Fracture

Definition

A fracture is a break in any bone in the body. There are different kinds of fractures:

• The bone may be fractured but stable, which is known as a simple fracture or a closed fracture.
• Bone fragments may be sticking through the skin, which is known as a compound fracture or an open fracture.

Fractures may also be described as:

• Chip ( avulsion fracture )—A small piece of bone is broken away from the main bone and usually attached to a ligament or tendon.
• Compression—The bone is compressed together, such as vertebrae.
• Comminuted—The bone is in pieces.
• Greenstick—One side of the bone is broken and the other side is bent but not broken.
• Intra-articular—The joint is affected.
• Growth plate fracture —A child's developing tissue is fractured.
• Transverse—The bone is broken in a horizontal line that is perpendicular to the surface of the bone cortex.
• Oblique—The bone is broken in a line that is less than a 90° angle to the surface of the bone cortex.
• Spiral—The line of the fracture forms a spiral.
• Stress—A thin fracture line occurs due to overuse rather than a single traumatic incident.

The Bones of the Body

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Causes

Fractures are caused by trauma to the bone. Trauma includes:

• Falls
• Twists
• Blows
• Collisions

Trauma is a physical force applied to the bone that the bone cannot withstand. Stronger bones can withstand more physical force than weaker bones.

Risk Factors

Fractures are more common in older adults.

Factors that increase the risk of fracture include:

• Postmenopause
• Decreased muscle mass
• Osteoporosis —decreased bone mass which weakens bones and affects both men and women
• Certain medication used to treat type 2 diabetes
• Accidents or violence
• Participation in sports
• Malnutrition
• Certain chronic diseases
• Child abuse
• Inactivity
• Conditions that increase the risk of falls, such as nerve or muscle disorders
• Certain congenital bone conditions—rare

Symptoms

Symptoms of a fracture include:

• Pain, often severe
• Instability of the area around the break
• Inability to use the limb or affected area normally
• Swelling or bruising
• Numbness
• Fainting

Diagnosis

You will be asked about your symptoms and how you injured yourself. The injured area will be examined.

Images may be taken of your bodily structures. This can be done with:

• X-rays
• CT scan
• MRI scan
• Bone scan

Treatment

Proper treatment can prevent long-term complications or problems. Treatment will depend on how serious the fracture is, but may include:

Initial Care

Extra support may be needed to protect, support, and keep the fracture in line while it heals. Supportive steps may include a splint, brace, or cast. A sling may be necessary to help stabilize the arm.

Some fractures cause pieces of bone to separate. The doctor will need to put these pieces back into their proper place. This may be done:

• Without surgery—anesthesia will be used to decrease pain while the doctor moves the pieces back into place
• With surgery—pins, screws, plates, rods, or wires may be needed to reconnect the pieces and hold them in place

Children’s bones are still growing at an area of the bone called the growth plate. If the fracture affected the growth plate, a specialist may be needed. Injuries to the growth plate will need to be monitored to make sure the bone can continue to grow as expected.

Healing and Rehabilitation

Healing time ranges from three weeks for a simple finger fracture to many months for a complicated fracture of a long bone. All fractures require rehabilitation exercises to regain muscle strength and joint motion.

Possible Complications

• Delayed union—It takes longer than usual to heal, but does heal.
• Nonunion—The bone does not heal and needs some special treatment.
• Infection—This is more likely to happen after an open fracture or surgery.
• Nerve or artery damage—This usually occurs as a result of severe trauma.
• Compartment syndrome—This is severe swelling in the spaces of the limbs that causes damage to body tissues.
• Late arthritis—This may happen if the surface of a joint is badly damaged.

Prevention

You can reduce your chances of getting a fracture:

• Avoid putting yourself at risk for an accident or other trauma to the bone.
• Do weight-bearing exercise regularly to build and maintain strong bones.
• Do strengthening exercises regularly to build strong muscles and prevent falls.
• Wear protective equipment when playing sports.
• Use proper fitness techniques.