Fractures, contusiones and their effects on driving

There are many causes for temporary functional loss affecting parts of the body after a trauma, and doctors should warn their patients against driving until the problem in question has been completely resolved.

It also takes injured bones a long time to heal, and sometimes events occur that slow or modify the recovery process and require repeated medical advice against driving.

Fractures

The main primary symptom is pain, which forces the patient to adopt an antialgic position. Functional impotency is sometimes, but not always, added to this situation.

Frequently, but not always, haemorrhage or displacement of the bones results in deformities.

Crepitation, in addition to abnormal movement can be observed in areas where this should not be possible ,when a long bone is broken.

When there is skin breakage, this is called an open fracture, and all fractures can be complicated by blood vessel injuries and damage to the neighbouring veins.

Vascular lesions can be associated with fractures produced by section, compression or contusion, while spasms are rare.

On occasions, ruptures in the intima can obstruct access to the collaterals or lead to the formation of thrombi.

Sectioning of a vessel, especially if it an artery, can cause serious haemorrhaging, arterial ischemia secondary to thrombosis or a compartimental syndrome leading to Volkmann ischemic contractures.

Nerve lesions associated with fractures are caused by contusion, trapping, overstretching and less frequently, sectioning.

Problems with consolidation, secondary deformities requiring later surgical intervention, open fractures infections, tetanus, pulmonary thromboembolism, fat embolism, osteomyelitis and osteonecrosis are all possible complications of the bone healing process.

The most frequently observed local complications affect the skin, and are wounds, skin loss, blisters or blebs as well as pressure ulcers.

Muscular complications caused by pulls, myositis ossification and tendonitis due to chronic ruptures between two and three months after the fracture, more frequently seen in the large extensor of the big toe and the large tendon of the biceps.

Also common is chronic tendonitis of the tibialis posterior after a fracture of the internal maleolo.

Decisive factors in the evolution of a fracture

Factors that generally influence bone recovery are age, functional activity, previous nerve function and nutritional status.

From a localised point of view, the seriousness of the trauma, the type of bone affected, its vascularisation, muscle cover, degree of bone loss, immobilisation, inflammation, possible infection, and pathological conditions in certain patient groups such as diabetics and smokers.

Treatment

The three objectives of the treatment of any kind of trauma lesion are reduction, immobilisation and soft tissue care.

External mobilisation can be achieved through various techniques, including ferules, casts and continuous tractions, which are among the most common.

In the case of joint fractures, in addition to reducing to the greatest extent possible the number of bony fragments to conserve joint surfaces, the complete immobilization of the area is required until the healing process has finished.

This means that adherence and fibrosis occurs, with resulting joint rigidity, most frequently observed in the knee, elbow hand and especially the wrist.

This is the reason why rehabilitation of certain joints can take weeks or months, to recover range of movement, and in some cases, in spite of the effort made, limitations remain.

Post-traumatic artrosis is produced by lesions to the cartilage or a poor fracture reduction.

Contusions, sprains and luxations

A contusion is a direct trauma to the joint that does not result in a fracture.

It causes pain, swelling, functional impotency and leaking blood, which means a compression bandage needs to be applied and a degree of rest imposed.http://medicosporlaseguridadvial.pre.mapfre.net/cap_en.asp?p=9.2._med_es

Luxation occurs when trauma results in the extremities of the bones losing normal contact, which causes great pain, deformity and functional impotency.

Once the emergency situation has been dealt with, the injury will need to be immobilised for a minimum of three weeks, functional recovery and a normal range of movement. In resistant cases, surgery can be required.

Sprains are indirect traumas to the joint itself, caused by a brusque movement, which cause ligament distension and injury to the soft tissues.

Sprains cause pain, swelling, bleeding and functional impotence and require bandaging for at least three weeks as well as active physiotherapy. Sometimes immobilisation by means of a plaster cast is necessary, and in serious or resistant cases, surgery can be indicated.

It can leave sequelae such as laxitud, breakage of the meniscus, rotulian subluxation or joint instability, making correct control of the joint difficult and making changing gear and applying to the vehicle’s pedals risky.

We can conclude, that curing traumas of the bones, even the most simple ones, takes a very long time.

Circumstances can frequently occur that delay or modify correct recovery, meaning tight control is required in each situation.

Tips

• Driving is not permitted while immobilised by bandage or plaster cast.
• The patient may not drive until an expert has confirmed that strength, sensitivity, stability have been recovered and the condition is completely cured without any resulting limitations on movement.
• While the patient is officially off work because of a trauma, he may not drive.
• The fact he is not able to drive for a long period of time makes the patient impatient, and he will try to asset that he feels better than he really does, and that the limitations he experiences at the wheel are of minor importance, and he may drive on his own volition, risking an accident.
• Surgery requires a recovery period that will vary in length depending on the recovery of functionality and safety, during which time driving will not be permitted until the specialist gives express permission.
• After the surgical intervention, the decision as to the appropriate period of convalescence before driving without limitations commences is down to the doctor.
• All sequelae, even those which are partial, can modify function.
• If sequelae remain, they should be evaluated because of their possible effects on driving, and the patient should be informed of these, as well as his likelihood of recovering in time.
• All sequelae causing limitations to movement, strength or sensitivity require medical reports from a specialist giving details of the disability, describing the new situation and evaluating the possibility of the patient driving safely.
• Permanent disabilities may need to be evaluated with the specialist medical report to try and adapt the vehicle to the driver and allow driving with restrictions set out in the Law applicable to each particular case.