What is a fracture?
A fracture, also known as a broken bone, is a condition that changes the contour (shape) of the bone. Fractures often occur when there is a high force or impact put on a bone.
Fractures are common--there are millions in the United States every year--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). There are more than one million “fragility” fractures every year that are due to osteoporosis. Medical care is needed immediately after a bone is fractured.
What are the types of fractures?
There are many types of fractures:
- A fracture can be closed (the skin is not broken) or open, which is also called a compound fracture (the skin is open and the 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 into two or more pieces.
- A stress fracture, sometimes called a “hairline fracture,” is like a crack and may be difficult to see with regular X-rays.
These are the different types of partial, complete, open, and closed fractures:
- Transverse: the break is in a straight line across the bone.
- Spiral: the break spirals around the bone.
- Oblique: the break is diagonal across the bone.
- Compression: the bone is crushed and flattens in appearance.
- Comminuted: the bone fragments into several different pieces.
- Avulsion: a fragment of bone is pulled off, often by a tendon or ligament.
- Impacted: the bones are driven together.
What are the causes of a fracture?
Fractures occur when a force that is stronger than the bone itself is applied to a bone. Fractures can occur from falls, trauma, and a direct blow to a bone. Repetitive forces caused by running can cause a fracture, as well. These running fractures are often called stress fractures; these are small cracks in the bone. Osteoporosis may also cause a fracture in older people.
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.
Diagnosis and Tests
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, (cross-sectional images), horizontally and vertically, of the body.
Management and Treatment
How is a bone fracture treated?
A bone fracture is usually treated with a cast and/or splint. A cast or splint will immobilize the bone (keep it from moving) in order to encourage the bones to align (straighten) and to 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 used to stabilize and realign fractures before surgery. Traction uses a system of pulleys and weights to stretch the muscles and tendons around the broken bone.
If a fracture is bad enough, the patient may need surgery. Hip fractures almost always require surgery, because other treatments require that the hip remain immobilized for a long time, and often have poor results. Internal and external rods and/or pins may be used to hold the bone in place to allow the bones to align.
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 (a collection of blood outside of the blood vessels) around the fracture. **
- Haemarthrosis: bleeding into a joint space that causes the joint to swell
- Blood clot in a blood vessel: blockage of a blood vessel that 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:
- 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. Have an eye exam every year and be sure to use your glasses or contacts.
- If your balance is poor, balance training and physical therapy are important.
- 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.
As we age, we are more likely to have weak bones. When bones get weak, it is very easy for them to break. Many fractures are a result of osteoporosis, a loss of calcium in bones.
Prevention is important. Get enough calcium every day (1200-1500 mg in diet or supplements) and vitamin D (800-1000 IU) to keep bones strong. A multivitamin usually contains 400 IU 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
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.
Outlook / Prognosis
How long does it take for a bone fracture to heal?
Each person’s healing process is different and depends on the location of the fracture and how severe it is, as well as the patient’s age and nutritional status. For example, a fractured leg will take much longer to heal than a fractured finger. Generally, younger people heal more quickly than older people. Proper nutrition also plays a role. The average healing process takes anywhere from 6 to 8 weeks.
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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 healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.
This document was last reviewed on: 02/07/2017