Fractures

Any bone in the body can be fractured. Most fractures are caused by an injury such as a direct impact or a twisting movement, which may occur during an athletic activity or a fall.

Susceptibility to fractures increases with the bone disorder osteoporosis, which mainly affects women after the menopause and results in brittle bones. Fractures that occur in bones affected by tumours are called pathological fractures and may occur after minor injury or even spontaneously.

The most common sites of fracture in elderly people are the neck of the femur (thighbone) and the lower end of the radius bone of the forearm near the wrist. A fracture at the end of the radius, known as a Colles’ fracture, may occur if a person trips and breaks his or her fall with an outstretched arm.


What are the types?

There are two main types of fracture: closed (simple), in which the broken bone does not break through the over-lying skin; and open (compound), in which the bone pierces the skin and is exposed. Open fractures are more serious because of the risk of infection and an increased risk of damage to nerves and blood vessels. Open and closed fractures may be further subdivided according to their shape and pattern.

Transverse fracture: in a transverse fracture, there is a straight break across a bone. Transverse fractures, often in a long bone in the arm or leg, are usually due to a powerful blow, such as that sustained in a collision during a traffic accident.

Spiral facture: this type of fracture is also known as an oblique fracture. Spiral fractures are usually caused by sudden, violent, rotating movements, such as twisting the leg during a fall. Spiral factures usually occur in arm and leg bones.

Greenstick fracture: if a long bone in the arm or leg bends, it may crack on one side only, producing a break called a “greenstick” fracture. This type of fracture occurs only in children, whose bones are still growing and flexible.

Comminuted fracture: in a comminuted fracture, the bone is broken into small fragments, which increases the likelihood of damage to soft tissue surrounding the broken bone. These fractures are usually caused by severe, direct forces.

Avulsion fracture: in this type of fracture, a piece of bone is pulled away from the main bone by a tendon, a fibrous band that attached muscle to a bone. It usually results from a sudden violent twisting injury.

Compression fracture: a compression fracture occurs if spongy bone, like that in the vertebrae of the spine, is crushed. This type of fracture is often due to osteoporosis.

Fractures caused by repeated jarring of a bone are called stress fractures. They may occur in the feet or shinbones of long-distance runners. In the elderly, fractures may result from minor stress such as a cough, which can break a rib.

What are the symptoms?


The symptoms of a fracture depend on its type and may include:
- Pain and tenderness, which may limit movement of the affected area.
- Swelling and bruising.
- Deformity in the affected area.
- Crackling noise (crepitus) caused by grating of the ends of the bones on movement or pressure.
- In an open fracture, damage to skin, bleeding, and visible bone.

All fractures cause a certain amount of internal bleeding because of damage to blood vessels in the bone. The broken bone ends may cause further bleeding by damaging tissue and blood vessels in the injured area. In some fractures, blood loss may be severe and can occasionally lead to shock.

Various complications may be associated with a fracture. For example, if you fracture a rib, there is a risk that the broken rib may puncture a lung. An open fracture may become infected.

Delay in treating a fracture properly may result in failure of the bone to heal and permanent deformity or disability. Consult a doctor immediately if you think that you have a fracture.

How is diagnosed?

Your doctor will arrange for you to have X-rays of the affected area to reveal the type and extent of the fracture. CT scanning or MRI may be needed to investigate complex fractures. If a fracture was not due to injury, your doctor may check for a possible underlying disorder that may have weakened your bones.

What is the treatment?

If the broken ends of the bone have been displaced, they will need to be returned to their original position to restore normal shape. This process is known as reduction. Depending on the location and severity of the fracture, a broken bone may be manipulated back into its correct position under local or general anaesthetic, either 1 without an incision (closed reduction) or through an incision in the skin (open reduction). The fractured bone may be held in place until it has healed fully by using one of several methods.

In some cases, it may not be appropriate to immobilize a broken bone. For example, a broken rib is generally not immobilized because the chest needs to expand normally during breathing. This is important to reduce the risk of pneumonia, which can develop as a result of shallow breathing and an impaired ability to cough. As a preventive measure, you may be asked to take deep breaths regularly.

Occasionally, healing is slowed down because not enough blood can reach the fracture site or because the broken bone has not been immobilized effectively. In such cases, surgery may be needed; the splintered bone is removed and bone taken from a different part of the body is grafted in its place. A broken bone, such as a fracture in the femur close to the hip joint, may be replaced with an artificial substitute, in this case comprising either part of the femur or the entire hip joint.

You may need to have physiotherapy after the fracture has healed to restore mobility to a nearly joint and strengthen the surrounding muscles.

What is the prognosis?

In adults, most fractures take 6-8 weeks to heal. Fractures in children generally heal much more quickly. Fractures in babies may heal in a couple of weeks.

FRACTURES TREATMENS

Although some broken bones do not need immobilization, most have to be returned to their correct position (reduction) and held in place so that the fractured ends are able to heal and joint together properly. The method of immobilization chosen for a particular fracture depends on the type, location, and severity of the fracture.


Immobilization in a cast: the simplest form of immobilization is a cast, a rigid casing that is applied to a limb and left in position for several weeks to hold the fractured bone ends together and prevent movement. Casts are usually made from plaster, plastic, or resin. They are removed using an electric saw, which cuts through the cast.

Internal fixation: bones that are severely fractured may need metal plates, screws, nails, wires, or rods to be inserted surgically to hold the broken bone ends together. A cast may not be required. Internal fixation is often used for fractures at the ends of bones.

External fixation: a specialized technique known as external fixation is often required to repair bones that are fractured in several places. In this technique, pins are inserted through the skin into the bone fragments. The pins are help in place by an external metal frame, which allows the affected limb to be used normally within a few days. The frame and pins are removed when the bone has healed.

Traction: traction is used for the temporary immobilization of a fracture until further treatment of the injury can be carried out. The technique is often used for fractures in the shaft of the femur (thighbone). Weights are used to maintain alignment because the powerful muscles in the thigh would normally pull on the ends of the broken bone, forcing them out of alignment.