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Fractures

What is a fracture?

A fracture, also known as a broken bone, is a condition that alters the contour in the bone. There are many types of fractures. Fractures often occur when there is a high force or impact put on a bone. Fractures are common (over 1 million every year in the US) and can be caused by a number of things. People break bones in sports injuries, car accidents, falls, or from osteoporosis (bone weakening due to aging). Although most fractures are caused by trauma, they can be “pathologic” caused by an underlying disease such as cancer or severe osteoporosis. Medical care is needed immediately after a bone is fractured.

Different types of fractures

Fractures can be closed (the skin is intact) or open also called compound (the skin is open and risk of infection significant). Some fractures are displaced--there is a gap between the two ends of the bone. These often require surgery. A partial fracture is an incomplete break of a bone. A complete fracture is a complete break of a bone causing it to be separated in two or more pieces. Below is a list of the different types of partial, complete, open, and closed fractures.

  • Transverse: when the break is in a straight line across the bone
  • Spiral: when the break spirals around the bone
  • Oblique: when the break is diagonal across the bone
  • Compression: when the bone is crushed, causing the bone to flatten in appearance
  • Comminuted: when the bone fragments into several different pieces
  • Avulsion: when a fragment of bone is pulled off often by a tendon or ligament
  • Impacted: when the bones are driven together

What are the signs and symptoms of fractures throughout the body?

Arm Pain, swelling, abnormal bend, difficulty using or moving arm, warmth, bruising, or redness
Elbow Pain, swelling, bruising, stiffness, a ‘pop’ noise at the time of fracture, or visible deformity
Wrist Pain, swelling, decreased use of hand and wrist, a crooked or deformed appearance, and unable to hold a grip
Hand Pain, swelling, tenderness to touch, stiffness, and weakness. Deformities are not always common.
Finger Pain, swelling, unable to move the finger, a shortened finger, or a depressed knuckle
Leg Severe pain, swelling, tenderness, bruising, obvious deformity, and the inability to walk
Knee Pain, swelling, bruising, inability to straighten the knee and the inability to walk
Ankle Severe pain, swelling, tenderness to touch, bruising, deformity, and the inability to walk
Foot Severe pain, swelling, bruising, numbness in toes and foot, decreased range of motion, inability to walk comfortably, and visible deformity
Toe Pain, swelling, discoloration, and bruising. You should be able to walk, but not comfortably.

What are the causes of a fracture?

Fractures occur when there is a force applied to a bone that is stronger than the bone itself. Fractures can occur from falls, trauma, and a direct blow to a bone. Repetitive forces caused by running can cause a fracture as well. Often these running fractures are termed stress fractures; these are small cracks in the bone. Osteoporosis may also cause a fracture within the older population.

How is a fracture diagnosed?

  • X-ray: X-ray imaging produces a picture of internal tissues, bones, and organs. Most fractures are diagnosed by using an x-ray.
  • Other tests (usually not needed if the fracture is obvious on X-ray)
  • Magnetic resonance imaging (MRI): An MRI is a procedure that produces a more detailed image. It is usually used for smaller fractures or stress fractures.
  • Bone scan: an agent is injected that binds in the area of the fracture where bone turnover is higher than normal.
  • Computed tomography scan (CT, or CAT scan): a three-dimensional imaging procedure that uses a combination of X-rays and computer technology to produce slices or cross-sectional images horizontally and vertically of the body.

How is a bone fracture treated?

A bone fracture is most commonly treated by the use of a cast and/or splint. A cast or splint will immobilize the bone in order to promote bone alignment and prevent use of the bone. In some cases when the bone is small (toes or fingers) no cast is needed and the fracture is immobilized by wrapping. Medication may also be prescribed to ease the pain of the fracture.

Traction may also be necessary to treat a fracture. Traction uses a system of pulleys and weights to stretch the muscles and tendons around the broken bone.

If a fracture is bad enough, surgery may be required. Hip fractures almost always require surgery since non-operative treatments require prolonged immobilization and often result in poor functional outcome. Internal and external rods and/or pins may be used to hold the bone in place in order for bone alignment.

How long does it take for a bone fracture to heal?

It depends. Each person’s healing process is different. It depends on the location of the fracture, the severity of the break, age, and nutritional status. For example, a fractured leg is going to take a lot longer to heal than a fractured finger. Generally, younger individuals heal faster than older individuals. Proper nutrition also plays a role. The average healing process takes anywhere from 6 to 8 weeks.

What are the possible complications of a bone fracture?

  • Compartment syndrome: raised pressure within a closed part of the body (compartment) that cuts off blood supply to muscles and nerves, often caused by bleeding and hematoma around the fracture site.
  • Haemarthrosis: bleeding into a joint space causing the joint to swell
  • Shock
  • Blood clot in a blood vessel : blockage of a blood vessel which can break off and move through the body
  • Complications from casting such as pressure ulcers, and joint stiffness
  • Delayed bone healing
  • Damage to surrounding tissue, nerves, skin, blood vessels, or nearby organs
  • Wound infection

How can I prevent fractures?

Falling is the main cause of fractures. There are several ways to prevent falling both indoors and outdoors.

Indoors
  • Keep rooms free of clutter.
  • Eliminate wires and cords that run across the walking areas.
  • Wear shoes, not just socks, in the house.
  • Be sure each room is well lit.
  • Use skid-free rugs throughout the house if you must use rugs.
  • Use a cane or walker if you need to.
  • Make sure your vision is as good as it can be. Get yearly eye exams and make sure to use your glasses or contacts.
  • If your balance is poor balance training and physical therapy are important.
Outdoors
  • Use a cane or walker if you need to.
  • Wear rubber-soled shoes.
  • Put salt down on icy sidewalks, driveways, and steps.
  • Use care at curbs.
  • Pay attention to your surroundings.
  • Leave a porch light or outside light on if you are returning after dark.

Many fractures are a result of osteoporosis, a loss of calcium in bones. Prevention is important. Get enough calcium (1200-1500mg in diet or supplements) and vitamin D (800-1000IU) each day to keep bones strong. As we age, we are more likely to have weak bones. When bones get weak, it is very easy for them to break.

A multi-vitamin usually contains 400IU vitamin D and calcium tablets can have additional vitamin D. Some examples of food that contain these important nutrients are:

  • Dairy products: milk, yogurt, and eggs
  • Whole grains: brown rice, oats, and rye
  • Vegetables: broccoli, spinach, and kale
  • Beans: chickpeas, black beans, and tofu
  • Almonds

It is also important to get plenty of weight bearing exercise (exercise that involves heel strike activity such as walking) each day to keep bones strong and healthy.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/25/2013…#15241