Fractures

A fracture typically refers to a broken bone. It occurs when a force exerted against the bone is stronger than the bone can structurally withstand. Bones can break either partially or completely in a number of directions, including cross-wise, lengthwise or in the middle. In some cases, fractures cause little pain or may even go unnoticed. Usually patients experience severe or moderate pain.

Less commonly, cartilage can fracture, such as in the trachea, ribs, nose or ear. A bone fracture can also involve fracturing of the cartilage on the end of that bone. Bones form the human frame (skeleton) that supports and protects the organs and other softer parts of the body. Contrary to popular belief, bones are not static or lifeless. They are a form of connective tissue, with new cells replacing old ones throughout a person’s life. Large bones have a center made of marrow, which has cells that develop into red blood cells red blood cells (which carry oxygen to all parts of the body) and white blood cells (which help fight disease). The minerals calcium and phosphorus are also found in bones.

Fractures can occur in any bone but are most likely to occur in the wrist, ankle or hip:

Other areas prone to fractures include the spine, ribs, arm, fingers, leg, ankle, heel, foot, clavicle (collar bone) and jaw.

Fractures vary in severity, with several factors determining the significance of a fracture. Such factors include the degree and direction of the force placed upon the bone, the type of bone involved and the person’s age and general health.

In some cases, complications may be associated with bone fractures.

There are several types of fractures. Bones can either break completely or partially. Complete bone breaks are categorized as:

• Closed fracture. Fracture that does not lacerate the skin.
• Open fracture. Also known as a compound fracture, it is a break in which the ends of the broken bone lacerate the skin. In some cases, the blow or injury that caused the break may be responsible for the laceration. The bone may or may not be visible in an open fracture. There is an increased risk of infection with these fractures.
• Nondisplaced fracture. Fracture in which the pieces on either side of the break line up.
• Displaced fracture. Fracture in which the pieces on either side of the break do not line up. The bones of displaced fractures may require surgery to make sure they are properly aligned before casting, or may need reduction.
• Transverse fracture. Fracture at right angles to the long axis of the bone.

There are several types of partial fractures that may occur.

Finally, there are two types of fractures that are more likely to occur in children. Children’s bones are more likely to bend than to break because their bones are softer than adults. They are:

• Buckle or torus fracture. One side of the bone bends – creating a raised “buckle” – without breaking the other side.
• Greenstick fracture. Partial fracture in which one side of the bone is broken and the other side bends.

Children also are vulnerable to fractures that damage the growth plates at the end of bones that regulate bone growth. If growth plates do not heal properly after a fracture, the bone may grow at an angle or grow more slowly than normal. For this reason, pediatricians closely monitor fractures in children to ensure that no damage to the growth plate has occurred.

There are many causes of bone fractures.

In addition, people can experience dizziness due to conditions such as vertigo or orthostatic hypotension (a drop in blood pressure when moving from sitting to standing) or medications such as antihypertensives, anesthetics or some birth control pills. These individuals are advised to take precautions against fainting and falls.

Some medical treatments can increase the risk of osteoporotic fractures. They may include radiation therapy to the pelvic area, use of corticosteroids (taken for a wide range of conditions, from herniated discs to carpal tunnel syndrome to asthma), hormone therapy for prostate cancer, and possibly use of certain anticoagulants.

When a person fractures a bone, it is usually obvious. A snap or cracking sound may be evident, followed by pain, tenderness and swelling. In some cases, a limb may be deformed, or the bone may penetrate the skin.

When a bone fractures, emergency care should be summoned if the injury is serious. This includes situations in which the patient is seriously injured in the head, neck or back, or if the broken bone lacerates the skin.

Stress fractures are tiny cracks in a bone that usually result from overuse or repetitive application of force (such as the pavement against a foot bone during jogging). Stress fractures may be barely noticeable when they first occur, but may get worse over time. A femoral stress fracture in the thigh is a common condition in runners.

In contrast, the first sign of a spinal compression fracture is a decrease in the person’s height. Pain is often a late symptom that may go unnoticed in the beginning, although in some cases excruciating pain is felt early. Osteoporosis is a common predisposing factor for compression fractures.

Fractures typically diagnose themselves, as most people experience symptoms that make it obvious that they have broken a bone. However, a physician will typically review a medical history and perform a physical examination (including checking for swelling and tenderness).

Stress fractures can be more difficult to diagnose and may not always appear on an x-ray. However, patients who suffer stress fractures often experience pain, tenderness and mild swelling.

A cartilage fracture, such as to the costal cartilage in the ribs, may be diagnosed with a CAT scan or ultrasound.

When a fracture is suspected, the patient should seek immediate medical care. If the injury appears to be serious, an ambulance should be called. Less serious injuries can be stabilized through the following steps:

• Remove clothing from the injured area. If necessary, use scissors to remove clothing rather than trying to force an injured limb through a sleeve or pant leg.
• Apply a cold compress or an ice pack wrapped in cloth to the area.
• Place a makeshift splint on the injured body part. This should consist of soft padding around the injured part and be taped together with something firm, such as a board or rolled-up newspaper. The firm piece should extend above and below the injured part to help keep it in place.
• Seek medical care. Avoid eating in case surgery is needed.

The body itself begins the first step in the treatment of a fracture. When a fracture occurs, the body forms a protective blood clot and callus or fibrous tissue. New bone cells begin to grow on either side of the fracture line and eventually grow toward each other. This closes the fracture and the callus is absorbed.

To aid this natural healing process, physicians may use casts, splints, pins or other devices to hold a fracture in the correct position while it heals. The two major types of immobilization devices are:

• External fixation methods. Include plaster and fiberglass casts, cast-braces, splints and other devices. Casts are usually used on fractures, as they encircle the injury and keep it completely fixed in place. However, less serious fractures may require less stringent forms of immobilization, such as a splint (which supports the fractured bone on one side only).
• Internal fixation methods. Use metal plates, pins or bone screws to hold the broken pieces of bone in proper position during healing.

In cases of a displaced fracture - where the bone breaks and comes out of alignment - the bone will need to be set back in the right position. This is known as a closed reduction, and it is performed before casting, splinting or other similar procedures. In more serious cases, surgery may be necessary to successfully realign the bone.

Patients who have casts placed around arm fractures will sometimes be given a sling. This is a piece of cloth with a strap that loops around the back of the neck. Patients place their arm in the cloth, which rests over the chest and abdomen. Slings make it easier for people to support the weight of the cast. Patients who have casts placed around a leg may be given crutches to help them keep weight off the affected leg.

Some fractures, such as a broken hip due to osteoporosis, may require joint replacement. Vertebral fractures may also require surgery.

Fractures usually take anywhere from several weeks to several months to heal. However, pain typically subsides enough to allow the patient to resume using the bone in normal activities long before the fracture has healed.

Stress fractures often require less treatment than traditional fractures and can be healed with cryotherapy and rest. However, casts, splints and surgery all are sometimes used to treat more significant stress fractures.

Not all fractures can be prevented. However, people can take steps to strengthen their bones and make them less susceptible to breaking. Weight-bearing exercises, such as jumping rope, jogging, walking and weight training can strengthen bones by increasing a person’s bone mass.

The risk of stress fractures can be reduced by warming up and stretching before physical activity, which is frequently the cause of these types of fractures. It also helps to start new exercise programs slowly and to build up intensity gradually. People should also wear the appropriate footwear and avoid what are known as the “terrible toos” – exercising too much, too fast, too hard and for too long.

People can also reduce their risk of fractures by taking precautions against trauma, such as wearing seatbelts and observing bicycle safety rules.

Diets with adequate amounts of calcium, vitamin D and possibly soy can decrease the risk of osteoporosis, a bone-thinning disease that often leads to fractures. Some high-risk patients are prescribed osteoporosis medications such as bisphosphonates to help strengthen their bones. These drugs can reduce the risk of fractures by between 40 and 60 percent, according to the Arthritis Foundation. The American College of Rheumatology recommends bisphosphonates for people who require long-term corticosteroid therapy for conditions such as asthma.

Scientists have found that the risk of fractures may be lower in people taking certain medications for other conditions, such as beta blockers (used to treat high blood pressure and some heart conditions) or statins (used to control cholesterol).