When I was learning art and science of fracture treatment, I remember one of our teachers saying this often,”Bones unite even without orthopedician”.
And this,”Bones unite in spite of orthopedicians”.
Though we use to smile at these cliches, both the statements have a profound meaning. The more I treat, the better I have become at understanding these.
First one is obvious but it is the second one which has deeper reverberations.
In this era of hyper gadgets and fix if its broken attitude, the statement even becomes truer.
We as surgeons must remember that our treatment should not harm or make the prognosis worse.
There is no ideal fracture treatment. Not yet and I suspect it would not be there.
Fracture treatment should be based on many factors like the type of injury, demands of the patient, cost-effectiveness, and expertise of the doctor.
The aim of fracture treatment per se, whether it is surgical or nonoperative is to reduce the fracture fragments into an acceptable anatomical alignment that would produce a restoration of function to a maximum possible extent.
One of the major points of concern in fracture treatment is to answer the question – Does this fracture need surgical fixation?
For a very very long time, people avoided surgery in fractures. Then new gadgets were introduced and the balance started tilting.
Today, the balance tilts unfavorably towards surgical fixation.
In the opinion of many, it is an overkill and cost-inflating fracture treatment.
Surgery, where indicated, provides very good results. It is the need of the treatment in those cases.
But in other cases, it may just be not required.
Surgery is not without risks of its own. Even if you point out that the percentage is quite low, I would say it is not zero.
Sometimes, our treatments create a bigger mess than the injury.
Here is the truth of the second statement I mentioned above.
The desirable endpoint of fracture treatment is the sound union of the bone.
But various factors may preclude that.
Whenever a person has an injury, he or she must visit the physician to get examined and treated. And he should be given the best possible treatment.
That best treatment should not be guided just by how the x-ray looks, eagerness to operate or other factors.
The best fracture treatment chosen should be optimum too.
I have seen people selling homes, postponing studies, sacrificing relations and making other things to get near and dears treated with what was deemed as best.
And worthiness might haunt them for a long time.