Expert Fracture & Trauma Management

Understanding Fracture & Trauma Care in the Indian Context

Road traffic accidents, workplace injuries, and falls remain leading causes of fractures in Telangana. At Ajuda Hospitals, our 24/7 trauma center follows ATLS (Advanced Trauma Life Support) protocols, combining emergency stabilization with advanced fracture fixation techniques to minimize disability and restore function.

Fractures range from simple cracks to complex multi-fragmentary injuries with soft tissue damage. Delayed or improper treatment can lead to mal-union, non-union, infection, or permanent stiffness. Our multidisciplinary approach—orthopaedic surgeons, anesthetists, intensivists, physiotherapists—ensures optimal outcomes even in polytrauma cases.

Hyderabad's two-wheeler density and construction boom contribute to high trauma volumes. Our golden-hour protocols prioritize life-saving interventions first, then definitive fracture management. Whether it's a sports injury in a young athlete or an osteoporotic hip fracture in an elderly patient, we tailor treatment to age, bone quality, and functional demands.

When to Consult Our Trauma Specialists

For suspected stress fractures or non-emergency injuries, schedule a consultation within 24-48 hours. Early imaging and treatment prevent complications.

Our Diagnostic Approach

Emergency Assessment & Stabilization

Upon arrival, our trauma team performs primary survey (ABCs: airway, breathing, circulation) to identify life-threatening injuries. Splinting of suspected fractures, IV access, pain management, and tetanus prophylaxis begin immediately. Secondary survey documents all fractures, lacerations, and associated injuries.

Advanced Imaging

• Digital X-rays: Two views (AP and lateral) within 15 minutes of arrival. Portable X-ray in resuscitation bay for unstable patients.
• CT Scans: 3D reconstruction for complex fractures (pelvis, acetabulum, tibial plateau, pilon). Identifies occult fractures missed on plain films.
• MRI: Ordered for ligament injuries, occult hip fractures in elderly, or spinal cord compression.

Fracture Classification

We use AO/OTA classification to describe fracture pattern, guide implant selection, and predict healing time. Open fractures graded per Gustilo-Anderson (Type I-IIIC) to determine urgency of debridement and antibiotic coverage.

Pre-operative Planning

Fracture pattern analysis on 3D CT models. Templating for implant size (plate length, nail diameter, screw position). Anesthesia risk stratification and consent. Coordination with vascular surgery if arterial injury present.

Treatment Pathways

Our fracture management follows Indian Orthopaedic Association and AO Foundation principles:

Emergency Stabilization (Golden Hour)

Open fractures: Wound irrigation, debridement within 6 hours, broad-spectrum IV antibiotics (cefazolin + gentamicin), tetanus toxoid. Temporary external fixators for damage-control in polytrauma.

Neurovascular compromise: Urgent closed reduction under sedation to relieve pressure on arteries/nerves. Fasciotomy if compartment syndrome suspected (pain out of proportion, tense swelling, absent distal pulses).

Non-Surgical Management

Indications: Stable fractures, minimally displaced fractures, pediatric greenstick fractures, clavicle fractures, rib fractures.

Techniques:

• Closed reduction: Manipulation under sedation to realign fracture, followed by plaster casting
• Traction: Skin/skeletal traction for femoral shaft fractures in children or pre-operative in adults
• Functional bracing: Early mobilization with hinged braces for humeral shaft fractures

Follow-up: Weekly X-rays first 3 weeks to detect loss of reduction. Cast changes at 3-4 weeks. Union confirmed by radiological bridging callus at 6-12 weeks.

Surgical Fixation Techniques

Open Reduction Internal Fixation (ORIF)

Indications: Displaced intra-articular fractures (ankle, wrist, elbow), open fractures after debridement, non-unions.

Procedure: Surgical exposure through extensile incisions. Anatomical reduction under direct vision. Plates and screws compress fracture fragments. Wound closure over suction drain.

Advantages: Perfect anatomical restoration; early joint mobilization prevents stiffness.

Rehabilitation: Range-of-motion exercises start 48 hours post-op. Non-weight-bearing for 6-8 weeks until callus visible on X-ray.

Intramedullary Nailing

Indications: Femoral shaft, tibial shaft, humeral shaft fractures.

Procedure: Small incision near joint. Guidewire passed through fracture site into marrow cavity under fluoroscopy. Hollow nail inserted over wire. Interlocking screws at both ends prevent rotation and shortening.

Advantages: Minimally invasive. Load-sharing device allows early weight-bearing. Preserves fracture hematoma for faster healing.

Outcomes: 95% union rate at 12-16 weeks. Full weight-bearing by 8 weeks in most femur fractures.

MIPPO (Minimal Invasive Plate Osteosynthesis)

Indications: Metaphyseal fractures (proximal tibia, distal femur), osteoporotic bones in elderly.

Procedure: 2-3 cm incisions. Plate tunneled under skin without exposing fracture site. Locking screws provide angular stability. Preserves periosteal blood supply.

Advantages: Faster healing (8-10 weeks vs 12-16 weeks with open plating). Lower infection rate. Smaller scars.

Special Populations

Pediatric Fractures: Growth plate injuries require precise reduction to prevent limb-length discrepancy or angular deformity. We use K-wires or flexible nails to avoid damaging growth plates.

Elderly with Osteoporosis: Locking plates provide better hold in weak bone. Calcium/vitamin D supplementation post-op. Early mobilization prevents DVT and pneumonia.

Diabetic Patients: Tight glucose control (target <180 mg/dL) peri-operatively reduces infection risk. Offloading fractures in Charcot foot arthropathy.

What to Expect: Your Care Journey

Emergency Room (0-2 Hours)

• Triage, pain management (IV morphine/fentanyl), splinting
• Digital X-rays, blood tests (hemoglobin, glucose, creatinine)
• Orthopaedic surgeon assessment, consent for surgery
• Pre-anesthetic checkup, nil-by-mouth orders

Operating Theatre (2-6 Hours Post-Admission)

• Spinal/general anesthesia per fracture location
• 1-3 hour surgery depending on complexity
• Intra-operative fluoroscopy confirms implant position
• Plaster slab or compression dressing applied

Post-Operative Ward (Days 1-3)

• IV antibiotics for 24-48 hours, oral continuation for 5-7 days
• Pain control with oral analgesics; avoid NSAIDs if bone healing concern
• Wound inspection, drain removal at 48 hours
• Physiotherapy consult: ankle pumps, quadriceps isometrics to prevent DVT
• X-ray confirmation of alignment before discharge

Outpatient Follow-Up

• Week 2: Suture removal, wound check, first post-op X-ray
• Week 6: Repeat X-ray for callus formation; advance weight-bearing if adequate healing
• Week 12: Full X-rays; most fractures demonstrate union; transition to full activities
• Months 6-12: Implant removal if symptomatic (plates causing irritation) or elective in young patients

Technology & Innovation

C-Arm Fluoroscopy

Real-time X-ray imaging during surgery ensures:

• Perfect reduction of fracture fragments before fixation
• Accurate screw placement avoiding joints and neurovascular structures
• Confirmation of nail/plate position without reopening wound

Radiation Safety: Pulsed mode reduces surgeon and patient exposure by 70%. Lead aprons and thyroid shields for OR team.

3D CT Reconstruction

Pre-operative virtual surgery on 3D models allows:

• Measurement of fracture fragment size and displacement
• Implant templating (plate contour, screw length)
• Anticipation of intra-operative challenges (bone loss, comminution)

Outcome: 30% reduction in operative time and 50% fewer revision surgeries.

Locking Plate Technology

Fixed-angle screws lock into plate holes, creating a "internal external fixator." Advantages:

• No need for perfect plate contouring
• Better hold in osteoporotic bone (screws don't back out)
• Minimal periosteal stripping preserves blood supply

Preventing Complications

Fracture complications include:

Immediate (0-2 Weeks)

• Compartment syndrome: Swelling within muscle compartments causes ischemia. Emergency fasciotomy within 6 hours prevents muscle death.
• Fat embolism: Long bone fractures release fat into bloodstream, causing respiratory distress and confusion. Early fixation reduces risk.
• Infection: Open fractures carry 10-40% risk. Our protocol: debridement within 6 hours, IV antibiotics, delayed wound closure.

Early (2-6 Weeks)

• DVT/PE: Blood clots in leg veins can embolize to lungs. Prevention: early mobilization, calf exercises, heparin injections in high-risk patients.
• Implant failure: Inadequate fixation or premature weight-bearing. We use post-op X-rays and restricted weight-bearing protocols.

Late (>6 Weeks)

• Non-union: Fracture fails to heal by 6 months. Risk factors: smoking, diabetes, infection. Treatment: bone grafting, exchange nailing.
• Mal-union: Heals in wrong position causing deformity or arthritis. Corrective osteotomy if functional impairment.
• Stiffness: Prolonged immobilization causes joint contractures. Early physiotherapy and CPM (continuous passive motion) machines prevent this.

Our Prevention Strategy:

• Prophylactic antibiotics within 1 hour of surgery
• Chemical DVT prophylaxis (enoxaparin) for lower limb fractures
• Smoking cessation counseling—doubles non-union risk
• Structured physiotherapy protocols from day 1

Why Ajuda for Fracture & Trauma Care?

Take the First Step

Fractures require urgent expert care to prevent lifelong disability. If you've sustained a traumatic injury, call our ER at 9010550550 immediately or visit Ajuda Hospitals for 24/7 trauma services.

For non-emergency fracture concerns, schedule a consultation with our orthopaedic team. Early diagnosis and treatment ensure the best functional recovery.