Greensticks, spirals and splinters

Nurturing

BENDY BONES Kids’ bones tend to bend a bit and only partly break, a bit like a green stick.


Health
Andrew O'Brien

Break a leg; it seems like a strange way to wish someone luck. But then apparently that’s the point. Apparently, there is a superstition in the performing arts that to wish someone good luck is to actually invite bad luck. And so, going by the reverse logic, wishing someone ill might just bring them luck.
I once worked with an orthopaedic consultant who made it clear that staff should never say ‘good luck’ to a patient before they went for surgery. He reasoned that people would be happier knowing they had a good surgeon rather than a lucky one. It’s hard to argue the point, but the habit of wishing someone good luck is pretty much ingrained in all of us at this stage.
But what if you are unlucky enough to literally break a leg, or any other bone for that matter? What can you expect in the weeks and months afterwards?
Before we get into the aftermath, let’s get some definitions straight. In medicine, a broken bone is referred to as a fracture. If I had a dollar for every time someone told me they didn’t have a break, just a fracture, I’d be a rich man. The terms are interchangeable.
There are, however, different types of fracture that can happen for different reasons. For the sake of ease, we’ll concentrate here on acute fractures of the limbs; the type that usually happens as a result of a trauma of some sort.
Fractures can be defined by their direction across or through the bone, meaning we see transverse fractures going straight across, oblique fractures running diagonally and spiral fractures doing what spirals do. It’s also possible to get a compression fracture, where the bone – usually a vertebra – is crushed, an impacted fracture, where the end of the bone is squashed in and comminuted fractures, where the bone is broken into three or more pieces. The most common type of break in children is known as a greenstick fracture. This is because kids’ bones tend to bend a bit and only partly break, a bit like a green stick, rather than snap like a brown one.
How a fracture is managed depends on a multitude of factors, including what part of the bone is damaged, how many pieces there are and how stable those pieces are. In very nasty cases, the bone may break the skin or damage surrounding tissues, adding further complications. As a rule, the more unstable a bone is and the more pieces there are, the more likely some type of surgical intervention is required. In less messy cases, the old plaster cast is still the way it’s done.
It may surprise you to know that when you break a bone, the pain has often settled within a week or so. Once you’ve been treated – either surgically or not – the affected limb will usually be immobilised in a cast or sling for six weeks. It should be noted that a bone is nowhere near fully healed at this stage, rather it is healed just enough to be stable and start taking some load.
This explains in part why someone with a leg fracture keeps using crutches for a few weeks after their cast comes off. The idea is to gradually increase the weight on the leg, allowing the bone to re-adapt to load and get stronger. The fact that your foot hasn’t taken it’s usual pounding for six weeks means that it can be very sensitive as well.
It isn’t just bony healing that takes time; after a period of immobilisation, joints stiffen and muscles weaken. This means that a big part of your rehab programme involves working on range of movement and strengthening exercises at the joints and muscles around the fracture.
Something people often don’t realise is that if you break your wrist, the muscles around your shoulder get weak with the lack of use. Similarly hip muscles get weak after broken ankles, so the rehab programme involves more than just concentrating on the injury site.
Most people who suffer relatively simple fractures make a good recovery within three to six months. More complex cases such as those who require surgery or who damage other structures can take much longer, but they can still expect to get back doing most of the things they did before their injury.
With a bit of luck, you’ll never need to know any of this. But like my surgeon friend says, it’s best not to rely on luck.

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.