Category: Ankylosing Spondylitis

ABSTRACT

Fracture of bone is a condition in which a patient experiences unbearable pain  and if not cured in the right way can cause major trouble to the patient and can lead to lifetime abnormalities. As our skeleton protects the internal organs and is tough and flexible. It also supports the weight of our body. Hence bones that construct our skeleton provide great stability. Bone fracture is a medical condition in which the constituents of the skeleton i.e bones gets damaged due to external force or by some underlying pathological conditions like osteoporosis, osteopenia, osteomyelitis etc are more prone to fractures. Both Ayurveda and Modern Science explains ample importance of proper healing of a fractured bone in their own ways.

INTRODUCTION

Any break in the continuity of a bone or cartilage, which may be partial or complete can be termed as a fracture. The commonest sites of fracture include wrist, ankle and hip.There are certain reasons that cause fracture which includes trauma like fall from height, road traffic accidents etc. Fractures can also be caused by a few diseases that weaken one’s bone like osteoporosis, osteopenia and a few other conditions that make them prone to fractures.

CAUSES

Fractures can be caused by trauma like fall from height, road traffic accidents direct blow or by repetitive forces such as those caused by running or practising a certain sport that causes stress fracture.

SIGN AND SYMPTOMS

The sign and symptoms differ according to the type of fracture if it’s a closed or an opened one.

1. Swelling
2. Tenderness
3. Pain
4. Deformity of site
5. Bruising
6. Redness
7. Crepitus
8. Loss of function

TYPES OF FRACTURE

Based upon the type of break

1. Complete Fracture
2. Incomplete Fracture

Based on relationship with outside climate

1. Open Fracture
2. Closed Fracture

Based on the Pattern

1. Transverse
2. Spiral
3. Compound
4. Longitudinal

Specific type of fractures –

1. Greenstick
2. Comminuted
3. Impacted

DIAGNOSIS

IMAGING TESTS

1.  Physical examination
2. X Ray – For finding out the exact location and extent of fracture.
3. CT Scan/ MRI – It helps to visualise fracture, bleeding and soft tissue damage.

LAB TESTS

1. CBC (Complete Blood Count)- To find out if hematocrit is increased or decreased.
2. Coagulation profile – It alters due to blood loss and hence should be checked.

MANAGEMENT

Management of fracture includes

1. Emergency Care– It includes -rest of the site by splinting, next is ice therapy followed by compression and elevation to reduce swelling.
2. Definitive care-
3. Reduction – It can be done:

(a) Closed reduction- its initial and standard method of reduction.it can be done under conscious sedation.
(b) Open reduction – it’s done if the closed reduction fails to reach the need, its done surgically.

1. Immobilisation
2. Traction
3. Splinting
4. Rehabilitation – It consists of joint mobilisation, gait training etc. it’s done to prevent stiffness.

COMPLICATIONS

Early complications

1. Shock
2. Fat embolism
3. Deep vein thrombosis
4. Infections

Late complications

1. Delayed union (slower production of new tissue)
2. Non-union(body’s inability to heal fracture)
3. Mal union(occurs when fractured bone heals in an abnormal position)

AYURVEDIC ASPECT OF FRACTURE (ASTHI-BHAGNA)

In Ayurveda, fracture can be correlated with bhagna. When the continuity of asthi(bone) is broken partially or completely can be termed as asthibhanga or asthibhagna. According to ayurvedic Scriptures Bhagn includes both asthibhagna (fracture) and sandhibhagna (Dislocation) under bhagna.

NIDANA (CAUSES)

According to Ayurveda and in modern Science there are no such differentiations about the cause or nidana of bhagna. It is same as mentioned above like-

1.         External trauma
2.         Intrauterine fracture
3.         Indirect trauma
4.         Pathological reasons- in patients of tuberculosis.

BHEDA (TYPES OF BHAGNA)

Acharya Sushruta explains two types of bhagna, there are

1. Savrana bhagna (Open fracture)
2. Avrana bhagna (Closed fracture)

Another type is

1. Apurna bhagna (Incomplete fracture)
2. Purna bhagna (Complete fracture)

1. APURNA BHAGNA

As the name itself says that in this type of bhagna the asthi i.e bone doesn’t separate into fragments. It can be correlated to incomplete fracture in modern.

Apurna bhagn is further divided into

1.  Picchit (depressed) bhagna- Bone fragment is displaced from its anatomical position as seen in injury of head.
2. Vakra (Green stick) bhagna- as explained above in the modern aspect its commonly seen in children.
3. Sphutit (fissured) bhagna- there are cracks in bone but the fragments aren’t displaced.
4. Chinna bhagna

2. PURNA BHAGNA

In this type of bhagna, the bone fragments are completely separated from each other. This type is further divided into-

1.  Apatit (transverse)
2.  Kanda (oblique)
3.  Ashwakarna (spiral)
4.  Majjanugata (Impacted)
5.  Patit (comminuted)
6.  Karkatak (Multiple)

All the above-mentioned types are the same as mentioned in the modern aspect.

LAKSHANA OF BHAGNA

LOCAL

1. Deformity
2. Abnormal mobility
3. Loss of function
4. Discoloration & tenderness

GENERAL

1.  Shock
2. Aseptic traumatic fever

UPDRAVA (COMPLICATIONS OF BHAGNA)

Acharya Sushruta mentioned that complications of bone injury could be local or systemic. Local complications like mal union or non union. Even tight bandaging can lead to swelling , pain or even  avascularization that can lead to gangrene. Systemic complications can be fever, abdominal distention and a few others.

SADHYASADHYATA (PROGNOSIS)

• Acharya Sushruta described the prognosis of fracture into three categories which are Sukh sadhya (easily curable), kasht sadhya(cured with difficulty) and asadhya (incurable)
• Sukhsadhya- Acharya Sushrut explained that patients fractured during balyakala (childhood) or with a minor crack or a hairline fracture can be managed without difficulty.
• Acharya Sushruta also mentioned about the importance of ritu for healing a fractured bone, he said fractured bone heals better in shishir ritu.
• Kashtsadhya – Healing can be difficult if the type of fracture is of comminuted (churnit), incomplete (chinna), impacted (majjanugata).
• Asadhya – Churnit (comminuted) bhagn of frontal or iliac bone, complete fracture or dislocation of pelvic bone also fracture of temporal bone, septum or vertebral column can be asadhya.
• Acharya Sushruta also explained the importance of post treatment care of the bone and said that even after proper treatment the fractured bone may not unite in the right way as it should if displaced improperly during immobilisation period or even by improper bandaging. All these factors can lead to failure of treatment.

AYURVEDIC LINE OF TREATMENT

The ancient Ayurvedic texts describes chikitsa of asthi bhagna and categorised it into general management, specific management according to the type & site of fracture and described about the Pathya & apathya (do’s and don’ts) as according to Ayurveda the Pathya & apathya plays a major role in healing. General chikitsa of bhagn includes Anchan(traction), Pidana (manipulation by local pressure), Sanshipt (stabilise) and Bandhana(immobilisation). All these four principles of management of fracture explained by Sushruta are adopted today by the Modern Sciences too.

• Kushabandhana or splint explained by Acharya Sushruta has a soft sheath- like surface that  provides support to the fractured bone.
• Alepa or paste of lal chandana or Shata dahuta Ghrita (100 times washed ghee) can be used.
• Timing of bandhana or bandaging plays a crucial role, in saumya ritu(winters) bandaging should last for 7 days, in normal temperature for 5 days and during agneya ritu (summers) for 3 days.

MANAGEMENT OF SPECIFIC TYPE OF FRACTURE

Ayurveda has a vast explanation of treatment of different types of fracture depending upon its site, here are a few common sites and treatment of fractures.

1. In fracture of tibia , fibula or femur traction should be applied carefully along the direction of bone after a gentle massage by using Ghrita (Ghee). A fractured arm should also be treated the same way.
2. In case of dislocation of the shoulder joint, the axilla should be raised and bandaged the part by swastika bandha(figure of eight) should be done.

HERBAL REMEDIES BY PLANET AYURVEDA FOR EARLY HEALING OF FRACTURES

Planet Ayurveda is a GMP-certified company offering products worldwide that shows extreme results. All the products are prepared by following the ancient Ayurvedic texts and using natural ingredients under the guidance of MD Ayurveda experts.The main goal of the company is to eliminate the source of any disease and provide a healthy life to mankind. All the products are completely safe and devoid of any kind of adverse effects.

1. Lakshadi Guggul
2. Cissus Power Capsule
3. Ashwagandhadi Ghrit
4. Bone support Capsules
5. Dashmoola Capsules

1. LAKSHADI GUGGUL

Lakshadi Guggul from Planet Ayurveda is a combination of herbs that helps to pacify the vata dosha from the body which ultimately increases the level of asthi. This will help in improving bone health and hence the fracture will heal in a better way. It contains  Laksha (Laccifer lacca), Asthisamharaka (cissus quadrangularis), Arjuna (Terminalia arjuna) and various other herbal drugs combined in the form of tablets.

Dosage– 1-2 tablets twice or thrice daily with lukewarm water.

2.  BONE SUPPORT CAPSULES

Bone Support capsules by Planet Ayurveda helps in regaining natural bone mineral density of bones which ultimately helps in better healing of the fractured bone. It’s a great blend of- Shudh Laksha (Laccifer lacca) , Suhanjana Beej (Moringa oleifera)- which is rich in calcium and helps in bone strengthening , Praval pishti (Corallium rubrum) which too is rich in calcium, Mukta (Compound of pearl calcium)etc. As the name signifies itself, it provides better support and is also known to increase the bone mineral density if taken properly.

Dosage –1 capsule twice a day

3.  ASHWAGANDHADI GHRIT

Ashwagandha Ghrita by Planet Ayurveda supports muscle mass, relieves stress, and improves energy, strength, and vitality that excellently helps the bones too. It also helps in reducing fatigue especially caused by pain due to fractures. Its components are- Ashwagandga (Withania somnifera), Vibhitaki (Terminalia bellirica), Go Ghrita (cow’s Ghee), Go Dugdha(Cow’s milk) which acts as vata dosha pacifiers.

Dosage– 3-6 gms mixed with mishri.

4.  CISSUS POWER CAPSULE

Cissus power capsules from Planet Ayurveda are formed of dried Hadjod (Cissus quadrangularis).  Hadjod which helps in the building and functioning of bones is a major constituent of Cissus Power Capsule.Thus helpful in healing fractures.

Dosage– 1-2 capsules twice a day with water.

5.  DASHMOOLA CAPSULE

Dashmool means the roots of 10 herbs, so here special roots of 10 different plants are combined to prepare the capsules. It contains herbs such as Bilwa (Aegle marmelos), Shyonak (Oroxylum indicum), Agnimantha (Clerodendrum phlomidis), Gambhari (Gmelina arborea), Kantakari (Solanum surattense), Brihati (Solanum indicum), Prishnaparni (Uraria picta), Shaalparni (Desmodium gangeticum) and various other drugsare being used.This capsule is very effective in calming the vata dosha, thus reduces pain. Bilwa is used in fractures for wound healing. Shyonak is used as a antispetic. Patla is used for its anti-inflammatory properties. Agnimantha is useful in cases of swelling and inflammation. Gambhari is useful for reducing pain and Shaalparni has an antipyretic property.

Dosage– 1-2 capsules twice daily with plain water after meals.

CONCLUSION

We can conclude that the description of fractures and its management explained by Acharya Sushruta and modern medical Science are a lot similar from each other. Basically the concept and principle of approach remains the same from ancient to till date, like ‘Bandha’ by Acharya Sushruta is explained by ‘Bandaging’ in Modern Sciences, Savrana- Avrana as open-closed fracture and many more. Ayurveda has given ample importance to Asthi Sharira also explained it pathya-apathya (do’s & don’ts) of bhagna. Such immense knowledge clearly states the understanding and far sightedness of our Acharyas as their principles and managements are still applicable in today’s era with tremendous efficacy.