Fractures
What is a bone fracture?
A bone fracture is a medical term for when the continuity of bone is broken. It means the same things as a broken bone. A crack (not only a break) in the bone is also known as a fracture. Fractures can occur in any bone in the body. A large percentage of fractures occur because of sudden high force, impact or stress on the bone. Some fractures can be the result of medical conditions that weaken the bone. For example, osteoporosis, some cancers, or osteogenesis imperfecta (brittle bone disease). A bone fracture caused by a medical condition is known as a pathological fracture. Bone healing is a natural process. Treatment (plasters, cast, surgery and otherwise) involve giving the bone optimum conditions to heal itself.
There are several different ways in which a bone can fracture; for example, a break to the bone that does not damage surrounding tissue or tear through the skin is known as a closed fracture. On the other hand, one that damages surrounding skin and penetrates the skin is known as a compound fracture or an open fracture. Compound fractures are generally more serious than simple fractures, because, by definition, they are contaminated and can become infected. They also occur from much higher trauma. The older we get, the less force our bones can withstand. Because children’s bones are more elastic, therefore paediatric fractures tend to be different to adult fractures. Children also have growth plates at the end of their bones – areas of growing bone – which may sometimes be damaged.
Causes of Bone Fractures
Healthy bones are extremely tough and resilient and can withstand surprisingly powerful impacts. However, fractures can be caused due to various reasons, such as:
- Falls
- Accidents
- Direct blow
- Sports injury
- Repetitive Strain Injury (RSI)
- Underlying illness causing weaker bones
Symptoms of bone fractures?
The signs and symptoms of a fracture vary depending on various factors, however, common signs and symptoms of a fracture may include:
- pain
- swelling
- bruising
- discolored skin around the affected area
- angulation with the affected area bent at an unusual angle
- patient is unable to put weight on the injured area
- discomfort in moving or grating sensation in the affected area
- if it is an open fracture, there may be bleeding
- the sufferer may look pale and clammy
- there may be dizziness (feeling faint)
- feeling of sickness and nausea
If possible, do not move a person with a broken bone until a healthcare professional is present to assess the situation.
Types of bone fractures?
- Avulsion fracture is when a muscle or ligament pulls on the bone, fracturing it.
- Comminuted fracture is when the bone is shattered into many pieces.
- Compression (crush) fracture generally occurs when a bone collapses under pressure.
- Fracture dislocation is when a joint becomes dislocated, and one of the bones of the joint has a fracture. These are more serious than simple fractures.
- Greenstick fracture is when 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 because their bones are softer and more elastic.
- Hairline fracture is a partial fracture of the bone. Sometimes this type of fracture is harder to detect with routine x-rays.
- Impacted fracture is when one fragment of the bone goes into another.
- Intraarticular fracture is where the break extends into the surface of a joint.
- Longitudinal fracture is when the break is along the length of the bone.
- Oblique fracture is when a fracture is diagonal to a bone’s long axis.
- Pathological fracture is when an underlying disease or condition has already weakened the bone, resulting in a fracture.
- Spiral fracture is where at least one part of the bone has been twisted.
- Stress fracture is when a bone is broken because of repeated stress and strain. Metatarsal fractures are more common among athletes, sports players, and kids with active lifestyle.
- Torus (buckle) fracture is when a bone deforms but does not crack. More common in children. It is painful but stable.
- Transverse fracture is a straight break right across a bone.
Bone Fracture Diagnosis and Treatment?
To diagnose a fracture, our doctors will:
- carry out a physical examination to identify signs and symptoms of a fracture
- interview the patient and any witnesses about the circumstances that may have caused the injury
- will order an X-ray, MRI or CT Scan if necessary
Fracture treatment focuses on:
- appropriate and optimum immobilization of the fractured bone
- aligning the broken ends of the bone, known as the process of reduction – usually performed with patient asleep under general anesthetic
- supporting the bone’s natural healing process, and
- making sure the best possible function of the injured part after healing
- Physical therapy to help restore muscle strength and mobility after the bone has healed. 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.
Complications in a fracture
Heals in the wrong position – this is known as a malunion; either the fracture heals in the wrong position or it 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.
Fracture prevention
Nutrition and sunlight – the human body needs adequate supplies of calcium for healthy bones. Milk, cheese, yoghurt, and dark green leafy vegetables are good sources of calcium.
Your body needs Vitamin D as it plays a vital role in maintaining healthy bones by absorbing calcium. Exposure to sunlight, as well as eating eggs and oily fish are good ways of getting vitamin D.
Physical activity – the more weight-bearing exercises you do, the stronger and denser your bones will be. Examples include skipping, walking, running, and dancing – any exercise where the body pulls on the skeleton.
Older age not only results in weaker bones, but often in less physical activity, which further increases the risk of even weaker bones. It is important for people of all ages to stay physically active.
How long does it take for a fractured bone to heal?
If a broken bone has been aligned properly and kept immobile, the healing process is usually between 4 to 8 weeks, however the actual time for it to heal can vary. The patient’s age, which bone is affected, the type of fracture, as well as the patient’s general health and cigarette smoking are some of the factors which influence how rapidly the bone heals. If the patient smokes regularly, the healing process will take longer.
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.
Can menopause cause risk of fractures or osteoporosis among women?
Menopause – oestrogen, which regulates a woman’s calcium, drops during menopause, making calcium regulation much more difficult. Consequently, women need to be especially careful about the density and strength of their bones during and after the menopause.
The following steps may help reduce post-menopausal osteoporosis risk:
- 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.
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What is fracture immobilisation?
Immobilising the fracture while keeping bones aligned to support proper healing may include:
- Plaster casts or plastic functional braces to provide pain relief and 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 immobilised for 2-8 weeks. The duration depends on the age of the patient, which bone is affected and whether there are any complications, such as a blood supply problem or an infection.
What is delayed bone union or non-union in fractures?
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.
