The AO / ASIF Principles:Fracture (Cast) Disease

Abstract

Restoration of anatomic relations correlates highly with functional outcome in the hand. The priorities in treatment are a stable, well-maintained reduction and early motion. Prolonged immobilization, especially in a nonfunctional cast, can lead to a vicious cycle of pain, swelling, and unresolved edema. Edema fluid is a proteinaceous exudate that will congeal into scar tissue around joints and tendons and cause joint stiffness, contracture, and tendon adhesions. Muscle atrophy, brawny skin /induration, and osteoporosis follow. Reflex sympathetic dystrophy may sometimes occur and further complicate the picture. This constellation of symptoms and physical changes has been called “fracture disease.” Like proud flesh and suppuration in soft tissue healing, it is not a necessary part of fracture repair and can be avoided. Prevention is the best treatment. All fracture treatment, whatever the method, must be geared to achieve stability and function to prevent these complications.