Frequently Asked Questions:
   
Q. What is a Fracture?
  A. A bone fracture is a medical condition in which a bone is cracked or broken, or fracture is breach in continuity of the bone.
   
  Q. Symptoms of a fracture?
  A. The most common symptoms are:
  • Swelling around the injured area
  • Loss of function in the injured area
  • Bruising around the injured area
  • Deformity of a limb
   
  Q . What causes a fracture?
 
A. While many fractures are the result of high force impact or stress, bone fracture can also occur as a result of certain medical conditions that weaken the bones, such as osteoporosis, certain types of cancer or osteogenesis imperfecta.
   
  Q . What are the various types of fractures?
 
A. The various types of fractures are simple, stress, comminuted, impacted, compound, complete and incomplete.

Butterfly Fracture
This type of fracture has slight comminution at the fracture site which looks largely like a butterfly. The fracture site has butterfly fragments.


Closed Fracture
When there is a closed fracture there is no broken skin. The bones which break do not penetrate the skin (but may be seen under the skin) and there is no contusion from external trauma.


Comminuted Bone Fracture
A comminuted fracture has more than two fragments of bone which have broken off. It is a highly unstable type of bone fracture with many bone fragments.


Complete Bone Fracture
This is where the bone has been completely fractured through its own width. This is opposite from a hairline fracture or incomplete bone fracture where there is only a "crack" and not a complete break.

Complex Fracture
This type of fractured bone severely damages the soft tissue which surrounds the bone.


Compound Bone Fracture
When this occurs, the bone breaks and fragments of the bone will penetrate through the internal soft tissue of the body and break through the skin from the inside. There is a high rise of infection if external pathogenic factors enter into the interior of the body.

Compression Fracture
This type of bone fracture generally occurs after a fall where the vertebral column is compressed and then under the extreme pressure cracks or breaks. This type of bone fracture may also be referred to as an Impact Fracture.

Double Fracture
With this type of broken bone there is multiple fractures on the same bone or two bones which are fractured at the same time (i.e. - tibula and fibula). This type of trauma generally requires internal fixation of the fractured bones. It is also known as a Segmental Fracture.


Fissure Fracture
This bone fracture has minimal trauma to the bone and surrounding soft tissues. It is an incomplete fracture with no significant bone displacement and is considered a stable fracture. In this type the fracture the crack only extends into the outer layer of the bone but not completely through the entire bone. It is also known as a Hairline Fracture.


Fracture-Dislocation
This type of fracture is complicated with a dislocation of the joint proximal to the fracture site.

Fragmented Fracture
During this fracture the trauma will result in many broken bones leaving many pieces of bone within the patient.

Greenstick Fracture
The pathology of this type of fracture includes an incomplete fracture in which only one side of the bone has been broken. The bone usually is "bent" and only broken on the outside of the bend. It is mostly seen in children and is considered a stable fracture due to the fact that the whole bone has not been broken. As long as the bone is kept rigid healing is usually quick.

Hairline Fracture
This bone fracture has minimal trauma to the bone and surrounding soft tissues. It is an incomplete fracture with no significant bone displacement and is considered a stable fracture. In this type of fracture the crack only extends into the outer layer of the bone but not completely through the entire bone. It is also known as a Fissure Fracture.


Incomplete Fracture
This occurs when the bone breaks but the ends do not completely separate leaving the bone with a "crack" which does not extend the complete width of the bone. This is opposite from a complete bone fracture where the broken bone ends are completely severed from each other.

Impact Fracture
This type of bone fracture generally occurs after a fall where the vertebral column is compressed and then under the extreme pressure cracks or breaks. This type of bone fracture may also be referred to as a Compression Fracture.


Impacted Fracture
Type of fracture where the ends of the broken bones are wedged together.


Multiple Fractures
In this type of fractured bone there are several fracture lines on one bone. It can also mean several fractures in one patient but on separate bones but generally due to the same injury. Generally due to traumatic injuries, this will be evident in a patient who has a fractured pelvis and clavicle due to a fall or hit by a car.


Oblique Fractures
These types of fractures are one of rarest forms. They are an oblique break in the bone which is very unstable (break at an angle). They can be easily diagnosed as spiral fractures.

Open Bone Fractures
This type of fracture classified as when a broken bone protrudes to the exterior of the body giving rise to soft tissue injuries of the muscles, tendons and ligaments. There is a high risk of injection to the internal tissues.

Segmental Fracture
With this type of broken bone there is multiple fractures on the same bone or two bones which are fractured at the same time (i.e. - tibula and fibula). A bone breaks in which several large pieces of bone have broken away from the broken bone. This type of fracture easily becomes an open fracture. It is also known as a Double Fracture.

Simple Fracture
A simple bone fracture is one of the better types of fractures as there is only bone damage with little or no soft tissue damage and the broken bone ends do not penetrate the skin.

Spiral Fractures
In this pattern a bone has been broken due to a twisting type motion. It is highly unstable and may be diagnosed as an oblique fracture unless a proper x-ray has been taken. The spiral fracture will look like a corkscrew type which runs parallel with the axis of the broken bone.

Stable Fracture
A stable fracture is a broken bone which is generally transverse, oblique, greenstick or a hairline fracture which is somewhat secure.

Transverse Bone Fracture
In this type of fracture the bone has been broken giving rise to a transverse break or fissure within the bone at a right angle to the long portion of the bone. It is most often caused by direct traumatic injuries.

Unstable Fracture
An unstable fracture is generally a broken bone which is comminuted, oblique or a spiral fracture requiring external or internal fixation. While open (compound) fractures involve wounds that communicate with the fracture and may expose bone to contamination. Open injuries carry an elevated risk of infection; they require antibiotic treatment and usually urgent surgical treatment (debridement). This involves removal of all dirt, contamination, and dead tissue.

   
  Q . Explain Bone healing.
 
A. The natural process of healing a fracture starts when the injured bone and surrounding tissues bleed. The blood coagulates to form a blood clot situated between the broken fragments. Within a few days blood vessels grow into the jelly-like matrix of the blood clot. The new blood vessels bring white blood cells to the area, which gradually remove the non-viable material. The blood vessels also bring fibroblasts in the walls of the vessels and these multiply and produce collagen fibres. In this way the blood clot is replaced by a matrix of collagen. Collagen's rubbery consistency allows bone fragments to move only a small amount unless severe or persistent force is applied. At this stage, some of the fibroblasts begin to lay down bone matrix (calcium hydroxyapatite) in the form of insoluble crystals. This mineralization of the collagen matrix stiffens it and transforms it into bone. In fact, bone is a mineralized collagen matrix; if the mineral is dissolved out of bone, it becomes rubbery. Healing bone callus is on average sufficiently mineralized to show up on X-ray within 6 weeks in adults and less in children. This initial "woven" bone does not have the strong mechanical properties of mature bone. By a process of remodeling, the woven bone is replaced by mature "lamellar" bone. The whole process can take up to 18 months, but in adults the strength of the healing bone is usually 80% of normal by 3 months after the injury.
   
  Q . What are factors effecting bone fracture healing.
 
A. Several factors can help or hinder the bone healing process. For example, any form of nicotine hinders the process of bone healing, and adequate nutrition (including calcium intake) will help the bone healing process. Weight-bearing stress on bone, after the bone has healed sufficiently to bear the weight, also builds bone strength.
   
  Q . What is growth plate injury.
  A. Growth plate injuries, as in Salter-Harris fractures, require careful treatment and accurate reduction to make sure that the bone continues to grow normally.
   
  Q. Treatment Options?
  A. To heal properly, the bone must be realigned. The most common realignment procedures are:
The three main treatment options for bone fractures are:
  • Casting : Immobilization using a cast or splint.
  • Open reduction, and internal fixation - this involves a surgery to repair the fracture-frequently, metal rods, screws or plates are used to repair the bone, and remain in place, under the skin, after the surgery. This procedure is recommended for complicated fractures not able to be realigned (reduced) by casting, or in cases in which the long-term use of a cast is undesirable. Open reduction, and external fixation - this involves a surgery to repair the fracture, and placement of a external fixation device on the limb with the fracture. This device is an external frame which supports the bone and holds it in the correct position while it is healing. This technique is generally applied to complex fractures that cannot be repaired using open reduction, and internal fixation. The advantage of internal fixation is that it often allows early mobility and faster healing. Unless the internal fixation causes problems, it is not necessary or desirable to remove it. The long-term prognosis is excellent. The length of the hospital stay depends on factors such as the condition of the bone, the presence of infection, the state of the blood and nerve supply, and presence of other injuries. Children's bones heal rapidly, usually in 6 weeks time.
  • After the bone is realigned, medication and rehabilitation will help the recovery process. Medication is used to lessen the pain. Rehabilitation prevents stiffness. Rehabilitation involves light movement of the tissues surrounding the injury. It helps increase blood flow which will aid the healing process.
   
  Q. How bone fracture can affect common person?
  A. Following things can happens if you have fracture in any part of your body:
  • Doctor puts plaster for 6 – 12 weeks.
  • Or you are operated and bones are fixed by metal plates or rods.
  • You are advised to take rest from work for longer period.
  • You may not be able to walk for many months.
  • You may not be able write or sign important papers for longer period.
  • Your job is on risk due to long leaves.
  • Your earnings suffer due to non workings.
  • You are troubling others due to your fracture.
  • Your ambulatory period is too long.
  • Your doctor has told you that your fracture is complicated and will take long time to recover.
  • It will take longer time to gain normal strength of fractured bone.
  • Your fracture is at place where blood supply of bone is less so there will be delayed union.
   
  Q. Is there any medicine that can influence bone fracture healing?
 
A. Yes ancient traditional Indian bone healer cissus quadrangularis linn[UNION] – ancient bone fracture healing accelerator influences bone fracture healing. Cissus quadrangularis is an indigenous medicinal plant of India. The use of this plant by the common folk for promoting fracture healing process is an old practice. It has been prescribed in ancient Ayurvedic texts by Bhava Prakash and Chakra Dutta as a general tonic especially for the fractured patient. Since then it has been in extensive use by bone setters both for external application and as an internal medicine to be taken with milk. It was prescribed in the ancient Ayurvedic texts as a painkiller, with bone fracture healing properties. Modern research has shed light on Cissus’ ability to speed bone healing by showing that it acts as a glucocorticoid antagonist. It promotes bone growth and fracture healing, In addition to speeding the remodeling process of the healing bone, Cissus also leads to a much faster increase in bone tensile strength.
   
  Q. What says clinical trial on Cissus Quadrangularis Linn.
  A. Clinical trial shows:
  • 33-55% reduction in healing time.
  • 90% tensile strength in 6 weeks.
  • Pain, tenderness, and swelling reduction.
  • Strengthens tendon and muscles which helps in early recovery.
  • Anti-osteoporotic property helps to prevent depletion of calcium in immobilized limb and in patient on bed rest.
   
  Q. Why to use or prescribe Cissus Quadrangularis linn ?.
  A. It is bone fracture healing accelerator.
  • Reducing morbidity, decreasing the period of immobilization & suffering, hastening the recovery process leading to early weight bearing, mobility, ambulation and return to normal life.
  • Helps in achieving normal tensile strength in minimal period.
  • It also act as an anti-inflammatory and analgesic so reduces use of analgesics thus promoting healing.
  • In immobilized limb, depletion of calcium occurs in bones. It prevents depletion.
  • It gives strength to tendon and muscles which helps in early recovery.
  • It improves strength of gastric mucosal lining.
   
  Q. How Cissus Quadrangularis Linn (UNION) Work?.
 
A. Cissus quadrangularis showed a marked influence in the rate of fracture healing by influencing early regeneration of all connective tissues of mesenchyma origin, namely the fibroblasts, the chondroblasts and osteoblasts involved in the healing and quicker mineralization of the callus. It has greater impact on osteoblastic proliferation than other cellular responses. Cissus quadrangularis causes less amount of tissue reaction in the fractured region leading to optimum decalcification in the early stage with minimum of callus formation. Hence deposition of calcium is just enough to join the two broken segments of bone so that its remodeling takes much faster. This early completion of calcification process and earlier remodeling phenomenon lead to early recovery of Cissus treated animals. Cissus is also shown to cause early gain in the tensile strength of fractured bones of about 90 per cent of its normal strength at the end of 6 weeks. Cissus quadrangularis builds up the chemical composition of the fractured bone namely its mucopolysaccharides, collagen, calcium, phosphorus and others as well as its functional efficiency. Mucopolysaccharides play an important role in the healing by supplying raw materials for repairs. Therefore it seems that in the early period of bone fracture healing the greater the accumulation of these materials more rapid will be the rate of healing. Rapid the utilization of these raw materials earlier will be completion of healing process. Cissus quadrangualris not only causes the greater accumulation of mucopolysaccharides but also an earlier disappearance of mucopolysaccharides from the fractured area, associated with the earlier calcification and firmer callus formation. In clinical trials Cissus quadrangularis as per radiological and clinical observations has been found to cause considerable reduction in the healing time of fractures by 55-33 percent. In few of the treated cases, although radiologically only, an early callus formation was observed but clinically the symptoms of fracture such as pain, tenderness, and swelling were significantly absent.
   
  Q. How safe is Cissus Quadrangularis Linn ?.
 
A. 3 Month sub chronic toxicity studies conducted shown no toxic effect on experimental animal. Studies conducted in different doses of C.Q. from low to high, found no toxic effect. That the lethal dose LD 50 is over 2000 m.g. per kg on experimental animals. Studies show that it is so safe.
   
  Q. What are the other benefits in fracture healing of Cissus Quadrangularis Linn ?.
  A. Cissus also possess analgesic properties on an mg per mg basis comparable to aspirin or anti-inflammatory drugs like Ibuprofen.
   
  Q. What are the Dosage of C.Q.L.?.
  A. The typical recommended daily dosage of Cissus extract is between1000 m.g.to 1500 mg, depending on the concentration of the extract and the severity of symptoms. For the powder of the dried plant.
   
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