources does she have on hand for first aid, to possibly minimize long-term damage - can she improvise a splint or crutch? (Also, if this is a SF or fantasy setting, what medical tech is available for healing once she does get rescued? An injury that would permanently cripple someone today may be little more than an inconvenience with sufficiently advanced options.)

The break is caused by the kidnapper, because he's a sick person with a twisted sense of irony. He breaks her leg and tells her that if she waits long enough, it will become bad enough that it'll need to be amputated, and that her boyfriend can do it, since he's a doctor, but she's not really supposed to date him because he's older than her and her parents don't approve. A sprain or strain would probably not be enough, it has to hurt her and make her unable move and there's a possibility that it might actually become bad enough to cause irreversible damage.
Also, she doesn't have any resources on hand. She's kept in a sort of bedroom with barely anything inside besides a bed, a desk and that's about it, so a splint might be difficult to build in these circumstances, but I could find a way to make this a possibility.
It isn't SF or fantasy. The story takes place in California, probably 2017, andevery character is human.

leahutinet
07-23-2017, 10:29 PM
Do you need her to be mobile, or will she be able to stay in bed or use crutches or a wheelchair?


I need her to be able to walk as if nothing had happened, or at least, almost. But it's okay if it takes weeks or months to get there.

leahutinet
07-23-2017, 10:35 PM
so i think your best bet for duration for her to be missing is 1-2 months (and she definitely needs a splint)

What you're saying is that the break can be left untreated for 1-2 months only if she has a splint, and after that, damage can be permanent?

Roxxsmom
07-24-2017, 12:08 AM
I'm not a medical professional either, but I teach anatomy and physiology, and as per the sources we use to teach this subject, the rate at which fractures heal and knit depends on the nature of the break (the degree of displacement of the bone ends, presence of bone fragments etc), the age of the person in question (young people tend to heal faster than older people), even nutritional status.

Generally, when a bone breaks, a fracture hematoma forms first, within a few hours. This is a result of broken blood vessels, and is essentially a large clot or scab that weakly holds the ends of the bone together. As new capillaries grow in the hematoma over the next 3 weeks or so, something called a fibrocartilaginous callus forms. This is essentially the formation of collagen fibers that helps connect the broken ends of the bone, but it is still too fragile to support weight. During this period, it might be possible to re-align bone ends that are starting to heal crooked via the use of traction devices (https://janeaustensworld.wordpress.com/2010/10/08/setting-a-broken-bone-19th-century-medical-treatment-was-not-for-sissies/), which were used even in Hippocrates's time (http://www.hellenicaworld.com/Greece/Science/en/Hippocrates.html).

Next, the bony callus starts to form. This is when the bone-forming cells start to produce actual spongy bone. This takes about 3-4 months in most cases, and once it's well underway, the ends of the fracture will be fused pretty firmly together. It still isn't as strong as the original bone, so with a weight-bearing bone, the cast (or internal pins and plates) would be left in place until this phase is complete. For someone healing without modern medicine, this means they would need the leg to be splinted, at least, and walk with a cane during this period (and if the ends are badly misaligned, they may not be able to walk on it at all until much later in the healing process). Attempts to re-break the bone would likely result in the break being at the same site. I'm not an orthopedist, but I'm guessing that traction devices might have some effect earlier in this process.

Re-breaking a partially healed bone would be pretty risky (and excruciating) in a pre-modern setting.

After the bony callus is complete, bone remodeling takes place, where dead fragments of bone are absorbed by the bone-absorbing cells and compact (dense) bone replaces spongy bone around the periphery of the fracture site. This takes place over subsequent weeks and months. If the fracture was set well, eventually there may be no sign of it, even on x-ray. However, sometimes a thickened area remains. If the bone wasn't set well, the limb will be healed with a permanent bend or deformity. Once the bone is nearly as dense as the original bone (within a few months), even an attempt to re-break the bone (short of more modern orthopedic surgical techniques and equipment) could be problematic, as it might not break in the exact same place.

Note that in a setting without modern equipment, painkillers and know how, even doctors couldn't always get good results with fixing broken limbs where the ends were badly misaligned. I saw a display of Colonial-era skeletons in the Smithsonian some years ago. Some of them had crooked and badly healed limbs.

https://www.linkedin.com/pulse/broken-leg-year-1350-full-article-wiel-van-der-mark

MaeZe
07-24-2017, 12:21 AM
This is another one of those medical questions where the answer is, you can tailor the injury to the story. Decide what you want to happen, then create an injury that fits.

As for the threat of amputation, the bad guy doesn't have to be right, so again, what the characters believe doesn't have to match the injury.

Roxxsmom's post is excellent for understanding the processes.

Sage
07-24-2017, 05:36 PM
Also moved from YA forum

GeorgeK
07-24-2017, 11:16 PM
I'm not clear what your goal is for the character's injury. How is the leg broken? Which bone(s) are you talking about? If it's just the fibula and proximal (lower leg but closer to the knee) enough, it very well may heal completely without any treatment at all eventually (a few months) and would be stable for walking on it although would hurt quite a lot. If it's distal (closer to the ankle) and right into the the ankle it still would be technically stable to walk on but would hurt worse and may eventually fuse the ankle for a permanent limp. Now the tibia and femur provide structural strength for upright posture. A hairline fracture of either likely would eventually heal but again with a lot of pain in the meantime even with a splint. If they attempt to use the limb then there's always the risk of it becoming worse, the fracture extending and if there's a complete fracture it definitely will not be an ambulatory situation and attempting to walk might convert it to a displaced or even compound fracture. Those would need traction to reset the bones and then a cast. If one were very lucky a splint may be adequate. Note that most people don't know the proper way to put on a cast and tend to make it too loose in which case it doesn't stabilize the bones or too tight which can result in compartment syndromes and even gangrene.

Tsu Dho Nimh
07-28-2017, 03:25 AM
The break is caused by the kidnapper, because he's a sick person with a twisted sense of irony. He breaks her leg and tells her that if she waits long enough, it will become bad enough that it'll need to be amputated, and that her boyfriend can do it, since he's a doctor, but she's not really supposed to date him because he's older than her and her parents don't approve.

Unless it's a "open" fracture, with skin broken and bone exposed, it will probably be fixable by a decent orthopedic surgeon. They re-break the bone and align the ends (under anaesthesia).

Let's also assume he's clueless about medicine.


Also, she doesn't have any resources on hand. She's kept in a sort of bedroom with barely anything inside besides a bed, a desk and that's about it, so a splint might be difficult to build in these circumstances, but I could find a way to make this a possibility.

You know ... cardboard and duct tape makes decent splints. We use them in ski patrol all the time.
A Cub Scout brought his buddy into the clinic with a marvellous splint made of a branch and a scarf.
My dad splinted my mom's busted leg with some newspapers and tape for transport.

If she has magazines or newspapers and something to tie around them she can McGyver a splint that will minimize damage. And if she elevates the broken part she can minimize swelling and pain.

Basically she needs to support the bone above and below the broken part to minimize movement of the bone. It's going to hurt, but judging from the skiers I've treated, just immobilizing and elevating the broken bone helps a lot.

X-ray of the common "tib-fib" (tibula and fibula) fracture. This got the usual cardboard and duct tape treatment for transport.


http://images.freeimages.com/images/large-previews/25f/broken-leg-xrayseries-1-1430561.jpg