Fractures

DIAGNOSIS: Compression fracture should be suspected with traumatic compression injury. It should also be suspected in patients with osteoporosis, or in patients on long-term steroid treatment, and older patients (over 60). In these high risk groups, a compression fracture can occur with minor trauma, lifting, or even bending over.

EXAM: Point tenderness over fracture area. Decreased, painful range of motion, and pain in all positions, not relieved by rest.

If it is uncertain whether a compression is new or old, a bone scan should be performed. Consider bone density study if trauma was relatively minor or patient is high risk for osteoporosis, since osteoporosis will not be apparent on radiograph until at least 30% of bone loss has occurred.

TREATMENT: Bracing with a Cash or Jewett outhouses until fracture is fully healed. Extension program. Avoid flexion until fully healed. Avoid lifting over 10 pounds until fully healed. Bed rest may be necessary for the first several days because of severe pain, but this should be kept to a minimum since immobilization speeds bone resumption, and will also contribute to pain. Aerobic conditioning is very important and should be encouraged during healing period. Swimming and water running can be particularly helpful. Strengthening should be added following fracture healing.

Ice is very helpful for pain relief, and physical therapy is essential to hasten rehabilitation, particularly in the apprehensive patient.