to confirm stress fractures and some spiral frac-
tures.
Treatment Options and OutlookTreatment immobilizes the bone ends. The most
common method of immobilization is a plaster or
fiberglass cast, applied as a wet wrap around the
fracture and usually spanning the joints above and
below the break in the bone. The cast hardens as
it dries, and remains in place for three to six
weeks for most fractures. Other methods of exter-
nal immobilization include splints and braces.
Sometimes the doctor must move the bone
ends into alignment, a procedure called reduction.
For most fractures that require reduction, the doc-
tor first administers a strong sedative or
ANESTHESIA, then manipulates the bones. When no
incision is necessary the reduction is a closed
reduction; when the doctor must open the frac-
ture site to realign the bones the reduction is an
open reduction (surgery). During an open reduc-
tion the doctor generally places pins, plates,
screws, or nails to hold the bone ends in place.
Fractures set via open reduction generally do not
require casting and the person can return to
movement as tolerated because the hardware
holds the bone together.
Most fractures heal within 6 to 10 weeks.
Immobilized muscles atrophy (shrink), and the
person may need PHYSICAL THERAPYto restore MUS-
CLE STRENGTHand JOINTrange of motion after the
doctor removes the cast or other immobilizing
device. The area of HEALINGremains thicker than
the rest of the bone for up to a year. Refracture at
the same site is very unlikely.
Risk Factors and Preventive Measures
MOTOR VEHICLE ACCIDENTS and athletic or recre-
ational activities that expose a person to impact or
falling present the greatest risk for fractures. Older
people are vulnerable to fractures with falls, pri-
marily as a consequence of OSTEOPENIAor osteo-
porosis (conditions in which the bones become
thin and weak). Proper protective equipment—for
example seat belts, pads, braces, and helmets—can
prevent many fractures and other injuries.
See also ACCIDENTAL INJURIES; ATHLETIC INJURIES;
CONCUSSION; HIP FRACTURE IN OLDER ADULTS; SPRAINS
AND STRAINS.
frozen shoulder See ADHESIVE CAPSULITIS.gangrene The death of tissue (necrosis) resulting
from deprivation of BLOODcirculation to an area of
the body. Gangrene most commonly affects the
digits (fingers and toes) and extremities (hands
and feet). FROSTBITE,PERIPHERAL VASCULAR DISEASE
(PVD), NEPHROPATHYof DIABETES, severe INFECTION
(such as clostridial infections and NECROTIZING
FASCIITIS), and RAYNAUD’S SYNDROME are common
causes of gangrene. TESTICULAR TORSIONin which a
TESTICLEbecomes strangulated (twisted such that
its blood supply is cut off) can result in testicular
gangrene. A strangulated HERNIA, which entraps a
segment of bowel, can similarly result in intestinal
gangrene. Gangrene can also affect internal organs
that lose their blood supply, such as may occur
with a major thromboembolism (blood clot in an
ARTERY). Gangrene tends to progress as it con-
sumes healthy tissue. Gangrenous tissue is charac-
teristically black or greenish black and may have a
foul odor. Because the tissue is dead, the person
has no sensation of PAINfrom the area though
inflamed tissue at the periphery of the gangrenous
tissue may cause intense pain.
Methods to improve blood circulation, such as
thrombolytic medications to dissolve blood clots
and vasodilator medications to dilate (widen) the
arteries for increased blood flow, may restore
enough circulation to allow the area to heal. Oxy-
gen delivered under pressure in a hyperbaric
chamber is sometimes successful in restoring
enough oxygen to the tissues that they can begin
to heal. Generally, however, the doctor must sur-
gically remove all gangrenous tissue for HEALINGto
take place. Such removal may require AMPUTATION
of the affected digit or limb. Often recovery is then
complete, depending on the underlying cause for
the gangrene. People who have diabetes, PVD, or
peripheral neuropathy have increased risk for
gangrene to develop in what would otherwise be
minor wounds.
See also INFECTIOUS ARTHRITIS; OSTEOMYELITIS;
PROSTHETIC LIMB.gout A form of inflammatory arthritis. Gout
develops when uric acid crystals form within the
JOINTcapsules, causing irritation and INFLAMMATION.
Uric acid is a waste byproduct of the METABOLISMofgout 323