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A spiral fracture is when a bone breaks in a helix pattern under a twisting or torsion force. These types of fractures often produce jagged edges that can make it difficult to reduce, or realign, the bone for immobilized healing. When this is the case, the best treatment for this torsion fracture is surgery to insert pins or rods to stabilize the bones. If the spiral fracture is fairly clean and the bones can be easily reduced, then immobilization can be accomplished using a cast. Typical recovery time for this type of twisting fracture is four to six weeks.
It is easy to picture a spiral fracture if you take a stick and break it by applying a twisting force. The broken ends of the stick are angled and uneven. It can be difficult to realign the two broken ends to make the stick whole again. This is the situation with most spiral fractures in a bone. Typically, the fractured bone ends are jagged and uneven, and some bone fragments may even break completely free.
In this extreme case, two problems arise in the treatment of this type of fracture. First, it can be very difficult to reduce the uneven ends of the bone so that the bone can be immobilized. Second, the bone fragments may lacerate blood vessels and muscles. This is especially true if the bone was not properly immobilized before medical treatment was received. These problems make surgery the best option when the fracture creates jagged and uneven bone ends.
Surgery to restore broken bones is called open reduction and requires general anesthesia. During open reduction, the torsion fracture in the bone is revealed through an incision in the skin. The area surrounding the break will be inspected for blood vessel or muscle tears and, if necessary, these issues will be repaired. The bone is then realigned as much as possible; secured using a pin, screws or a rod; and finally the incision is sutured closed. The bone will be immobilized and protected during healing using a cast or splint.
Occasionally, especially in children, a spiral fracture will be relatively clean and a closed reduction, or realigning of the fractured bone without surgery, can be performed. Closed reduction of a twisting fracture is typically done with local anesthesia, but general anesthesia may also be used. In the case of a clean twisting fracture, the break is reduced and then immobilized with a cast or splint. Most spiral fractures, whether treated with open or closed reduction, take four to six weeks to heal.
I know parents are often terrified when they find out their child has a spiral fracture, because, so often, this is considered a definite sign of child abuse because of the way the bone has to break.
I knew a couple whose little girl got a spiral fracture in her leg after falling off the sofa. She was about 18 months old. Child services were called and the child was put in foster care for about two weeks while the "investigation" went on.
Finally, the child's pediatrician intervened on behalf of the parents and insisted the child be given a bone density scan. Turns out, she had brittle bone disease. Fortunately, the child was returned immediately to her parents.
A friend of mine worked a summer at a daycare. She was on the playground with the kids, and somehow got her hand twisted in a swing chain. She had a spiral fracture of her middle finger and broke her wrist very close to her hand. The spiral fracture was apparently very clean, and not displaced because the doctor just put a fingertip splint on it.
Seems like it was healed before we started back to class in September. I remember she was out of the cast by then. The doctor said the spiral fracture healed just fine and she shouldn't have any problems with it. I don't think she ever has.
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