Fracture

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A fracture is a broken bone. It can range from a thin crack to a complete break. Bone can fracture crosswise, lengthwise, in several places, or into many pieces. Most fractures happen when a bone is impacted by more force or pressure than it can support.

A bone fracture is a medical condition where the continuity of the bone is broken.If you suspect you have a fracture, seek medical help immediately.

A significant percentage of bone fractures occur because of high force impact or stress.However, a fracture may also be the result of some medical conditions which weaken the bones, for example osteoporosis, some cancers, or osteogenesis imperfecta (also known as brittle bone diseases).A fracture caused by a medical condition is known as a pathological fracture.

Types of bone fracture-

There is a range of fracture types, including:

• Avulsion fracture – a muscle or ligament pulls on the bone, fracturing it.
• Comminuted fracture – the bone is shattered into many pieces.
• Compression (crush) fracture – generally occurs in the spongy bone in the spine. For example, the front portion of a vertebra in the spine may collapse due to osteoporosis.
• Fracture dislocation – a joint becomes dislocated, and one of the bones of the joint has a fracture.
• Greenstick fracture – the bone partly fractures on one side, but does not break completely because the rest of the bone can bend. This is more common among children, whose bones are softer and more elastic.
• Hairline fracture – a partial fracture of the bone. Sometimes this type of fracture is harder to detect with routine xrays.
• Impacted fracture – when the bone is fractured, one fragment of bone goes into another.
• Intraarticular fracture – where the break extends into the surface of a joint
• Longitudinal fracture – the break is along the length of the bone.
• Oblique fracture – a fracture that is diagonal to a bone’s long axis.
• Pathological fracture – when an underlying disease or condition has already weakened the bone, resulting in a fracture (bone fracture caused by an underlying disease/condition that weakened the bone).
• Spiral fracture – a fracture where at least one part of the bone has been twisted.
• Stress fracture – more common among athletes. A bone breaks because of repeated stresses and strains.
• Torus (buckle) fracture – bone deforms but does not crack. More common in children. It is painful but stable.
• Transverse fracture – a straight break right across a bone.

Closed vs. open

A closed fracture is also called a simple fracture. In a closed fracture, the broken bone doesn’t break your skin.

An open fracture is also called a compound fracture. In an open fracture, the ends of the broken bone tear your skin. When your bone and other internal tissues are exposed, it puts you at higher risk of infection.

Incomplete vs. complete

In an incomplete fracture, your bone doesn’t break completely. In other words, it cracks without breaking all the way through. Types of incomplete fracture include:

• hairline fracture, in which your bone is broken in a thin crack
• greenstick fracture, in which your bone is broken on one side, while the other side is bent
• buckle or torus fracture, in which your bone is broken on one side and a bump or raised buckle develops on the other side

In a complete fracture, your bone breaks completely. It’s snapped or crushed into two or more pieces. Types of complete fracture include:

• single fracture, in which your bone is broken in one place into two pieces
• comminuted fracture, in which your bone is broken or crushed into three or more pieces
• compression fracture, in which your bone collapses under pressure
• nondisplaced fracture, in which your bone breaks into pieces that stay in their normal alignment
• displaced fracture, in which your bone breaks into pieces that move out of their normal alignment
• segmental fracture, in which your bone is broken in two places in a way that leaves at least one segment floating and unattached

Incomplete fractures are more common in children. Their bones are softer than those of adults. As a result, they’re more likely to bend than break. Complete fractures can happen at any age.

causes

Most fractures are caused by a bad fall or automobile accident. Healthy bones are extremely tough and resilient and can withstand surprisingly powerful impacts. As people age, two factors make their risk of fractures greater: Weaker bones and a greater risk of falling.

Children, who tend to have more physically active lifestyles than adults, are also prone to fractures.

People with underlying illnesses and conditions that may weaken their bones have a higher risk of fractures. Examples include osteoporosis, infection, or a tumor. As mentioned earlier, this type of fracture is known as a pathological fracture.

Stress fractures, which result from repeated stresses and strains, commonly found among professional sports people, are also common causes of fractures.

Fast facts on fractures

Here are some key points about fractures. More detail and supporting information is in the main article.

• Most bone fractures are caused by falls and accidents.
• Bone fractures caused by disease are referred to as pathological fractures.
• A compound fracture is one that also causes injury to the overlying skin.
• There are a number of different types of fractures, including avulsion, comminuted, and hairline fractures.
• Bone healing is a natural process, treatment revolves around giving the bone optimum conditions to heal itself.

Symptoms

The signs and symptoms of a fracture vary according to which bone is affected, the patient’s age and general health, as well as the severity of the injury. However, they often include some of the following:

• pain
• swelling
• bruising
• discolored skin around the affected area
• angulation – the affected area may be bent at an unusual angle
• the patient is unable to put weight on the injured area
• the patient cannot move the affected area
• the affected bone or joint may have a grating sensation
• if it is an open fracture, there may be bleeding

When a large bone is affected, such as the pelvis or femur:

• the sufferer may look pale and clammy
• there may be dizziness (feeling faint)
• feelings of sickness and nausea.

If possible, do not move a person with a broken bone until a healthcare professional is present and can assess the situation and, if required, apply a splint. If the patient is in a dangerous place, such as in the middle of a busy road, one sometimes has to act before the emergency services arrive.

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Doctor Examination

Your doctor will do a careful examination to assess your overall condition, as well as the extent of the injury. He or she will talk with you about how the injury occurred, your symptoms, and medical history.

The most common way to evaluate a fracture is with x-rays, which provide clear images of bone. Your doctor will likely use an x-ray to verify the diagnosis. X-rays can show whether a bone is intact or broken. They can also show the type of fracture and exactly where it is located within the bone.

fracture diagnosis

Most fractures are caused by a bad fall or automobile accident. Healthy bones are extremely tough and resilient and can withstand surprisingly powerful impacts. As people age, two factors make their risk of fractures greater: Weaker bones and a greater risk of falling.

Children, who tend to have more physically active lifestyles than adults, are also prone to fractures.

People with underlying illnesses and conditions that may weaken their bones have a higher risk of fractures. Examples include osteoporosis, infection, or a tumor. As mentioned earlier, this type of fracture is known as a pathological fracture.

Stress fractures, which result from repeated stresses and strains, commonly found among professional sports people, are also common causes of fractures.

Complications

Heals in the wrong position – this is known as a malunion; either the fracture heals in the wrong position or it shifts (the fracture itself shifts).

Disruption of bone growth – if a childhood bone fracture affects the growth plate, there is a risk that the normal development of that bone may be affected, raising the risk of a subsequent deformity.

Persistent bone or bone marrow infection – if there is a break in the skin, as may happen with a compound fracture, bacteria can get in and infect the bone or bone marrow, which can become a persistent infection (chronic osteomyelitis).

Patients may need to be hospitalized and treated with antibiotics. Sometimes, surgical drainage and curettage is required.

Bone death (avascular necrosis) – if the bone loses its essential supply of blood it may die.

risk factors

Anyone can be experience a fracture. But you’re more likely to develop one if you have brittle bones, or low bone density. You’re more likely to develop brittle bones if you:

• are older
• have osteoporosis
• have endocrine or intestinal disorders
• are taking corticosteroids
• are physically inactive
• drink alcohol
• smoke

Diagnosis

Medical intervention focuses on supporting the bone as it heals naturally.

A doctor will carry out a physical examination, identify signs and symptoms, and make a diagnosis.

The patient will be interviewed – or friends, relatives, and witnesses if the patient cannot communicate properly – and asked about circumstances that caused the injury or may have caused it.

Doctors will often order an X-ray. In some cases, an MRI or CT scan may also be ordered.

Bone healing is a natural processTrusted Source which, in most cases, will occur automatically. Fracture treatment is usually aimed at making sure there is the best possible function of the injured part after healing.

Treatment also focuses on providing the injured bone with the best circumstances for optimum healing (immobilization).

For the natural healing process to begin, the ends of the broken bone need to be lined up – this is known as reducing the fracture.

The patient is usually asleep under a general anesthetic when fracture reduction is done. Fracture reduction may be done by manipulation, closed reduction (pulling the bone fragments), or surgery.

Immobilization – as soon as the bones are aligned they must stay aligned while they heal. This may include:

• Plaster casts or plastic functional braces – these hold the bone in position until it has healed.
• Metal plates and screws – current procedures may use minimally invasive techniques.
• Intra-medullary nails – internal metal rods are placed down the center of long bones. Flexible wires may be used in children.
• External fixators – these may be made of metal or carbon fiber; they have steel pins that go into the bone directly through the skin. They are a type of scaffolding outside the body.

Usually, the fractured bone area is immobilized for 2-8 weeks. The duration depends on which bone is affected and whether there are any complications, such as a blood supply problem or an infection.

How is a fracture treated?

If you’re diagnosed with a fracture, the treatment plan will depend on its type and location.

In general, your doctor will try to put the broken bone pieces back into their proper positions and stabilize them as they heal. It’s important to keep pieces of broken bone immobile until they’re mended. During the healing process, new bone will form around the edges of the broken pieces. If they’re properly aligned and stabilized, the new bone will eventually connect the pieces.

Your doctor may use a cast to stabilize your broken bone. Your cast will likely be made from plaster or fiberglass. It will help keep the injured area stabilized and prevent broken bone pieces from moving while they heal.

In rare cases, you may need traction to stabilize the injured area. Traction stretches the muscles and tendons around your bone. Your doctor will administer it using a system of pulleys and weights positioned in a metal frame over your bed. This system will produce a gentle pulling motion that your doctor can use to stabilize the injured area.

For more complex or compound fractures, you may need surgery. Your doctor may use open reduction, and internal fixation or external fixation to keep your bones from moving.

In open reduction and internal fixation, your doctor will first reposition or “reduce” the pieces of broken bone into their normal alignment. Then they will connect or “fix” the broken bone. This occurs by using screws, metal plates, or both. In some cases, your doctor may insert rods through the center of your bone.

In external fixation, your doctor will put pins or screws into your bone above and below the fracture site. They will connect these pins or screws to a metal stabilizing bar positioned on the outside of your skin. The bar will hold your bone in place as it heals.

Your doctor may also prescribe medication to control pain, fight infection, or manage other symptoms or complications. After the initial treatment stages, they may recommend physical therapy or other strategies to help you regain normal use.

healing

Healing – if a broken bone has been aligned properly and kept immobile, the healing process is usually straightforward.

Osteoclasts (bone cells) absorb old and damaged bone while osteoblasts (other bone cells) are used to create new bone.

Callus is new bone that forms around a fracture. It forms on either side of the fracture and grows toward each end until the fracture gap is filled. Eventually, the excess bone smooths off and the bone is as it was before.

The patient’s age, which bone is affected, the type of fracture, as well as the patient’s general health are all factors which influence how rapidly the bone heals. If the patient smokes regularly, the healing process will take longer.

Physical therapy – after the bone has healed, it may be necessary to restore muscle strength as well as mobility to the affected area. If the fracture occurred near or through a joint, there is a risk of permanent stiffness or arthritis – the individual may not be able to bend that joint as well as before.

Surgery – if there was damage to the skin and soft tissue around the affected bone or joint, plastic surgery may be required.

Delayed unions and non-unions

Non-unions are fractures that fail to heal, while delayed unions are those that take longer to heal.

• Ultrasound therapy – low-intensity ultrasound is applied to the affected area daily. This has been found to help the fracture heal. Studies in this area are still ongoing.
• Bone graft – if the fracture does not heal, a natural or synthetic bone is transplanted to stimulate the broken bone.
• Stem cell therapy – studies are currently underway to see whether stem cells can be used to treat fractures that do not heal.

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