What is IT Band Syndrome ?

The ilio-tibial band or IT band is a flattened tendon like structure which runs from the tip of iliac bone (anterior superior iliac spine) of pelvis, along the outer side of the thigh, up to the leg bone (tibia), just below the knee joint. It provides surface for attachment of the gluteus maximus muscle and tensor fascia lata muscle. It lies along the outer part of the thigh, and during bending of the knee (flexion), it becomes taut and moves forward due to the contraction of the muscles attached to it. This results in constant friction of the IT band with bony prominences, especially the lateral epicondyle of femur.

Picture 1: IT Band or Iliotibial Band

Aggressive or repetitive muscle contractions, as occurs during weight-lifting, running, or cycling, can be particularly injurious to the IT band. A sudden increase in these activities can cause local inflammatory changes in the IT band over a period of weeks to months, which manifest as IT band syndrome (ITBS). Though, IT band injury and IT band syndrome are used synonymously, there is a slight difference. The term ITBS, is suggestive of an irritated IT band due to inflammation, which is not necessarily injured. But the term IT band injury can only be used if there is physical evidence of injury on MRI.

IT Band Injury Symptoms

The IT band injury symptoms mainly consist of pain around the knee, especially during activities like running or jumping. IT band pain is classically felt on the outer side of the knee, but can vary in its exact location. Most people with this injury have pain slightly above the knee, where the IT band rubs on the lower end of thigh bone (femur). However, some may have pain slightly below the knee, where the band attaches to the outer part of the upper end of leg bone (tibia). In rare cases, like pregnancy or elderly individuals, the pain may occur near the hip, and is called IT band injury of hip. However, this is not at all related to sports or activity, but just due to an increased laxity of the hip ligaments, which puts additional stress on the IT band. With passing time, there is an increase in the severity and duration of IT band pain, which may also occur after activity and even during rest. Contrary to the popular belief, IT band tear symptoms are quite mild compared to the former, because of the laxity of the torn IT band.

IT Band Syndrome Diagnosis

Knee pain on the outer aspect can be attributed to a variety of causes, ranging from arthritis to ligament injuries, and so on. Hence, one has to rule out several important diagnoses related to knee pain, before labeling it as IT band pain. Basic investigations, like clinical examination and x-ray can rule out a plethora of causes. But it is only after an MRI of knee, that we can pinpoint the exact cause and location of the injury. Clinical examination by an orthopedic doctor also brings to light certain important clues, like

• Pain during Ober’s Test, which is a test for detection of shortening of the IT band.
• Pain during heel strike phase of the gait cycle, during which the contraction of the gluteus maximus and tensor fascia lata muscles makes the IT band taut. In simpler terms, the pain occurs when the leg is straight, during walking, running, or cycling.

Thus, apart from investigations, examination by an orthopedic doctor experienced in sports injuries is quintessential.

IT Band Injury Treatment

IT band injury treatment requires the expertize from several modalities, like

• Orthopedic doctor for accurate diagnosis and monitoring of the healing process.
• Physical therapist for suggesting and assisting in various exercises for IT band injury.
• Massage therapist for deep tissue massage which reduces IT band injury recovery time.

It is highly essential to refrain from any sporting activity and take complete rest during the recovery period. Excessive reliance on any particular form of therapy with ignorance towards the other modalities can result in slower healing or even IT band contractures or shortening. This complication is very difficult to treat and may even require surgery. It has been observed that use of certain orthotic footwear prevents stress on the IT band and is encouraged during the recovery period. However, since this is at the cost of altered dynamics on the knee and ankle joints, one should not be using such orthotics after recovering from the IT band injury.

IT Band Injury Stretches

IT Band Injury Exercises

Related Articles

• Broken Knee Injuries Symptoms, Diagnosis, and Treatment
• Non Weight Bearing Exercises

What is a Dislocated Finger Joint ?

Dislocated finger joint occurs when an injury causes damage to the joint ligaments or capsule, such that the joint forming surface of a finger bone or phalanx is extruded out of the joint. Thus, a finger dislocation leads to failure of joint mobility and causes a stiff, swollen, and painful finger joint. Sometimes, a finger bone may also be broken along with the dislocation, in which case it is called a fracture-dislocation. Another situation is when the dislocation is incomplete and the joint surface glides in and out of the joint, when subjected to force in a particular direction. This is called subluxation, and is due to the laxity of the joint capsule or ligaments after an injury.

Types of Dislocated Fingers

• PIP dislocation or proximal interphalangeal joint dislocation is the commonest type of finger dislocation, which occurs in the first finger joint from the knuckles. Traumatic injuries are a common cause of PIP dislocation.
• DIP dislocation or distal interphalangeal joint dislocation occurs in the finger joint near the nail. It is commonly seen in patients of finger arthritis due to age or rheumatoid arthritic deformities.
• Knuckle dislocation or metacarpo-phalangeal dislocation is a serious type of finger dislocation, which can occur due to severe arthritis of the hand or high impact sports injuries.

Dislocated Finger Pictures

Picture 1: Dislocated Finger Photograph

Picture 2: Dislocated Finger Joint Diagram

Picture 3: Dislocated Finger X-ray

Dislocated Finger Video

Dislocated Finger Symptoms

A dislocated finger develops swelling within an hour after the injury. Though, this is the first symptom in any finger or thumb injury, but the swelling in a dislocated finger is highly pronounced and near a finger joint. The joint may appear crooked (Picture 1 & 4), when compared with the same joint on the opposite hand, due to the displaced alignment of the bones. Pain is less compared to other finger injuries, and is specifically felt on attempted movements of the affected joint. Joint stiffness is a highly specific symptom of finger dislocation due to the abnormal alignment of the joint surfaces.

Picture 4: Dislocated Finger Symptoms

In short, a person with a dislocated finger will have a disfigured, fixed, and swollen joint that causes pain on attempted movement.

Dislocated Finger Treatment

Due to the visual similarity of all finger injuries, one has to first confirm the presence of dislocation before initiating treatment for the same. This is easily achieved with a plain x-ray of the hand (Picture 3), which helps us to visualize bony injuries.

Dislocated Finger – Primary Management

After confirming the diagnosis of finger dislocation, a person has to be evaluated for anesthesia fitness or given a high dose of analgesic, which is necessary for tolerating the painful maneuvers in dislocation treatment. An orthopedic surgeon, specialized in hand injuries is the best person for dislocated finger treatment. However, in the case of an open wound with damage to several minute structures clearly evident, a plastic surgeon’s opinion could be critical for accurate treatment.

Dislocated Finger – Aftercare

Once the dislocated finger is relocated or reduced, it becomes necessary to maintain the finger joint in a stable position. This allows the injured finger joint capsule and ligaments to heal and regain strength. This can be achieved with a finger splint or buddy strapping for a period of 4 weeks. Needless to say, both these methods cause finger stiffness due to the prolonged immobilization or inactivity of fingers. This has to be countered with graded finger rehabilitation exercises and gripping exercises with a softball.

Picture 5: Finger Rehabilitation Exercises

Picture 6: Finger Dislocation Physical Therapy

Finger Splint or Buddy Strapping

A finger splint is a plastic or pliable metal with sufficient padding that is applied over the finger. It keeps the finger straight and prevents bending completely. A buddy strapping is when the injured finger is taped to an adjacent finger, which acts like a splint and prevents movements. A finger splint is ideal for severe injuries or fracture dislocations and subluxations, where even slight movements can cause misalignment and improper healing.  A buddy strapping is better suited for mild injuries as it allows slight movements. This is helpful as it causes less stiffness of fingers compared to a finger splint. Thus, both the treatments have their own advantages and disadvantages.

Old Dislocated Finger Treatment

A dislocated finger may be neglected or overlooked in an acutely injured patient, due to preference given to other severe injuries. In this situation, the classical symptoms of a dislocated finger are no longer seen and stiffness or disfigurement of a dislocated finger joint being the only clues appreciable. Due to the prolonged misalignment, there is degeneration of the joint surfaces and shortening of the ligaments and tendons across the joint, making it completely useless. So the treatment for such dislocations involves replacement of the finger joint rather than relocation or reduction. This is called silastic joint replacement.

Dislocated Finger Treatment Video

Importance of Knee Joint

Knee joint is the largest and most complex of all joints in the body. It is indispensable for walking and running, which are basic human necessities. Though, it appears like a simple hinge joint, just like in a door. But the structural complexity and the sophisticated phenomenon of locking and unlocking, make it an important dynamic support while standing as well as walking.

Picture 1: Knee Joint

Picture 2: Knee Joint – Ligaments and Menisci

The lower ends of femur and tibia take part in forming the knee joint along with the knee cap or patella (Picture 1). These bones are maintained in alignment by several restraining ligaments, like anterior and posterior cruciate ligaments (ACL and PCL), medial and lateral collateral ligaments, and the medial and lateral menisci (Picture 2). Several strong muscles, like quadriceps, and biceps femoris, control the movements of knee joint, and are also responsible for displacement of fractures near the knee joint. Hence, even a small alteration in the bony alignment, after a knee injury, severely affects the balance and gait of a person.

Types of Knee Injuries

The types of knee injuries depend on the location and nature of the knee injury as well as the specific bone injured. Intra-articular knee fractures which involve the portion of bone within the knee joint generally need aggressive treatment and later may lead to premature knee arthritis (post-traumatic knee joint arthritis). Floating knee is a type of broken knee, where lower end of femur and upper end of tibia are both broken and the knee as a whole becomes freely mobile and devoid of support.

Picture 3: Broken Knee on X-ray

• Femur Fracture of lower end – is a major knee injury, which can be undisplaced, comminuted, or intra-articular and is quite difficult to heal.
• Tibia Fracture of upper end – is a major knee injury, which can be undisplaced, displaced, or intra-articular.
• Broken Knee Cap – is one of the most common knee injuries and can be undisplaced, displaced, or compound.
• Broken Fibula near knee joint – is a minor knee injury, but concurrent injury to the peroneal nerve can also occur causing foot drop.
• Torn Knee Cartilage – can be due to meniscal knee injury or injury to the articular cartilage and is generally seen in intra-articular fractures.
• Torn Knee Ligaments – generally indicate less injury to bones, as the traumatic force gets exhausted in tearing the knee ligaments, but are extremely difficult to heal.

Knee Injury Symptoms

After an accident or a fall, many people are confronted with the question, “how do you know if your knee is broken? The answer is pretty simple, because a broken knee causes inability to stand or even move the knee slightly. Minor knee injuries may cause less severe symptoms, but are always tender to touch and profusely swollen. Regardless, of the severity a visit to the ER is necessary if any of the following symptoms of broken knee are present.

• Hemarthrosis or blood in the knee with no broken bone, occurs in torn knee ligaments or torn knee cartilage usually within 2 hours after knee injuries. It may also result in knee bruising if the knee injury is outside, but near the joint.
• Knee locking is a sudden painful block in knee movement and is due to interposition of torn knee cartilage or ligament parts between the articular surfaces after a knee injury.
• Knee swelling is due to inflammation of the soft tissues due to knee injuries.
• Knee instability is due to bone fractures or tearing of soft tissues and is a specific indicator of severe knee injuries.
• Knee pain is a non-specific sign of knee injuries and is present in all grades of severity.

The presence of a pale foot with tingling or numbness over foot is a sign of injured blood vessels and nerves, respectively, for which the person should be immediately brought to the ER of a nearby hospital, irrespective of the presence or absence of other symptoms of broken knee.

Broken Knee Cap

Broken knee cap is a serious knee injury, hence, one should not be looking for broken knee can remedies for recovery from broken knee cap. A visit to an ER for a broken knee cap x-ray should be done at the earliest, for any swelling after broken knee cap. The leg should be kept straight to reduce pain as well as prevent further damage to the broken knee cap. After confirmation of the fracture, a person may be given a broken knee cast or may have to undergo a broken knee surgery, for repair of the broken knee cap. Physical therapy exercises to rehabilitate broken knee cap consist of non weight bearing exercises during the immobilization phase or after broken knee cap surgery, to keep the muscles active and prevent stiffness.

Knee Injury Video

Video 1: Knee Injury while Skiing

Knee Injury Diagnosis and Treatment

Treatment of a knee injury begins by temporary stabilization of the broken knee, with the help of any splint or support, which keeps the knee straight. This prevents additional injury to the soft tissues around the broken bones and also reduces the internal blood loss, which facilitates early fracture healing. The patient should be rushed to the ER of a nearby hospital, where further investigations, like broken knee x-ray, and definitive management of the knee injury with a broken knee cast or broken knee surgery can take place.

Broken Knee X-ray

The earliest investigation in knee injuries diagnosis, is an X-ray of the knee. In growing children, knee injury diagnosis is difficult from a single x-ray. Hence, an x-ray of the normal knee may also be taken for diagnosing knee injuries in children. A broken knee x-ray (Picture 3) clearly shows bony knee injuries, and is especially useful in displaced fractures. For doubtful cases, a CT scan may be done for confirmation of the knee injury diagnosis.

MRI for Knee Injuries

MRI is generally done to diagnose a knee injury of soft tissues, like torn knee ligaments (ACL tear, PCL tear, collateral ligament tear, etc.), torn knee cartilage (meniscal tears), and tears of knee joint capsule. It is a 3 dimensional scan, which outlines the knee injuries anatomy for accurate knee injury diagnosis.

Broken Knee CT Scan with 3D reconstruction

3D-CT Scan is a highly sophisticated investigation, which artificially reconstructs the geometry of the bony structures of the knee joint. It is a 3 dimensional x-ray image, which gives the precise location and orientation of the bone fragments in a broken knee. Thus, it is very important in intra-articular and comminuted fractures of knee joint, and greatly helps in pre-operative planning of a broken knee surgery.

Broken Knee Cast for Knee Injuries

A broken knee cast or a cylinder cast, is a plaster of paris scaffolding, which is applied for temporary stabilization of a broken knee. It generally helps in keeping the knee immobilized in the straight position with a slight bend of 15 degrees. Walking along with a broken knee cast after knee injuries, has to be non weight bearing with crutches (Video 2).

Video 2: Walking with Broken Knee Cast

For minor injuries, like undisplaced fractures, it can be used for permanent treatment for 6 weeks, without the need for broken knee surgery. A knee brace, like long knee extension brace or hinged knee brace, is more preferred as is comfortable and gives similar results.

Broken Knee Surgery for Knee Injury

Surgical treatment for a broken knee has to be done urgently after diagnosis of knee injury, if the fracture obstructs blood supply of the leg or causes a nerve injury. Broken knee surgery is performed by an orthopedic doctor along with a vascular surgeon or plastic surgeon, to repair the damaged blood vessels or nerves, respectively. For knee injuries, with no such complication, broken knee surgery may be delayed for up to 3-4 days to allow the knee swelling to subside and perform investigations, like MRI or 3D CT scan.

Broken knee surgery primarily aims at preventing any shortening of the leg and achieving a rigid fixation with orthopedic screws and plates made of stainless steel or titanium. These implants are only to maintain the alignment of the broken bones and cannot sustain the loads of weight bearing. Hence, non weight bearing with crutches (Video 2), is mandatory for at least 6 weeks after broken knee surgery. Many times a single surgery is insufficient to completely solve all the issues after a broken knee and further surgeries may be needed for complications, like leg shortening, post-traumatic arthritis, etc. A person may also require knee replacement surgery after a few years for a terminally stiff and arthritic knee joint.

Knee Injury Exercises

Physical therapy in the form of broken knee exercise is important to improve the function of a stiff and weaken knee from the prolonged immobilization for knee injuries. Successful knee injury rehabilitation depends on a strict adherence to physical therapy guidelines.

Video 3: Exercises for Knee Injuries

Broken Knee Injury Recovery Time

The length of hospital stay for broken knee can vary from a few days to a month, depending on the severity of the knee injury. Common knee injuries of the knee cap or other bones around knee, generally heal within 6 weeks and the person is discharged from the hospital almost on the same or second day. Complicated knee fractures with several open wounds require intensive management for replacement and maintenance of adequate blood volume. Broken knee surgery has to be done in an emergency along with repair of other injured structures, like torn knee ligaments and tendons and broken knee cartilage. Knee injury recovery can take even up to 6 months, in a broken knee cast, followed by broken knee exercise to have a complete functional knee injury recovery.

Knee Injury Prevention

Protection of direct exposure to knees while skiing and driving, with the use of knee pads is an important measure in knee injury prevention. Car accidents and motorbike stunts are major sources of knee injuries, and hence, following traffic rules and accepted speed limits, generally helps in knee injury prevention as well as preventing other major mishaps.

Related Articles:

• Non Weight Bearing Exercises
• Broken Thumb Injuries Symptoms and Treatment
• Bone Fracture Healing
• Orthopedic Bone Screws
• Injured in a Car Accident

Consequences of Bradycardia

The sudden and dramatic consequences of a slow heart rate can lead to a vicious cycle of continued oxygen deficit to important body tissues, like brain, kidneys, heart, etc. Decreased blood supply to brain due to a severe attack of bradycardia, leads to a permanent impairment in the brain functions or coma within minutes. Decreased blood supply to kidneys causes inability of the body to flush out harmful bi-products, like urea, nitrogen wastes, etc., which are toxic to the body. Decreased blood supply to the heart can lead to frequent chest pains and inability to tolerate any kind of stress. Thus, bradycardia has multiple grave consequences and needs to be treated immediately.

Bradycardia in Orthopedic Injuries

Orthopedic injuries, like fractures of long bones are prone to cause damage to the fatty tissue present in the bone marrow space. Due to the high velocity nature of the trauma causing these injuries, there is a high possibility of fat embolism taking place. Fat embolism is a process in which, fat droplets gain entry into the blood, and obstruct the smaller blood vessels of the lungs. This can lead to a severe attack of bradycardia or even cardiac arrest. This type of complication typically occurs within 48-72 hours after a major orthopedic injury or fracture.

Bradycardia in Orthopedic Surgery

The complication of bradycardia can also occur during replacement surgeries, like hip replacement, knee replacement, and so on. This is mainly attributed to the process of cementing, which involves injecting the cement in bone marrow space. During this procedure, there is always a possibility of the cement gaining access to the blood. The instant allergic reaction or anaphylaxis, to the cement leads to severe bradycardia. As the patient is under anesthesia, the patient may not be able to effectively convey his complaints and can become comatose. Hence, the cementing procedure has to be carefully monitored by an anesthetist. Many centers even give injectable corticosteroids to prevent such allergic reactions.

Thus, only vigilance and prompt treatment of bradycardia can ensure a safe passage of a patient though orthopedic injuries or surgeries.

Non Weight Bearing Types

Although, non weight bearing simply means, not to touch the foot on ground while walking. There are grades of non weight bearing where some degree of contact with the ground is permissible.

• Strict non weight bearing means absolutely no contact between foot and ground. This can only be feasible with the help of Crutches (Video 1) or a Walker (Picture 1). Simple leg injuries, like an ankle sprain or fibula fracture, which seem pretty trivial, benefit greatly with strict non weight bearing and can complicate if this is not followed properly. Strict non weight bearing is generally applied for the first 4-6 weeks after any knee injury or sprain involving the leg.

Picture 1: Non Weight Bearing Walker

(Source: Lumex Folding Walker)

• Partial weight bearing allows some degree of contact between the foot and the ground, but not for bearing the weight of the body. After 4-6 weeks of strict non weight bearing, partial weight bearing is applied to get unused muscles and bones ready to bear the weight of the body. During this stage the process of bone healing after injury or surgery is not fully complete. Hence, a couple of weeks of partial weight bearing helps the newly formed bone to gradually adjust to the stresses of weight bearing.
• Full weight bearing is when a previously injured person, is asked to put his normal weight on the involved leg. Non weight bearing with Crutches or a Walker beyond 8 weeks out of fear, pain, or anxiety, is completely useless and leads to thinning of leg muscles and increased inability to walk without support. Hence, it is strongly advised to follow weight bearing instructions of a qualified orthopedic doctor or physical therapist, without any fear or apprehension.

Video 1: Non Weight Bearing Crutches

(Source: Youtube )

Non Weight Bearing Exercises

It is frequently observed that during non weight bearing, people tend to not use the entire leg and thigh with fear of causing re-injury. Though, some parts need strict immobilization and a generally put into a non weight bearing cast or non weight bearing boot as per the type and extent of injury. Being cautious always prevents most of the complications like displacements or loosening of bone screws. However, the part of leg outside the non weight bearing cast unnecessarily suffers from the consequences of inactivity. Inactivity of leg muscles during the non weight bearing period causes thinning of the leg muscles due to non use (disuse atrophy). Non weight bearing leg exercises (Video 2) are simple bedside exercises, which help to keep the leg muscles active and prevent thinning of leg muscles during this period. There are 2 types of non weight bearing leg exercises,

• Isotonic non weight bearing exercises where the muscles are used for the complete range of movement that is permissible depending on the injury (Normal section of Video 2). These exercises help in maintaining the length of the muscles and preventing contractures (muscle shortening causing joint stiffness).
• Isometric non weight bearing exercises where the muscles are made taut and then relaxed in a repetitive manner (Advanced section of Video 2). These exercises help in maintaining the strength of the leg muscles and preventing weakness.

Video 2: Non Weight Bearing Knee Exercises

(Normal = Isotonic & Advanced = Isometric)

(Source: Youtube )

Yoga with non weight bearing leg or non weight bearing aerobic activity can also form an important part of non weight bearing exercise regime during the period of non weight bearing.

Non Weight Bearing Exercises Pain

Pain while performing non weight bearing exercises has to be dealt with very carefully. Mild discomfort while performing these exercises is natural because of the stretching of the stiff muscles and soft tissues. But pain at the surgical site or at the site of injury, is an alarming sign and demands prompt discontinuation of the exercise. Continued pain despite adequate rest after a particular non weight bearing exercise session can be a sign of re-injury. Hence, it should be followed by an evaluation by your orthopedist to check the current status of the area of surgery or injury.

Non weight bearing exercises are an excellent way to protect the legs from stiffness, contractures, and weakness, after the immobilization following an injury or surgery. Yet a proper guidance of a physical therapist is essential for preventing re-injury and other complications.

Related Articles:

• Bone Fracture Healing
• Orthopedic Bone Screws
• Broken Knee Injuries

Thumb Spica Cast

Thumb Spica Cast (Picture 1) or rigid thumb spica consists of layers of plaster of Paris or fiberglass molded over and enclosing the thumb, wrist, and forearm (Video 1). After application it takes around 15-30 minutes to harden and thereafter provides a firm support for healing of thumb injuries. Hence, it is the preferred method of immobilization of thumb fractures and severe thumb ligament injuries. This has the advantage of preventing additional damage through minor jerks during daily activities. It is also a compulsive immobilization, since a person cannot remove the cast by themselves. Disadvantages are mainly related to the weight and discomfort of the cast in performing daily activities, like having a bath.

Video 1: Thumb Spica Video (Click on Image)

(Source: University of Ottawa)

Compartment syndrome is a highly dreadful complication, which may occur from 1-3 days after application of a thumb spica cast. It occurs due to inability of the thumb spica cast to accommodate the hand swelling. The pressure of the swelling on the blood vessels and nerves cuts down the blood supply and sensations of the hand. Prompt removal of the cast is necessary to prevent permanent damage to the hand. Hence, a thumb spica cast should not cover the tip of the thumb, which can be observed for checking the integrity of the blood flow to the thumb.

Picture 1: Thumb Spica Cast

(Source: Queen’s University School of Medicine)

Thumb Spica Splint

Thumb Spica Splint (Picture 2) or a thumb splint, consists of a fabric enclosing a moderately pliable metal piece along the part that supports the thumb. It has adjustable straps to make it fit snugly around the thumb as well as the forearm, which rules out the need for a custom thumb spica splint. It provides ample of space to accommodate the hand swelling, which makes it a highly comfortable and light-weight alternative to the thumb spica cast for mild injuries of the thumb, like a sprained thumb. However, since it is not as sturdy as a cast one has to be careful to avoid additional injury. Hence, a thumb splint is not an ideal method of immobilization in children.

Picture 2: Thumb Spica Splint

(Source: ComfortFORM Thumb Spica Splint)

Selective immobilization of the specific part prevents altered dynamics at the other joints, like wrist, elbow, and shoulder. A mild injury does not necessitate a strict immobilization, and so with a thumb spica splint a person can perform a variety of activities without affecting the thumb injury. More compact modifications, like the hand thumb spica splint, are however, not recommended, as they may not offer the necessary support to the injured thumb. A thumb spica splint can be conveniently removed and put back on, like while taking a bath etc. But it is often advisable to ask your orthopedic doctor about the nature of the injury and the strictness of the thumb spica splint wear.

Thus, a complete evaluation of the thumb injury by an orthopedic doctor is extremely important for choosing between a thumb spica splint or cast.

Thumb Spica Additional Uses

Apart from thumb fractures and dislocations, a thumb spica splint or cast is also used for wrist injuries, like scaphoid fractures, lunate dislocation, etc. It is also useful in chronic degenerative diseases, like carpal tunnel syndrome and Kienbock’s disease. However, prolonged wear of a thumb spica splint beyond 4 weeks is not recommended and may cause grip weakness or even hand weakness.

Recommended Thumb Spica Splints

• Thermoskin Thumb Spica
• RhizoLoc Thumb Support

Related Articles:

• Broken Thumb Injury – Symptoms and Treatment
• Bone Fracture Healing

Fracture Healing Process

A fracture or break in a bone causes bleeding at the fracture site. This blood collects around the fracture forming a spindle shaped clot. The immune cells present inside this blood begin the repair process to bridge the gap between the ends of the broken bones. They form a scaffolding of collagen fibers, which is reorganized by the precursor bone cells from the ends of the bone to transform it into premature bone called osteoid. This osteoid is impregnated with calcium to form a loose supportive bone tissue called the callus. The callus is then subjected to remodeling during the normal renewal of bone tissue layers and is transformed into the normal hard bone tissue.

Fracture Healing Principles

The fracture healing process begins right from the time of injury and proceeds at a constant rate, with slight variations depending on age of patient and location of injury. Thus, there are high chances of a bone fracture uniting in a deformed position if the misalignment of bones caused by the injury is not corrected before bone fracture healing.

Picture 1: Malunion of wrist fracture

(Source: Wikimedia Commons)

Malunion (Picture 1) is bone fracture healing in a deformed position and may be functionally or cosmetically unacceptable. Also the gap between the ends of broken bones after injury should be less to ensure bone fracture healing. Failure of broken bones to unite is called nonunion (Picture 2) of fractures, which are highly resistant to any form of treatment.

Picture 2: Nonunion of Leg bones

(Source: Wikimedia Commons)

Bone fracture leads to loss of stability, since the main supporting structure is damaged. The pull of the muscles as well as the effect of gravity may act in 2 ways. It may either keep the ends of broken bones together and support the fracture, or it may pull the ends away from each other and prevent any corrective attempts by the orthopedic doctor. Thus, in the former case, there is no need for any special treatment and the bones can unite due to normal bone fracture healing. However, in the latter case, an orthopedic surgery may be required, which uses orthopedic bone screws or lag screw fixation to keep the ends of broken bones together.

Bone Fracture Healing at different Ages

Children have the highest potential for healing of broken bones. Even if the ends of broken bones are away from each other they tend to unite. Even if the broken bones unite with a deformity, it corrects over a period of few years along with the normal growth of the child.

Elderly people are prone to develop several complications like non-union, delayed union, and so on, after a bone fracture. Hence, many times, it is prudent to fix a bone with surgical methods in them to ensure they get enough support during their prolonged process of bone fracture healing.

Fracture Healing Recovery time

The time required for bone fracture healing process is highly variable depending on the location of the fracture as well as age of the patient. The average fracture healing time for some of the common fractures are

• Wrist fracture healing time – 3 to 4 weeks
• Fibula fracture healing time – 4 t0 6 weeks
• Tibia fracture healing time – 4 to 6 weeks
• Ankle fracture healing time – 5 to 8 weeks
• Rib fracture healing time – 4 to 5 weeks
• Jones fracture healing time – 3 to 5 weeks
• Foot fracture healing time – 3 to 4 weeks
• Metatarsal fracture healing time – 5 to 6 weeks
• Metacarpal fracture healing time – 3 to 4 weeks
• Hairline fracture healing time – 2 to 4 weeks
• Finger fracture healing time – 2 to 3 weeks
• Toe fracture healing time – 2 to 4 weeks

These average healing times are for the fractures that have been stabilized with some or the other form of fracture treatment, be it a cast, splint, or surgery. Several factors, like nutrition and severity of the fracture also lead to variable fracture healing time in different people having the same fracture.

In children most of the fractures heal within 3-4 weeks, whereas, in adults they take 4-6 weeks. Elderly people have a more delayed course of fracture healing and it may take up to 8 weeks. Fractures present in areas of high blood supply, like spine, wrist, and so on, heal earlier than that in areas of low blood supply, like scaphoid (wrist bone), tibia (leg bone), and so on. Hence, surgical treatment of such fractures is a must.

Related Articles:

• Orthopedic Bone Screws
• Lag Screw Fixation
• Broken Knee Injuries Symptoms, Diagnosis, and Treatment
• Broken Thumb Injuries Symptoms and Treatment

Lag Screw Strength Principle

The threads of the lag screw engage in the distal (away from the insertion point) piece of bone and hold it firmly. Thus, this piece of bone can be controlled by moving the head of the lag screw. The smooth portion of the lag screw passes through the proximal fragment of bone and hence, this piece is free to slide along the shaft of the screw. However, the head of the screw serves as a stopper to restrict this motion. When the lag screw is tightened, the head fits snugly on the entry point of the screw and forces the proximal fragment over the distal fragment. Thus, the 2 fragments of bone are not just aligned but compressed over each other. This provides tremendous lag screw strength for stabilization of broken bones and also for earlier and better bone fracture healing.

Lag Screw Uses

• Elbow Fractures (Broken Elbow)
• Ankle Fractures (Broken Ankle)
• Scaphoid Fracture (Broken Wrist)
• Proximal Tibial Fracture (Broken Leg near Knee)
• Hip Fracture (Broken Hip)

Related Articles:

• Orthopedic Bone Screws
• Bone Fracture Healing

Materials used for Orthopedic Screws?

Titanium screws are quite expensive but are preferred because of their durability and non-magnetic property, which makes them for all kinds of magnetic imaging, like MRI. A stainless steel bone screw is cheap and easily available in several types, but is not safe for medical imaging and its presence has to be clearly mentioned before any kind of medical imaging.

Why use Orthopedic Bone Screws?

Injury to the bones in the form of fractures causes the broken ends to move away from each other due to the muscular forces, e.g. knee injuries. A bone screw helps to keep the broken ends of the bone together, so that the bone fracture healing can proceed normally. A wide variety of metal plates (strips of metal with holes for screws) can be used along with screws for this purpose. Strong support by the bone screws help to ensure healing of the bones without any misalignment due to the muscular forces. This is very critical for 4-6 weeks during which the broken bones regain their full strength. The bone screws can be removed after a period of around 1-2 years.

Why Remove a Bone Screw?

Bone screws are treated as a foreign body by the human tissues. Hence, they are more likely to get infected from micro-organisms through the blood flow. An infected bone screw transmits the infection to the underlying bone. Bone infections are the most dreaded orthopedic complication and are highly difficult to treat. Hence, removal of a bone screw within 2 years is advisable. Beyond a period of 2 years, a layer of bone is formed over the screw, which makes removal of the screw complicated.

Types of Orthopedic Bone Screws

Depending on the consistency of bone tissue and the type of fracture, various types of orthopedic screws are in use. Some of the commonly used types are

• Cortical Screw used for hard bone tissue, like shaft of long bones.
• Cancellous Screw used for spongy bone present at the ends.
• Cannulated Screw used for passing a guide wire through it for accurate screw placement
• Herbert Screw is a headless screw for lag screw fixation of fractures involving the joint cartilage, so that even after placement of screw the joint movements are not obstructed by a screw head.
• Malleolar Screw used for ankle fractures.
• Pedicle Screw used for spine fractures or fusion.

A proper use of orthopedic bone screws is vital to surgical treatment of complicated orthopedic injuries. However, improper use can also lead to non union of the broken bones, infection, and damage to body tissues.

Related Articles:

• Lag Screw Fixation
• Bone Fracture Healing
• Broken Knee Injuries Symptoms, Diagnosis, and Treatment

Importance of Human Thumb

The thumb is an important component of grip due to its oppositional ability (ability to touch all the other fingers of the hand face to face, as in counting with fingers). An oppositional thumb is one of the most important evolutionary gift to man, and makes us unique from all the other animals. The ability of the thumb to help us perform various tasks, like holding, pinching, counting on fingers, writing, and so on, is undoubted. Hence, a thumb injury puts several functional restraints on the entire hand, just as a knee injury disables the entire leg.

Thumb Ligaments and Joints

The thumb contains 2 small bones called phalanges (singular: phalanx), which are connected by the inter-phalangeal joint. The phalanx near the hand or proximal phalanx is connected to the first metacarpal by the metacarpo-phalangeal joint. The ulnar and radial collateral ligaments are present on the sides of both the joints of thumb. Injury to the ulnar collateral ligament of the thumb is common, and is know as Skier’s thumb or Gamekeepers thumb.

Thumb Joint Pain Causes

The reflex concealment of the thumb leaves the metacarpo-phalangeal joint exposed. Also the pressure on the concealed part leads to significant tension on the joint. Hence, thumb injuries are more common near this joint (Picture 1), and lead to partial dislocation or subluxation of this joint along with ligament tears. This is felt as a clicking sensation on pressing over the base of the thumb. This sign of a broken thumb remains positive even months after the injury if orthopedic treatment is not taken. Thus, thumb joint pain is a common sign in majority of thumb injuries !

Types of Thumb Injuries

Thumb injuries can result from fractures or dislocations of the various joints of the thumb.

• Thumb fractures can be of Bennett (Picture 1) or Rolando (Picture 2) type.
• Thumb dislocations can be of the metacarpo-phalangeal (common) or inter-phalangeal type.
• Thumb ligament injuries can be in the form of Skier’s or Gamekeepers thumb

Picture 1: Broken Thumb Injury (Bennett’s Fracture)

(Source: Wikimedia Commons)

Picture 2: Broken Thumb Injury (Rolando Fracture)

(Source: Wikimedia Commons)

Broken Thumb Symptoms

The following are some of the common signs of a broken thumb

• Thumb Joint Pain is the most common among all symptoms of a broken thumb.
• Hand Swelling is a delayed symptom of thumb injury due to insufficient space in the thumb to accommodate the inflammatory fluids.
• Bruised Thumb is mainly due to ligament injury or broken blood vessels in thumb.
• Clicking over base of thumb is due to subluxation of the thumb joint.
• Pain on holding or gripping objects or when attempting to move is a prominent broken thumb sign.

Broken Thumb Video

Can a Broken Thumb get Infected ?

A traumatic injury leads to broken blood vessels in thumb along with inflow of immune cells. The accumulated blood is called a hematoma, which serves as a rich medium for growth of an infection. However, not all people with a broken thumb get infected. Taking a short course of antibiotics after an injury, until the swelling subsides, helps in preventing broken thumb infection.

Broken Thumb Treatment

Thumb, being a vital part of the hand, dictates the necessity to achieve a nearly perfect reconstruction of a broken thumb. Inability to do so may result in functional restraints despite treatment for a prolonged period. Hence, injuries of the thumb are better treated with the expertise of an experienced hand surgeon. Modern surgeries, like thumb joint replacement, and artificial thumb reconstruction, have provided options for treatment of even severely injured thumbs. However, keeping the affected hand elevated from the rest of the body forms an integral part in the care of a swollen broken thumb, since it helps to drain the swelling fluids. This can be done by keeping the hand on a couple of pillows while sleeping and in a sling with hand coming up to the shoulder during the day.

Many times one can get confused about how to find out if your thumb is broken. Except ligament injuries, which require an MRI, all other injuries of the thumb can be diagnosed by a plain X-ray of the hand (Picture 1 & 2). Doubtful cases of thumb injury, where there is a strong suspicion of a fracture, are subjected to a CT scan or bone scan, which picks up even minor hairline fractures. The common protocol, however, is to bring the broken ends of the bones or ligaments to their natural alignment as much as possible, with or without surgery. The next step is to keep them immobilized in this position until the fusion of the broken ends. This process takes around 3-6 weeks, depending on the age of a person (younger people recover early compared to elderly).

Picture 3: Thumb Spica Cast (Fiberglass)

(Source: Queen’s University School of Medicine)

The traditional way to immobilize the thumb was to put a plaster of paris cast from the tip of the thumb reaching right up to the elbow, which is called a thumb spica (Picture 3). This was quite heavy and inconvenient for daily activities. But it is still the recommended method for children, who are not aware of the gravity of the injury and may remove the user friendly options like thumb braces, or thumb splints. Adults on the other hand can be treated with simple and light-weight plastic supports for the thumb, which generally reach up to the wrist. These thumb splints, braces, or supports, come in a wide variety and can also be custom made by molding to fit the right size.

Broken Thumb Surgery

Surgical treatment of the thumb (Picture 4) is reserved for the complete thumb ligament tears and the fractures, which cannot be brought into alignment by closed methods. It involves attachment of the broken structures to each other with the use of orthopedic bone screws and plates or Kirchner’s wires.

Picture 4: Broken Thumb Surgery

(Source: Wikimedia Commons)

However, even after surgery the process of immobilization has to be followed for 3-6 weeks. Physical therapy in the form of thumb and grip strengthening exercises after discontinuation of the thumb spica cast or thumb splint, help in complete bone healing and regaining thumb movements.

Related Articles:

• Thumb Spica Splint or Cast?
• Orthopedic Bone Screws
• Bone Fracture Healing
• Broken Knee Injuries Symptoms, Diagnosis, and Treatment
• Dislocated Finger Joint Pictures and Treatment