question: How are broken bones in non-castable areas fixed?
comment: Well, if you break the neck of the femur, they drill a hole and install a screw bracket through the femur and into the head of the femur to hold it in place while it fuses back together. You can't put weight on that leg for 6-8 weeks. Then you get to learn how to walk again, as the muscles have all atrophied. If all that sounds incredibly painful, it is.
passages: Once diagnosed and located, surgery is the most common treatment for a malunion. The surgery consists of the surgeon re-breaking the bone and realigning it to the anatomically correct position. There are different types and levels of severity for malunions which helps determine the treatment. Most often, either screws, plates or pins are used secure the new alignment. In some cases, the bone may be trimmed to allow full orientation at the fractured spot. It is also possible that a bone graft could be used to help with healing.
   This treatment also requires surgery by an orthopedist. Pins or screws are placed into the fractured bone above and below the fracture site. The orthopedic surgeon repositions the bone fragments and pins or screws are connected to a metal bar or bars outside the skin which holds the bones in their proper position so they can heal. The external fixation device is removed after an appropriate time period.
  
  Section::::Prognosis.
   This treatment is only used when an orthopedic surgeon assigns it to restore the fractured bone to its original function. This method positions the bones to their exact location, but there is a risk for infection and other complications. The procedure involves the orthopedist performing surgery on the bone to align the bone fragments, followed by the placement of special screws or metal plates to the outer surface of the bone. The fragments can also be held together by running metal rods through the marrow in the center of the bone.
  
  Section::::Treatment.:External fixation.
   In this kind of reduction, holes are drilled into uninjured areas of bones around the fracture and special bolts or wires are screwed into the holes. Outside the body, a rod or a curved piece of metal with special ball-and-socket joints joins the bolts to make a rigid support. The fracture can be set in the proper anatomical configuration by adjusting the ball-and-socket joints. Since the bolts pierce the skin, proper cleaning to prevent infection at the site of surgery must be performed.
   Since the 1990s, modern techniques of presurgical planning were developed – allowing the surgeon to plan and simulate the osteotomy in a virtual environment, based on a preoperative CT or MRI; this procedure reduces the costs and the duration of creating, positioning, cutting, repositioning and refixing the cast models for each patient.
  
  Section::::Transferring the preoperative planning to the operating theatre.
   Once the fixator is attached to the bone, the deformity is characterised by studying the postoperative x-rays, or CT scans. The angular, translational, rotational, and length deformity values are then entered into specialised software, along with parameters such as the ring size and initial strut lengths. The software then produces a "prescription" of strut changes that the patient follows. The struts are adjusted daily by the patient until the correct alignment is achieved.
   In developing parts of the world, traditional bonesetters are widely popular and often the only address for treatment of bone-related injuries. Most often it will be the case that there is a shortage of orthopedic doctors and surgeons in the country and so the two practitioners coexist in the same setting. In parts of South America, Asia, and Africa, traditional bonesetters treat musculoskeletal injuries in general, not just fractures and dislocations. Traditional bonesetters are also known to offer cheaper services and allegedly faster treatment options.
   In the first phase, called the "osteotomy/surgical phase", the bone is cut, either partially, only through the hard exterior, or completely, and a device is fitted which will be used in the next phases. In the second phase, the latency period, which lasts generally seven days, the appliance is not activated and early stages of bone healing are allowed. In the third phase, the "distraction phase", the device, which is mounted to the bone on each side of the cut, is used to gradually separate the two pieces, allowing new bone to form in the gap. When the desired or possible length is reached, which usually takes three to seven days, a "consolidation phase" follows in which the device keeps the bone stable to allow the bone to fully heal. After the consolidation phase, the device is removed in a second surgical procedure.
   In the United States, more than 6.5 million bone defects and more than 3 million facial injury cases have been reported each year. More than 2.2 million bone graft procedures are performed worldwide per year. The common causes for bone craft are tumor resection, congenital malformation, trauma, fractures, surgery, osteoporosis, and arthritis. According to the National Ambulatory Medical Care Survey (NAMCS), in 2010, there were approximately 63 million visits to the orthopedic surgery department and about 3.5 million visits for fractures in the emergency departments in the U.S. Among the 6.5 million bone fracture or defect cases, approximately 887,679 people were hospitalized. 
   After a period of two to four years, the surgical stainless steel bar is removed from the patient's chest. This procedure lasts approximately ninety minutes. The length of time that the patient stays at the hospital following the bar removal procedure varies, depending on the amount of new bone growth surrounding the bar. Accordingly, the length of time may range from a few hours to several days, or up to one week.
  
  Section::::Complications.
   Different treatments for different fractures: 
  
  The general treatments for common fractures are as follows:
  
  Section::::Treatment.:Cast immobilization.
  
  Because most fractures heal successfully after having been repositioned, a simple plaster or fiberglass cast is commonly used.
  
  Section::::Treatment.:Functional cast or brace.
  
  A cast, or brace, that allows limited movement of the nearby joints is acceptable for some fractures.
  
  Section::::Treatment.:Traction.
   Surgeons may treat these types of fracture by replacing the fractured bone with a prosthesis arthroplasty. Alternatively the treatment is to reduce the fracture (manipulate the fragments back into a good position) and fix them in place with metal screws. Common practice is to repair Garden 1 and 2 fractures with screws, and to replace Garden 3 and 4 fractures with arthroplasty, except in young patients in whom screw repair is attempted first, followed by arthroplasty if necessary. This is done in an effort to conserve the natural joint since prosthetic joints ultimately wear out and have to be replaced.
   Three days after the catastrophic injury Larry Bramlage, DVM, of Rood and Riddle performed a fetlock anthrodesis, fusing the bones to eliminate the fetlock joint. The fusion took a plate 14 inches long and 18 screws to lock it into place with approximately two feet of wire laced into the back of the ankle to replace the ligaments. Dr. Bramlage also put in 12 inches of high-density polyethylene to replace the ligaments in the pastern joint.
  
  Section::::Retirement.
   This treatment consists of aligning a bone or bones by a gentle, steady pulling action. The pulling may be transmitted to the bone or bones by a metal pin through a bone or by skin tapes. This is a preliminary treatment used in preparation for other secondary treatments.
  
  Section::::Treatment.:Open reduction and internal fixation.
   During the procedure, bone cement is injected with a biopsy needle into the collapsed or fractured vertebra. The needle is placed with fluoroscopic x-ray guidance. The cement (most commonly PMMA, although more modern cements are used as well) quickly hardens and forms a support structure within the vertebra that provide stabilization and strength. The needle makes a small puncture in the patient's skin that is easily covered with a small bandage after the procedure.
  
  Section::::Procedure.:Kyphoplasty.
   Vacanti and his brother Joseph successfully used the same technique to grow a chest plate for a 12-year-old boy, Sean McCormack, who had been born without cartilage or bone over his heart and left lung. In 1998, the team at Massachusetts led by Vacanti grew a replacement thumb bone using a scaffold of coral for a man, Raul Murcia, whose thumb had been crushed. The work was approved by the FDA, but they did not approve also growing cartilage and tendons. Vacanti also grew a new trachea for a 14-year-old girl.
   Occasionally smaller bones, such as phalanges of the toes and fingers, may be treated without the cast, by buddy wrapping them, which serves a similar function to making a cast. A device called a Suzuki frame may be used in cases of deep, complex intra-articular digit fractures. By allowing only limited movement, immobilization helps preserve anatomical alignment while enabling callus formation, toward the target of achieving union.
  
  Splinting results in the same outcome as casting in children who have a distal radius fracture with little shifting.
  
  Section::::Treatment.:Surgery.
   In simple cases healing may be evident within 3 months. Gavriil Ilizarov revolutionized the treatment of recalcitrant nonunions demonstrating that the affected area of the bone could be removed, the fresh ends "docked" and the remaining bone lengthened using an external fixator device. The time course of healing after such treatment is longer than normal bone healing. Usually there are signs of union within 3 months, but the treatment may continue for many months beyond that.
  
  Section::::Treatment.:Bone stimulation.
   Bone fracture, which is a complete or partial break in the bone, is a very common condition that has more than three million US cases per year. Human bones have the ability to regenerate themselves by cycle of bone resorption and bone formation. The cell responsible for bone resorption is osteoclast, while the cell responsible for bone formation is osteoblast. That being said, the human body can regenerate fractured bone. However, if damage to bone is caused by a disease or severe injury, it becomes difficult for the body to repair itself. When the human body is unable to regenerate the lost bone tissue, surgeons come in and replace the missing bone using autografts, allografts, and synthetic grafts (artificial bone). When compare artificial bone to autograft and allograft, it is less invasive and more biocompatible since it avoids the risk of unknown viral infections.
   If x-rays show that the capitate fracture fragments are out of alignment, surgery is indicated. A surgeon can use small compression screws or K-wires to unite the two pieces of bone. The headless compression screw has advantage over the K-wire as it provides compression across the fracture site and allows early motion. It may be the case that the ligament between the сapitate and the scaphoid bone is also injured; if so, this would be repaired at the same time.
   Offered at NOHC, BIRMINGHAM Hip resurfacing was a relatively new procedure approved by the FDA in 2006. It is a minimally invasive alternative to total hip replacement that preserves the top of the femur with a metal ball. Dr. Mitchell Sheinkop, director of the joint replacement program, has performed this procedure on former MLB player Albert Belle and former NFL quarterback Jim Miller. He was also the first orthopedic surgeon in Chicago to be trained in the use of a knee-preserving resurfacing procedure called “The Journey Deuce.”
  
  Section::::Ranking and achievements.
   Section::::Materials and devices needed for preoperative planning and simulation.
  
  The osteotomies performed in orthognathic surgery are classically planned on cast models of the tooth-bearing jaws, fixed in an articulator. For edentulous patients, the surgical planning may be made by using stereolithographic models. These tridimensional models are then cut along the planned osteothomy line, slid and fixed in the new position.
   Compound fractures involve the bone's penetration through the skin. Some complex fractures can be treated by the use of bone grafting procedures that replace missing bone portions.
   If the bones remain normally aligned treatment may be by casting without weight bearing for around eights weeks. If the bones are not properly aligned surgery is generally required. Returning the bones to their normal position results in better outcomes. Surgery may be delayed a few days as long as the skin remained intact.
   Bone grafting
  
  Bone grafting is a surgical procedure that replaces missing bone in order to repair bone fractures that are extremely complex, pose a significant health risk to the patient, or fail to heal properly. Some kind of small or acute fractures can be cured but the risk is greater for large fractures like compound fractures.
  