Workplace Injuries and Fatalities on Construction Sites

But what kind of injuries happen on worksites?

We’ll have a look at the different kinds of workplace injuries, and then we’ll explore how the injuries are treated along with estimated recovery times. But first, we’ll briefly mention accident prevention. As the saying goes, an ounce of prevention is worth a pound of cure, even with the best medical treatment available.

The Workplace: Injury Prevention and Types of Injuries

Accident prevention is a priority in all Canadian industries. Extensive safety measures, employee safety training and compliance, and inspections by federal or provincial agencies all play their role and are effective in drastically reducing workplace fatalities, injuries, accidents, and incidents.

While we all do more than necessary to make the workplace safe for everyone, accidents can still occur. Unfortunately, some of these accidents can cause serious injuries.

The types of injuries that are seen on job sites, especially in construction or forestry, are soft tissue damage, fractures, and non-union which occurs after a fracture has been unsuccessfully treated.

The injuries can be caused by slips, trips, falls, collisions, lacerations, punctures, muscle strains, and being hit by falling objects.

Some of these injuries are not serious and you can get back to work in a day or two, but in some cases, especially with broken bones, your recovery will take quite a bit more time.

So what happens after you’ve been injured on the job? Immediate medical attention will let you know if you’ve got a soft-tissue injury or something more serious.

Injury treatment

The objective of workplace injury treatment is to get you, the worker, back on your feet as soon as possible without having to rely long-term on painkillers to get through the day. The kind of treatment you get depends on the type of injury you’ve got.

Soft tissue injuries

Bruises, sprains, strains, and stress injuries along with bursitis and tendonitis are all considered soft-tissue injuries. They can be divided into grades according to severity.

• Grade 1 injuries present with pain and swelling, but can be treated at home and heal in two or three weeks.
• Grade 2 injuries can take up to 3 months to heal, and full recovery depends on physiotherapy.
• Grade 3 injuries involve a complete rupture or tear of soft tissue and sometimes a fractured bone can be involved. Urgent medical attention is required, and surgery will most likely be needed. Recovery times can be very long.

Fractures

There are several different types of fractures or breaks that can be caused by an accident at work. In adults, the most common fractures are:

• Comminuted fracture: the bone is broken into two or more pieces.
• Hairline fracture: a thin, small, barely visible crack in the bone. A hairline fracture may not show up in an X-ray.
• Impacted fracture: a break where a bone fragment is forced into another bone fragment.
• Longitudinal fracture: the fracture is vertical, or along the length of the bone
• Oblique fracture: the fracture is on an angle
• Spiral fracture: a break that has been caused by a twisting motion.
• Stress fracture: a break caused by repetitive motion, stress, and strain. It is more common among athletes but can be caused by repetitive motions performed on the job.
• Transverse fracture: a fracture that is horizontal or straight across the bone.

Fractures can be proximal (top of the bone) or distal (bottom of the bone). Other types of fractures do exist, but are either more common in children or are caused by disease rather than accidents.

Fracture treatment

Fractures are not something that can be treated at home; you must seek medical attention. In all cases, for proper healing to occur, the bone must be placed back in correct alignment and immobilized. For minor fractures, a splint may be enough to permit a necessary amount of swelling and to keep the bone fixed in place. A cast may be required to further ensure immobilization.

Afterward, a person may have the cast removed and have a plastic, removable brace placed on the broken limb which will allow them to walk. For an uncomplicated fracture, immobilization could last anywhere from 2 to 8 weeks.

For more complex cases, fractures might be treated with metal plates and screws attached to the outer surface of the bone fragments to hold everything together. Intramedullary nails might be used: this is when a metal rod is placed along the shaft of the bone, through the fracture, and kept in place by a transverse nail.

In cases where intramedullary nails, plates and screws, or casts are inappropriate, external fixation with steel pins that go through the skin to the bone is an option.

If you have a fracture where the bone has fractured the skin, you need immediate urgent medical attention. You may also require surgery.

Healing

But how do bones heal after they are fractured?

Briefly, there are two types of bone cells involved in healing. Osteoclasts absorb damaged bone, while osteoblasts help build new bone. The new bone material is called callus, and it grows on the ends of the bone’s fractured parts, eventually filling in the gaps. The bone will eventually regain its normal, pre-fracture appearance.

The time it takes for the bone to heal completely depends on a few factors, but smoking and old age slow the process down. Physiotherapy will most likely be required to build up strength in the immobilized muscles, and if the skin had been broken, plastic surgery might be needed.

In all, healing time can take a few weeks to a few months.

Non-union

Unfortunately, bones don’t always heal properly, due to improper fixation at the time of treatment or due to other factors, such as fractures caused by high-energy trauma, or a high degree of soft tissue damage.

Delayed union is when the bones take much longer to fuse together, and non-union is when the bones don’t heal at all. Sometimes, healing can only occur with some form of intervention such as surgery or LIPUS (discussed below); without this intervention, there is no healing and non-union occurs. Non-union can be as high as 1.9% in women and 2.3% for men.

Luckily, there are treatments that can help prevent non-union, such as Low-Intensity Pulsed Ultrasound (LIPUS). A non-invasive treatment, it induces a regenerative effect on bone and other tissue by using low intensity, pulsed mechanical waves. A Melmak LIPUS device can heal 86% of non-union fractures, and can also help speed up the healing process for fresh breaks.

Therapy with a Melmak LIPUS device can take several months, depending on injury type and severity. Individual therapeutic sessions take about twenty minutes. The number of sessions prescribed will again depend on the severity, location, and type of fracture. Fortunately, if you can’t afford to buy the device, you can rent one from certain medical clinics to keep costs down. If you got injured while at work and you have WCB (Workers Compensation Board) insurance, you’ll be glad to know that LIPUS devices such as Melmak are covered.

Conclusion

We have a good workplace accident record in Canada compared to other countries, but as the numbers show, accidents still occur. Fractures are serious injuries that can occur at work, and you can be off the job for many months while waiting for the bones to heal. While most bones will heal without surgery, surgical intervention is sometimes required.

Further therapeutical treatment might be needed; physiotherapy will get the muscles strong and functional again, while LIPUS can help speed up the recovery process and heal non-union fractures. Overall, good accident prevention is crucial, and when accidents do happen, prompt medical action, fixation, and LIPUS all contribute to getting you back to normal as soon as possible.

References

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Heckman JD, Ryaby JP, McCabe J, et al. Acceleration of tibial fracture healing by non-invasive, low-intensity pulsed ultrasound. J Bone Joint Surg Am 1994;76:26-34.

Karladani AH, Granhed H, Karrholm J, Styf J. The influence of fracture etiology and type on fracture healing: A review of 104 consecutive tibial shaft fractures. Arc Orthop Trauma Surg 2001;121 (6):325.

Kristiansen TK, Ryaby JP, McCabe J, et al. Accelerated healing of distal radial fractures with the use of specific, low-intensity ultrasound. A multicenter, prospective, randomized, double-blind, placebo-controlled study. J Bone Miner Res 1997;79:961-73.

Lerner A, Stein H, et al. Compound high-energy limb fractures with delayed union: our experience with adjuvant ultrasound stimulation (exogen). Ultrasonics. 2004;42:915–917.

Leung K-S, Lee W-S, Tsui H-F, et al. Complex tibial fracture outcomes following treatment with low-intensity pulsed ultrasound. Ultrasound Med Biol 2004; 30(3): 389-95.

Nolte PA, van der Krans A, Patka P, Janssen IM, Ryaby JP, Albers GH. Low-intensity pulsed ultrasound treatment of nonunions. J. Trauma. 2001;51:693–703.

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