It is not infrequent that trauma associated with accidents results in injury and damage to the bone structure of a person's body. Evaluation of an injury claim involving fractures requires an understanding of the skeletal system, which forms the basic structure, or framework, of the body.
Bones are made up of living cells, and, although they seem hard, they actually consist of porous materials. Bones are most dense and least porous at the cortical shell. This is the hard shell we commonly associate with bone structure. Trabecular bone, sometimes referred to as marrow, is more porous and is found within the cortical shell. It can be up to 90 percent porous and is contained in the long bones, the pelvis bones, ribs, and back vertebrae. The trabecular structure contains blood and fat cells and is sometimes described as honeycomb in appearance. There are further divisions of bone structure at the cellular level; however, knowing these two structures will suffice for most claims professionals in evaluating fractures.
Nerve endings are contained in the periosteum, which is a thin outer coating on the outside of the cortical shell. When a bone is struck, the nerves in the periosteum relay the sensation of pain to the brain. The more severe the impact or damage to the periosteum, the more significant the pain is. When bone fragments rub against each other, a grating sound is often heard or friction felt. The sound is referred to as crepitus and results in severe pain.
Children are born with 270 bones. Fusion occurs with aging, leaving adults with approximately 206 bones. Any of these bones can be damaged by trauma caused by accidents. The extent of damage may vary depending on
The simplest description of a fracture is the breakage of a bone. Fractures are relatively common. According to WebMD, the average person has two fractures in his or her lifetime. There are four major categories of bone fractures:
A closed, non-displaced fracture is generally quicker to heal than a displaced, open fracture due to complications that can arise in the latter combination.
There are various types of fractures. Each type has different implications for healing and permanency of related disability. The most common types a claims professional will encounter include:
Fractures can also be described by their appearance or shape in the bone itself.
Treatment of fractures usually begins with reduction—the method of realigning or stabilizing the bone in its correct position for healing. Closed reduction involves placement without surgery by manipulating the bone into proper position. Open reduction is a surgical procedure that exposes the bone ends or fragments for proper placement. Open reduction often involves the use of screws, wires, plates, or other medical devices to immobilize the bone. These may or may not be removed following the healing process, depending on the severity and placement of the break and the amount of stability required. Open reduction is more expensive due to costs related to the surgical procedure.
Complications increase as the severity of the fracture increases. If the bone is aligned well, if there is immobility during the healing period, and if there is good blood supply through the healing period to encourage proper regeneration of bone material, the fracture should heal with little or no deformity or disability. However, claims professionals should treat fractures as complex injuries, even in their simplest state, due to the number of complications that can occur. Even in the healthiest person, the bone union may involve deformity, poor blood supply may result in non-union at the site, or a pathological condition may present itself and impair healing.
Any fracture involving a wound, such as a compound fracture, poses opportunities for bacterial infection or damage to arteries that can result in necrosis or gangrene. These can escalate if not treated promptly, leading to amputation or additional surgical interventions. Fractures can also damage nearby blood veins, resulting in the formation of blood clots that may hinder blood flow or even cause death if the clot enters the heart.
Because of the potential for increased severity, claims professionals need to obtain specific information to properly evaluate the injury and potential for disability. Information that should be obtained includes:
Claims professionals face additional challenges when evaluating fractures, so special care will need to be taken to understand the extent of the injury, the health condition of the injured party, and the potential for permanent disability. Great care should be taken to discover as much information as possible so that later exaggeration or claim padding can be prevented.
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