What is a fracture?

A bone fracture is a medical disorder in which bone integrity is broken.

A significant percentage of bone fractures occur because of high force impact or stress.

A fracture, however, can also result from some medical conditions that weaken the bones, such as osteoporosis, certain cancers, or imperfecta osteogenesis (also known as brittle bone disease).

A medical condition causing a fracture is known as a pathologic fracture.

Important facts about 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.

What is a bone fracture?

The word “break” is widely used by lay persons (non-professionals).

“Break” is a much less common word when speaking of bones among doctors, particularly bone specialists, such as orthopedic surgeons.

A crack in the bone (and not just a break) is also known as a fracture. There can be fractures in every bone in the body.

A bone can fracture in a variety of different ways; for example, a break to the bone that does not damage the surrounding tissue or tear through the skin is known as a closed fracture.

In the other side, one that affects the skin surrounding and penetrates the skin is known as a fracture compound or open fracture. In general, complex fractures are more severe than simple fractures, since they are infected by definition.

Many human bones are remarkably sturdy, and can stand up to reasonably heavy impacts or forces in general. But if the force is too strong, or something is wrong with the bone, it may fracture.

The older we get the less strength our bones will be able to handle. Since children’s bones are more elastic, they appear to be different when they do have fractures. Children often have growth plates at the end of their bones-growing bone areas-that can often be affected.

Types

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.

Symptoms

The signs and symptoms of a fracture differ by which bone is affected, by the age and general health of the patient, and by the severity of the injury. They also do, however, contain any 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.

Do not move a person with a broken bone until a health care professional is present, if appropriate, who can assess the condition who apply a splint if necessary. If the patient is in a dangerous location, such as in the middle of a busy road, even before the emergency services arrive, one needs to act.

Causes

Most fractures occur as a result of a bad fall or car accident. Strong bones are exceptionally hard and durable, and can withstand powerful impacts. As people age, there are two factors which increase their risk of fractures: weakening bones and greater risk of falling.

Kids, who appear to have more active lifestyles than adults, are vulnerable to fractures, too.

People with underlying disorders and conditions that could weaken their bones are at increased risk of fractures. Examples include osteoporosis, a tumor or an infection. This form of fracture is known as a pathologic fracture, as described earlier.

Often common causes of fractures are stress fractures, which result from repetitive stresses and strains that are usually found in professional sportsmen.

Diagnosis and treatment

A physician may conduct a physical test, recognise signs and symptoms and make a diagnosis.

If the patient is unable to interact adequately, the patient may be interviewed-or friends , family, and witnesses-and asked about conditions that caused or may have caused the accident.

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

Bone healing is a natural process which, in most cases, will occur automatically. The treatment for fractures generally seeks to ensure that the damaged part has the best possible function after healing.

Treatment also focuses on ensuring the optimal conditions for maximum recovery (immobilisation) for the broken bone.

The ends of the fractured bone need to be lined up for the normal healing process to begin-this is known as will the fracture.

When fracture reduction is performed, the patient is normally unconscious under a general anesthetic. Manipulation, closed reduction (pulling the bone fragments), or surgery may be used to minimize fractures.

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.

The fractured region of the bone is normally immobilised for 2-8 weeks. Period depends on which bone is damaged and if complications, such as a problem with blood flow or an infection, occur.

Healing – the healing process generally is simple if a fractured bone has been correctly positioned and held immobile.

Osteoclasts (bone cells) accumulate old bone which is weakened while osteoblasts (other bone cells) are used to produce new bone.

Callus is a new bone formed after a breakage. It forms on either side of the fracture and expands towards either end until it fills the gap in the fracture. The excess bone finally smooths out and the bone is as it had been before.

The age of the patient, the bone is affected, the form of fracture and the general health of the patient are all factors that determine how quickly the bone heals. If the patient smokes daily it may take longer for the healing process.

Physical therapy – Once the bone has healed, muscle strength and mobility will need to be returned to the affected region. If the fracture occurs near or through a joint, there is a chance of lifelong weakness or arthritis-it might not be possible for the person to bend the joint as well as before.

Surgery – if skin and soft tissue damage occurred around the affected bone or joint could require plastic surgery.

Delayed unions and non-unions

Non-union are not healing wounds, whereas delayed unions are the ones 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.

Complications

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

Bone growth disturbance – if a childhood bone fracture damages the growth plate, there is a possibility that the normal development of that bone may be impaired, thus increasing the likelihood of future deformity.

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

Patients can require hospitalisation and antibiotic treatment. Surgical drainage and curettage are often needed.

Bone death (avascular necrosis)-it can die if the bone loses its vital blood supply.

Prevention

Nutrition and sunshine – For healthy bones, the human body requires sufficient calcium supplies. Milk, cheese, yoghurt, and dark-green leafy vegetables are healthy calcium sources.

Our body requires vitamin D to consume calcium-sunlight exposure as well as eating eggs and fatty fish are healthy ways to get vitamin D.

Physical activity – The stronger and denser your bones would be, the more weight-bearing workouts you perform.

Examples involve skipping, jumping, running and dancing – any movement on the skeleton where the body pulls.

Older age results not only in weakened bones but also in less physical activity, which raises the likelihood of weakening bones even more. Staying physically active is essential for persons of all ages.

Menopause – Estrogen, which controls the calcium of a woman, decreases during menopause, making it much more difficult to control calcium. Women also need to be very vigilant about their bone density and strength before and after the menopause.

The following measures can help to reduce the risk of post-menopause osteoporosis:

• Do several short weight-bearing exercise sessions each week.
• Do not smoke.
• Consume only moderate quantities of alcohol, or don’t drink it.
• Get adequate exposure to daylight.
• Make sure your diet has plenty of calcium-rich foods. For those who find this difficult, a doctor may recommend calcium supplements.