Trauma

Heel fractures usually occur when people jump from a height and land awkwardly. The fractures can be displaced out of position or an displaced and treated on their merits oftentimes with non-weight bearing in a cast or boot for 6 to 12 weeks, or requiring operation to put the bones back into an anatomical position and hold them there with a plate and screws. Patients often develop stiffness after a calcaneal fracture, and can have pain for many years. Heel fractures are fortunately relatively uncommon, but may cause significant disability, such as stiffness, in the future.

Midfoot fractures referred to the part of the foot between the toes and the ankle joint. They were first recognised in the Napoleonic wars by a surgeon called Lisfranc, who noticed them when soldiers fell from the horse and their foot caught in the stirrup in this area and the ligaments will bones were injured. These injuries need to be carefully assessed and often treated with plates or screws to realign them and prevent the arch of the foot collapsing and developing arthritis. These are severe injuries and can lead to long-term disability and pain. It is important that they are diagnosed and treated accurately.

Stress fractures of the foot are common particularly in military recruits who have normal bones but are subjected to walking long distances with heavy packs, thus overwhelming the bones ability to tolerate the forces being applied. These are called ‘March’ fractures as they are caused by marching. Stress fractures can also occur in relation to normal walking if people’s bones are. The intial treatment approach isy to reduce the amount of weight bearing done, and support this with either a boot or plaster for somewhere between six and 12 weeks. It is important to also look for any secondary causes such as osteoporosis. The majority of these fractures do not require anything further than non-operative treatment.
 

The talus is the ankle bone, which sits between the bottom of the shinbone (tibia) and the top of the heel bone (calcaneus). Talus fractures often occur from high energy injuries such as car accidents. The blood supply to the talus can be compromised when displacement of the bone can lead to tearing of the blood vessels, and ongoing damage to the bone from a lack of blood (osteonecrosis). The treatment is non-weight bearing for between six and 12 weeks, and anatomical realignment of the fracture which needs to be held with plates or screws or both. It is common for people to have long-standing stiffness after a fracture of the talus.

Toe fractures are common when people stub their toes. So long as the toe is not pointing sideways and will fit into a shoe, a non-operative pathway is recommended. It is uncommon to develop arthritis in the toes after a fracture. Forefoot fractures refers to the bones directly joining to the toes and these also also generally treated without surgery, depending on the severity and the number of bones broken. If one bone is broken, usually the bones on either side will help to hold it at length and splint it in the right position. Non-operative treatment usually requires treatment in a walking boot or in a cast.

Paediatric femoral fractures are relatively uncommon. Treatment is predicated upon the age of the child, the size of the child, and the type of fracture. Very small children can be treated with an immediate cast called a spica which is put on in the operating theatre with the patient asleep. As patients get older flexible rods can be passed up the hollow part of the bone to hold the bone in position, or paediatric femoral rods can also be used. These are similar to ones used to treat adult fractures but have a smaller diameter. An non-operative alternative for some children is 6 weeks in traction, this depends on the child's age and type of fracture.

Fractures to the shaft of the tibia usually occur from high energy injuries such as sporting contact or motor vehicle accidents. Treatment is operative. Options include having an intra-medullary nail passed down the hollow inside of the bone with locking screws at either end to prevent rotation or shortening. Alternatively plates and screws may be used. Monitoring post-surgery is important to ensure that pressure in the compartment does not increase and threaten the blood supply to the calf muscle. The usual time for a shinbone fracture to heal in an adult is between 18 to 24 weeks, with weight-bearing allowed immediately or at 6 weeks. The risk of non-union of the tibia is higher than for most bones because a significant part of the bone is not surrounded by muscle which normally provides blood supply which helps to heal the fracture.

Femoral shaft fractures refer to fractures below the top of the hip bone and are usually the result of high-energy sporting or motor vehicle accidents. These require fixation with intra-medullary nails or rods which have locking screws at either end to prevent rotation or shortening. The healing rate is very good for these fractures. Femur fractures often occur in association with other injuries as people are often involved in car accidents. It takes between 18 and 24 weeks for the femur to heal but weight-bearing is generally allowed anywhere from immediately up to 6 weeks depending on the degree of common use and or fragmentation of the fracture. Unless there are issues, the medullary nail will be left in place.