Fractures, Slips & Falls

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Slip and Falls

Bone fractures can be caused in a number of ways, including car accidents, falls, bicycle accidents, work site accidents, assaults, and defective products. A fracture is a complete or incomplete break in a bone resulting from excessive force applied to that bone.

Emergency personnel and physicians in South Bend, Mishawaka, Elkhart, LaPorte, Plymouth, Syracuse, and throughout Indiana treat hundreds of broken bones on a daily basis. At Sweeney Julian, each South Bend personal injury attorney on our team has experience in representing victims of serious bone fractures caused by slip and fall accidents.

Bone Fractures in South Bend, Indiana

When an injury involves the bone and joint, it may be classified as a fracture-dislocation if the joint is dislocated. The human skeletal system is designed to support the human body, offer it protection, and provide a means of locomotion. Bone is the essential framework to which muscles are attached. Bone is constructed in layers. The outside layer is known as the periosteum. This is where blood vessels and nerve cells are located.

The next layer is the compact bone. This area has collagen and crystals of calcium and phosphorus. The next layer is of spongy bone, which has shock-absorbing qualities. Next, the medullary cavity, which is filled with marrow, forms the inside of the bone. This layered-tube architecture allows the bone its compression strength, keeping it very light.

Types of Bone Fractures

As the human skeletal system is comprised of numerous bones, the nature of a fracture injury can range from relatively benign to life threatening. Luckily, Northern Indiana is blessed to have some of the best orthopedic surgeons in the country. Fractures usually result from traumatic injury to a bone causing the continuity of bone tissues or bony cartilage to be disrupted or broken.

Fracture classifications include simple, compound, incomplete, and complete. Simple fractures - more recently termed "closed fractures" - are not obvious on the surface as the skin has not been ruptured and remains intact. Compound fractures - now commonly referred to as "open fractures" - rupture the skin, exposing bone and causing additional soft tissue injury and possible infection.

Single and multiple fractures refer to the number of breaks in the same bone. Fractures are termed complete if the break goes completely through the bone and are described as incomplete or "greenstick" if the fracture occurs partly across a bone shaft. This latter type of fracture is often the result of bending or crushing mechanisms on the bone. Fractures are also named by the specific portion of the bone involved and the nature of the break. The identification of the fracture line can further classify fractures. Types include linear, oblique, transverse, longitudinal, and spiral fractures. Fractures can be further subdivided by the positions of bony fragments and are described as comminuted, non-displaced, impacted, overriding, angulated, displaced, avulsed, and segmental.

Linear fractures have a break that runs parallel to the bone's axis or direction of the bone's shaft. For example, a linear fracture of the arm bone could extend the entire length of the bone. Oblique and transverse fractures differ in that the oblique fracture crosses the bone at approximately a 45 degree angle to the bone's axis. In contrast, the transverse fracture crosses the bone's axis at a 90-degree angle.

A longitudinal fracture is similar to a linear fracture. Its fracture line extends along the shaft but is more irregular in shape and does not run parallel to the bone's axis. Spiral fractures are described as crossing the bone at an oblique angle, creating a spiral pattern. This break usually occurs in the long bones of the body such as the arm bone (humerus) or the thigh bone (femur).

Treatment for Bone Fractures

Fracture treatment depends on fracture type, severity, the individual's age, and his or her general health. The first priority in treating any fracture is to address the entire medical status of the individual. If an open fracture is accompanied by serious soft tissue injury, it may be necessary to control bleeding and the shock that can accompany loss of blood. First aid is the initial treatment in emergency situations. It includes proper splinting, control of blood loss, and monitoring vital signs such as breathing and circulation.

Bone Fracture Immobilization
One of the first considerations for a medical provider is the immobilization of the fracture site. Immobilization can be done internally or externally. The primary goal of immobilization is to maintain the realignment of the bone long enough for healing to start and progress. Immobilization by external fixation uses splints, casts, or braces; this may be the primary and only procedure for fracture treatment.

Splinting to immobilize a fracture can be done with or without traction. In emergency situations, splinting is a useful form of fracture management if the injured individual must be moved by someone other than a trained medical person. It should be done without causing additional pain and without moving the bone segments. In a clinical environment, Gypsum plaster (plaster of Paris) casts are used for immobilization. Braces are useful as they often allow movement above and below the fracture site. Treatments for stress fractures include rest and decreasing or stopping any activity that causes or increases pain.

Fracture Reduction / Realignment
Next, the medical providers will reduce the fractured bones. Fracture reductions are either closed or open. Closed reduction refers to realigning the bones without breaking the skin. It is accomplished using manipulation and / or traction and is commonly done with some kind of anesthetic. Open reduction primarily refers to surgery that is performed to realign the bones. Fractures with little or no displacement may not require any form of reduction.

Traction is used to help reposition the bone. It works by applying pressure to restore proper alignment. The traction device immobilizes the area and maintains the realignment as the bone heals. The fractured bone is immobilized by applying opposing force at both ends of the injured area, using an equal amount of traction and counter-traction. Weights provide the traction pull needed or the pull is achieved by positioning the individual's body weight. Traction is a form of closed reduction and is sometimes used as an alternative to surgery. Since it restricts movement of the affected limb or body part, it may confine the patient to bed rest for an extended period of time.

Open Reduction
A patient may need open reduction if he or she has an open, severe, or comminuted fracture. This procedure allows the physician to examine and surgically correct associated soft tissue damage while reducing the fracture and, if necessary, applying internal or external devices. Internal fixation is a surgical procedure that is required when the fracture cannot be reduced by closed fracture methods. Internal fixation devices include plates, nails, screws, and rods. When healing is complete, the physician may or may not elect to remove these devices.

A fracture may be "comminuted." Comminuted fractures have two or more fragments broken into small pieces, in addition to the upper and lower halves of the fractured bone. Fragments of bone that maintain their normal alignment following a fracture are described as non-displaced. An impacted fracture is characterized as a bone fragment forced into or onto another fragment resulting from a compressive-type force. Overriding is a term used to describe bony fragments overlapping and shortening the total length of the bone. Angulated fragments result in pieces of bone being at angles to each other. A displaced bony fragment occurs from disruption of normal bone alignment with deformity of these segments separate from one another. An avulsed fragment occurs when bone fragments are pulled from their normal position by forceful muscle contractions or resistance from ligaments. Segmental fragmental positioning occurs if fractures in two adjacent areas happen with an isolated central segment. An example of segmental alignment is when the arm bone fractures in two separate places, with displacement of the midsection of bone.

Bone Fracture Repair Process

The process of fracture repair begins immediately at the time of bone fracture and is accomplished by the body itself without extraneous medical intervention. The first step in the repair of a fracture is the development of a hematoma, or pool of blood, that surrounds the fracture and provides the fractured bones with the nutrients needed to repair itself. The formation of a hematoma accounts for the swelling seen in the area of the fracture. After the hematoma surrounds the fracture, the process of bridging the gap in the fracture begins.

Bone fractures tend to heal "inside out," which means that the middle of the bone heals first and the outside heals last. The inside of the bone is called the medullary canal, and cells called osteoblasts begin to fill the fracture area inside the medullary canal of the fractured bones. In time, these tube-like structures form bridges that cover the gap caused by bone fractures. Eventually, these soft, "fibrous" tubes turn into cells that will form reparative bone matter.

After a fracture repair has begun on the inside of the bone, the process of repairing the outside of the bone begins. The outside of the fracture is covered with a substance called callus, which covers the exterior gap in the fracture. Callus can be seen by X-ray, and assists medical personnel in determining that the body's innate system of healing is functioning correctly.

What to Do if You Fracture a Bone

Although every fracture is different, there are some common sense things to do when you have been involved in an incident involving a fractured bone.

  • Get immediate medical treatment.
  • Listen to your doctor and follow his or her orders.
  • Have family members or friends take pictures that document not only your injury, but the site where the injury occurred. For example, if the fracture occurred because of car crash, take pictures of the location of the crash and the cars involved. You can never take too many pictures.
  • Document the injury. If the fracture occurred because of a car crash, make sure the police were called to the scene and that the police filled out a crash report. If the fracture occurred at a store, take pictures of where the fall occurred. If necessary, buy a disposable camera at the store and use that to take pictures. Take pictures over the course of your treatment and recovery as well.
  • Do not talk to the at-fault party's insurance company. The company is interested only in getting its insured out of trouble while at the same time settling your case for as little money as possible. Insurance adjusters know how to ask trick questions that will hurt your case. Unless you are trained to identify these questions, you could easily sink your case.
  • Get a lawyer. We hope you will hire Sweeney Julian Law Firm, but even if you don't hire us, you cannot hope to succeed without a lawyer. Contact the personal injury attorneys at our firm as quickly as possible.
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