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What is Upper and Lower Extremity Fracture Care?

Upper and lower extremity fracture care is the treatment or medical care rendered to a patient with a diagnosis of an upper or lower extremity fracture.

Upper and lower extremity fractures involve a break in the continuity of the bones of the upper or lower extremities. The bones may crack slightly or can break into many pieces. Your upper extremity bones include the humerus (upper arm), radius and ulna (forearm), and hand. Your lower extremity bones include the femur (thigh bone), tibia and fibula (shin bone), and foot.

Upper and lower extremity fracture care involve both non-surgical treatment measures such as casts, splints, and traction as well as surgical treatment measures such as open reduction and internal fixation with metal rods or plates.

Types of Upper Extremity and Lower Extremity Fractures

Bone fractures vary depending on the force involved and are classified into different types based on the location of the fracture, pattern of the fracture, and exposure of the fracture site. These include:

  • Transverse fracture: In this type of fracture, the break occurs as a straight, horizontal line going across the bone shaft.
  • Oblique fracture: In this type, the break occurs as an angled line across the bone shaft.
  • Comminuted fracture: A severe type of fracture where the bone breaks into 3 or more pieces.
  • Spiral fracture: A type of fracture caused by a twisting force with a fracture line that encircles the bone.
  • Open fracture: This is also known as a compound fracture and causes serious damage to the surrounding soft tissue structures as the bone fragments protrude out through the skin to the external air exposing the fracture site.
  • Stress fracture: Also called a hairline fracture, this fracture appears as small thin cracks in the bone and occurs due to overuse or wear and tear.

Causes of Upper and Lower Extremity Fractures

Some of the common causes of upper and lower extremity fractures include:

  • High-energy trauma, such as motor vehicle collisions or contact sports
  • Low-energy trauma in the elderly, such as a fall from standing
  • Pedestrian versus automobile accident
  • Falls from height
  • Mineral deficiency
  • Direct blow to the bone
  • Disease conditions, such as osteoporosis

Signs and Symptoms of Upper and Lower Extremity Fractures

Some of the common signs and symptoms of upper and lower extremity fractures include:

  • Pain, swelling, numbness, bruises, or tenderness at the fracture site
  • Restricted range of motion
  • Unable to bear weight
  • Bone deformity

Diagnosis of Upper and Lower Extremity Fractures

To diagnose upper and lower extremity fractures, your doctor will review your symptoms and medical history and conduct a thorough physical examination to look for signs of swelling, bruises, rupture of the skin, or any other bone deformities. In order to confirm the diagnosis and obtain further information on the severity of the fracture, your doctor may recommend:

  • X-rays: This study uses high electromagnetic energy beams to produce images of the bones and helps to detect whether the fracture is intact or broken and the type of fracture and its location.
  • CT scan: This scan uses special x-rays that produce images of the cross-section of your limb with clear images of any damage present that is not visible in an x-ray.
  • MRI Scan: This study produces images that help in detecting damage to soft tissues or ligaments using large magnetic fields and radio waves.

Upper and Lower Extremity Fracture Care

The treatment approach for upper and lower extremity fracture depends upon the type and severity of the fracture and involves both non-surgical as well as surgical methods.

Non-surgical Treatment

  • Casting and splinting: In this method, a cast or a splint is used to hold the fractured bone fragments in proper position until the bone heals. Casts and splints are typically made of plastic, fiber, or Velcro that encases the affected limb to support, stabilize, and protect the injured or fractured bones and joints while they heal.
  • Traction: This method is employed if significant leg-length discrepancy is noted and involves placing the limb in a weight and counterweight system (traction) to ensure the bones are realigned properly to stabilize the bone.
  • Closed reduction: For severe angled fractures in which the bones have not broken through the skin, your doctor will gently manipulate and align the bones properly without the need for surgery. This procedure is called a closed reduction and is performed under local anesthesia to numb the area while the doctor manipulates the bones. Once the procedure is complete, a cast is applied to hold the bones in place while they heal.

Surgical Treatment

Surgical treatment is recommended for complex or open fractures and may involve the use of: 

  • External fixation: In this procedure, metal pins or screws are placed into the bone below and above the site of the fracture. The screws and pins are secured to a rod outside the skin which holds the bones in the correct position while they heal.
  • Open reduction and internal fixation:
    • Intramedullary nailing: During this procedure, your surgeon makes an incision to access the fracture site and a metal rod is placed into the central canal of the bone passing across the fracture site. Both ends of the intramedullary nail are screwed to the bone to keep the bones and nail in proper position while the fracture heals.
    • Plates and screws: In this procedure, your surgeon makes an incision to access the fracture site and the bone fragments are reduced or repositioned into their normal alignment and held together by metal plates and screws fixed to the outer surface of the bone. The plates and screws method is employed when intramedullary nailing is not a viable option.

After the surgery, your doctor will recommend physical therapy to strengthen the bone and surrounding muscles and to help ensure return to optimum function as quickly as possible. However, complete healing of most upper and lower extremity fractures takes around 3 to 6 months or longer.

  • American Board of Orthopaedic Surgery
  • University of Florida
  • Lawrence General Hospital
  • American Academy of Orthopaedic Surgeons
  • NYU Langone Orthopedic Hospital
  • Johns Hopkins University