Is it fractured or broken? Sprained, strained, or torn?
A basic explanation of musculoskeletal injuries and how they are best treated.
Orthopaedic injuries – injuries to the musculoskeletal system – are the primary medical issues seen in sports medicine and one of the main reasons for hospital ER visits. What are the basics that patients and their families need to know about these problems when seeking care?
First things first – basic terminology. “Fracture” is the medical term for a broken bone, regardless of how bad a break it is. A fracture or break is further classified by anatomic location – which bone, along the shaft, or into the joint ; the soft tissue status – an open or compound fracture involves lacerations through overlying tissue and contamination of the fracture, a closed fracture has no lacerations; and the alignment and extent of damage – a fracture can be non-displaced (straight), minimally displaced (slightly shifted), or severely displaced. “Comminution” is a term which refers to how many pieces the bone is broken into.
“Strains” are tears of muscles or tendons, and “sprains” are tears of ligaments, the structures that hold bones together. These can be grade 1 ( mild strain/sprain), grade 2 (significant stretch), or grade 3 (complete disruption), but they are all tears.
Treatment of these injuries is directed towards interventions, whether surgical or non-surgical, that maximize overall function. For fractures, this means doing what is necessary to restore pre-injury anatomy. Depending on the location and displacement of the break, the fracture can be immobilized in a cast or brace, “set” or reduced by an orthopaedic surgeon and then casted, or treated surgically by realigning the bones and then stabilizing them with plates, screws, rods, etc. Open fractures and fractures extending into joints with displacement usually require surgery. Well-aligned fractures can often be treated non-surgically. All methods are designed to maintain the broken bone in the best position until the bones have healed, which usually takes at least 6 weeks in kids and 2-4 months in adults, possibly longer.
Treatment of tendon injuries depends on the capacity of the injured structure to heal with an acceptable functional result. Some tendon injuries, including most hamstring injuries and biceps injuries in the shoulder, are usually treated non-surgically. Others, such as Achilles tendon tears or biceps injuries in the elbow, usually require surgery for maximal function. Similarly, ligament sprains are treated non-surgically with protection or bracing and activity modification when they are in a location that heals in a functionally stable position with such treatment. Examples include the medial collateral ligament (MCL) of the knee and the AC ligaments injured in a grade 1-2 shoulder separation. Other ligaments may require repair (glenohumeral ligaments injured in recurring shoulder dislocations), while others require reconstruction (anterior cruciate ligament/ACL the knee).
There are a multitude of different injury patterns and subsequent medical options for care. Orthopaedic surgeons spend years (at least 5) in surgical residency after undergraduate and medical school training to obtain expertise in determining the best care for each injury pattern. As a patient, you need to seek care from a qualified, board-certified orthopaedic surgeon who recommends the same care for you that they would for their own families. This is the minimum level of care that should be expected.
I hope this information is helpful to you. Our goal is to provide high quality, compassionate, state-of-the-art care for all of our patients. If you need our help please give us a call at 205-971-1750.