Refracture
| Classification according to ICD-10 | |
|---|---|
| T14.2 | Broken bone |
| T79.8 | Other early complications of trauma |
| ICD-10 online (WHO version 2019) | |
In trauma surgery, a refracture is the fracture of a bone in the immediate area of a previous, not yet fully healed bone fracture as a result of inadequate trauma .
Definitions
Incomplete fracture healing
The fracture healing is considered complete when its last phase (“modeling” and “remodeling” phase) can be viewed radiologically as largely advanced. In this phase the callus (i.e. the bone replacement tissue formed in the first phases) is already replaced by solid (“compact”) bone.
Inadequate trauma
Inadequate trauma is an accident mechanism that, in a healthy bone, is unlikely to have fractured.
localization
The fracture line of the refracture does not have to be congruent with the original fracture line, but largely in its area. A refracture can be assumed if the area of the original and the new fracture largely overlaps in X-ray images placed one on top of the other.
causes
The most frequent cause of a refracture is the premature loading of the injured bone as a result of insufficient cooperation on the part of the patient or an incorrect assessment of the fracture consolidation by the attending physician. Other causes can be disorders of the healing of the bone fracture or generalized bone diseases ( e.g. osteoporosis ). In addition, the premature removal of osteosynthesis material can promote the development of a refracture.
treatment
Treatment follows the general principles of fracture treatment . In this case, more extensive procedures than in the case of the initial treatment must often be used ( e.g. autologous bone transplantation ), especially if insufficient stabilization during the initial treatment must be assumed as a partial cause. In general, when treating a refracture, a significantly longer treatment time is expected compared to the initial fracture.
Definition of terms and socio-medical meaning
On the one hand, the second fracture and, on the other hand, the delayed healing of the first fracture must be distinguished from the refracture.
A refracture is not present if, after the fracture has healed, another fracture of the same bone occurs due to adequate trauma. This differentiation becomes extremely important when the question of cost coverage is raised, for example, by a statutory accident insurance (GUV). The rejection of the assumption of costs by GUV for the treatment of a second fracture that arose in the context of an uninsured activity, in contrast to the assumption of costs for the first fracture after an insured accident, regularly leads to social court disputes. Whether there is an (insured) refracture or an (uninsured) second fracture can often only be clarified by means of complex, interrelated reports. For the insured person, the clarification of this question can have significant pension consequences.
The delayed healing of a primary fracture can, in exceptional cases, raise complicated questions regarding the cost of the insurance if the delay in healing is due to a general illness that is not the responsibility of the accident insurer. Normally, however, the principle applies that every accident insured person is “insured as he is”, including previous illnesses.
swell
- Rüdiger Spier, Horst-Joachim Japtok: Basic terms in accident medicine. Volume I: Course for clerks in private accident insurance. 2nd Edition. VVW Karlsruhe, 1998, ISBN 3-88487-726-7 , p. 74.
