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description= Posts about Personal Reflection written by These Bones Of Mine;
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i instinctively shot out my right arm to stop myself the pain from a fracture comes not from the bone breaking but from the damage to the soft tissues that surround the bone the periosteum a tough connective tissue that nourishes and covers all outer external surfaces of the bones barring articular surfaces of the long bones is home to nerves that the bones themselves are not white folkens 2005 42 a fracture of the bone often damages the periosteum tissues which causes pain and leads to swelling of local tissues the periosteum and associated endosteum membrane located on the inner surface of bones are also one of the origins where the precursor bone cells develop into chondroblasts and osteoblasts which are essential for helping the bone fracture heal successfully white folkens 2005 43 a small but significant benefit of having polyostotic fibrous dysplasia is the fact that the pathological fracture patterns tend to be transverse breaks due to the weak structure of the bone architecture which tends to limit injury to both the nerves and the soft tissues surrounding the fracture area marsland kapoor 2008 121 however due to the pathological bone porosity and the often high bone cell turnover rate as a part of the overall syndrome there is the prospect of extensive bleeding during surgical procedures this can lead to extensive blood loss during major operations such as during osteotomy procedures and or internal and external fixations to help improve the bowing of a limb or to correct pathological fractures as such the patient s blood is often cross matched beforehand with suitable blood groups for infusion during major surgical procedures to combat excessive blood loss in the immediate aftermath of the fracture i was given heavy painkillers and taken to hospital where after a light sleep overnight my arm was put into a cast before i underwent surgery later in the week in a hospital nearer my hometown the decision was taken not to reduce the bone before the surgery and just to rest it on weight bearing bones such as the tibia or femur or load bearing bones such as the mandible in adults it is important that the bone is reduced quickly and properly to minimise complications and induce good healing marsland kapoor 2008 120 the humeral fracture was openly reduced and fixated under general anesthetic with a titanium locking plate as can be seen in the above x ray and the surgeon achieved a good fix and stability of the distal humerus with the plate curiously even though the fracture was trauma induced it was less painful than the fracture that had occurred when i was 13 the arm still feels heavy and slightly cumbersome but there is no doubt that the internal fixation is preferable to the months in the plaster cast it will still take many months for the bone to heal properly as it is still in the early stages of the primary bony callus a process where woven bone bridges the initial fibrous connective tissue callus that responds to a fracture in the first few days this woven bone is after a few months later converted to lamellar bone and the fracture site will be further remodelled eventually if a fracture site is initially kept stable by immobilization or by fixation as in my case the bone can remodel so completely as to eliminate any trace of the original fracture white folkens 2005 48 traumatic fractures are found in all periods of human and hominin history and it is likely that you yourself have suffered a fractured bone of some description perhaps even unknowingly marsland kapoor 2008 121 they can be devastating requiring many years of surgery or physiotherapy to gain and improve movement as the sociologist ann oakley highlights in her 2007 book fracture adventures of broken body a personal account detailing the social and professional impact of a fractured right humerus accident which had impinged on nerves leading to reduced function and feeling fracture treatment has been practiced for thousands of years and it has long been known that with the reduction of the break and stabilization of the limb good results can be achieved marsland kapoor 2008 the study of fractures in populations can also highlight trends in the attention received as meyers 2012 has highlighted in an entry on the differences of fracture treatment between iron age and romano british populations in britain the right tibia of an adult courtesy of the free online resource digitised diseases notice the well healed mid shaft oblique fracture in the a anterior view b is the posterior view and c is the close up posterior view where right is proximal and left distal the callus is fully remodelled with smooth bone over the fracture site where the end is displaced laterally and proximally image credit digitised diseases 2014 master record number 0365 still this entry s approach is focused on the personal not at the population level another part of my body has broken and it is once again held together by titanium likely to be a permanent addition to my skeleton the movement at the glenohumeral joint otherwise known as the shoulder is normal while movement at the elbow joint comprised of the humeroulnar humeroradial and superior radioulnar joints is almost back to normal there is still a lack of full extension of the joint with noticed tension in the biceps brachii muscle as it acts as the antagonist to the triceps brachii muscle during forearm extension although daily physiotherapy should help to regain full movement i am no stranger to the strength of the metal in my body and i remain impressed by its capability in the use of orthopaedic fixation the use of metallic implants to fixate fractures is nothing new as lane 1895 and uhthoff et al 2006 attest whilst the use of casts to set fractures continues it is the increase in the use and versatility of technology and materials to give nature a helping hand that remains the next big step in treating bone fractures bali et al 2013 metal plates have been in use for over a hundred years where early pioneers such as lane 1895 lambotte 1909 and sherman 1912 first introduced plates to help stabilize fracture sites and help mobilize patients faster than plaster casts could allow uhthoff et al 2006 118 although these early plates suffered from corrosion problems it soon became apparent that internal plate fixation could provide a safe and efficient way for patients to heal whilst also regaining some form of movement various plate designs improved on earlier designs allowing for micromotion at the fracture site and compensation for bone resorption during the healing process uhthoff et al 2006 124 contend that there are still problems in the form of internal plates where compression and stress shielding can still lead to bone necrosis and cortical porosis in their conclusion they argue that there still needs to be a fine balance attained between a plate design that managed to reduce stress shielding and allows adequate micromotion at the site of a fracture both which they concur would help mimic biological healing there also drawbacks that can include plate palpability risk of infection temperature sensitivity and possible growth restriction with metallic implants bali et al 2013 167 ultimately however the body still has to heal the fracture itself over a matter of weeks and months white folkens 2005 48 it is interesting to note that sir william lane himself writing in the late 19th century and primarily focusing on lower limb fractures indicates the marked differences between upper and lower limb fracture treatment he states that although the upper limb does not take the weight of the body in the arm very considerable alterations may occasionally develop and are more marked and depreciating to the value of the individual as a machine in proportion as changes have already taken place in the particular joint or joints from the prolonged pursuit of a laborious occupation lane 1895 861 deciding that fractures of upper limb need not be set directly in their original anatomical form whereas lower limb bones should be set as close to as originally constituted due to their weight bearing nature furthering this view in the same letter to the british medical journal in 1895 he highlights that one cannot but feel that the perpetuation of methods of treatment which have been in use up to the present time must depend on the fact that surgeons have not taken such trouble to inquire into the subsequent life history of these patients as they have done in other departments of surgery lane 1895 863 there have been some distinct advances in using biodegradable plates in non weight bearing locations such as in the maxillofacial region a position where many would like to avoid the intrusive nature of a temporary or permanent metal plate a study by bali et al 2013 167 has highlighted the value of using biodegradable material to help fixate trauma induced facial fractures reporting that each individual in the small study cohort n 10 of varying ages reported good reduction of fracture and evidence for the total biodegradation of the plate after two years they also reported that no further surgical procedures were needed on their test cohort a significant finding as metallic implants often either need removing if they are temporary or debriding if they become infected both quite serious surgical procedures bali et al 2013 170 unfortunately the study highlights that biodegradable implants are unlikely to be currently safe to use in weight bearing or load bearing bones bali et al 2013 171 conclude by stating that further studies are needed but biodegradable plates and screws can provide satisfactory if expensive stabilization as internal fixations for mid face fractures medical science and engineering has certainly come a long way since lane first introduced the internal fixation plate yet humans are as prone as ever to fracturing their bones as a person with mccune albright syndrome i may know the pain of breaking a bone but i can be thankful that i live at a time and in a place where fractures can be confidently treated further information i ve written in more detail on polyostotic fibrous dysplasia and mccune albright syndrome here which details the way in the which the disease has affected my skeleton also on that particular post are a host of medical palaeopathology and osteology related articles to do with mccune albright syndrome and fibrous dysplasia in general alternatively search the blog for the keywords and numerous posts in which i ve highlighted the syndrome and the bone disease will appear a previous post on 3d printing in orthopaedic surgery can be found here and an entry giving a quick overview of some of the problems and approaches used in studying physical impairment and disability in archaeological contexts can be found here bibliography bali r k sharma p jindal s gaba s 2013 to evaluate the efficacy of biodegradable plating system for fixation of maxillofacial fractures a prospective study national journal of maxillofacial surgery 4 2 167 172 open access digitised diseases 2014 master record number 0365 accessed 18 08 14 http www digitiseddiseases org viewer viewer_overlay php mrn 0365 lane w a 1895 some remarks on the treatment of fractures british medical journal 1 1790 861 863 open access marsland d kapoor s 2008 rheumatology and orthopaedics crash course 2nd edition london mosby elsevier meyers k 2012 break a leg fracture treatment in iron age and roman britain bones don t lie accessed 11th august 2014 open access oakley a 2007 fracture adventures of a broken body bristol policy press uhthoff h k poitras p backmann d s 2006 internal plate fixation of fractures short history and recent developments journal of orthopaedic science 11 2 118 126 open access white t d folkens p 2005 the human bone manual london elsevier academic press tags bone fractures fractures history of fracture treatment human osteology medical history personal personal trauma trauma comments 1 comment categories bioarchaeology bone disease digitised diseases digitised diseases model fibrous dysplasia fracture fracture fixation fracture treatment human osteology mccune albright syndrome medical history orthopaedics palaeopathology pathology personal reflection polyostotic fibrous dysplasia university of bradford x ray pain briefly 17 jun just a quick note here i had the good luck of hearing historian joanna bourke on bbc radio 4 program start the week yesterday morning who was on the show debating the topic of her latest publication titled the story of pain from prayer to painkillers the book focuses on trying to understand and contextualise the feeling of bodily and physical pain from the 18th century ad to the modern period bourke who is a professor of history at birkbeck university of london presents a holistic history of understanding pain in which the topic is approached from numerous angles including not just the medical but also the cultural religious and political the book also deals with the personal experience of pain and the nature of suffering both in the individual sense and within wider society from the family out it certainly looks like an interesting and enlightening read having read a few reviews of the book itself and of having heard bourke herself discuss the differences in understanding the many types of pain it reminded of sociologists ann oakley s 2007 book fracture of which i discussed a little here although oakley s book is a much more personal and reflective study with its focus on the modern health perspective bourke 2014 also discusses the role and changes that medicine has gone through in the past and present approaches and treatments when considering illnesses and patients themselves of particular interest on the radio show this morning was bourke s assertion that different cultures experience pain in a myriad of ways this of course made me think of how bioarchaeologists approach the archaeological record and how we try to understand palaeopathology in relation to the individual osteobiographic context within the population and society that the person lived in together the original context of the landscape environment of the archaeology site read more about osteobiographical examples here bioarchaeology is as a field a burgeoning area of archaeological research one that ably and actively straddles the humanities and science divide with ease bioarchaeologists often complement their normal macro and micro assessment of the skeletal remains with the regular use of the latest scientific techniques and refinements including but not limited to stable isotopic and ancient dna analysis to help understand the processes implications and contexts of a pathology within a population this often includes trying to contextualise and understand traumatic or congenital pathologies that can be present in the skeletal remains of humans white folkens 2005 it must be remembered of course that only a small fraction of diseases known ever affect o...
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