Bone Fractures
Broken And Cracked Bones

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Bone Fracture


What Is A Bone Fracture?
What Are The Symptoms?
What Causes Fractures?
Types Of Fractures
How Is A Fracture Diagnosed?
How Is It Treated?
How Long Do Fractures Take To Heal?
What Can Go Wrong With A Bone Fracture?

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Bones and Joint Conditions
What Is A Bone Fracture?

A bone fracture is a crack or break in the bone. When most people think of a bone fracture they think of a cracked bone rather than a broken bone. Doctors and other medical staff however use the term fracture to refer to both a cracked and a broken bone. A fracture can occur in any bone in the body. There are several different ways a bone can fracture. For example, a simple fracture (also called closed fracture) is where there is a clean break in the bone and it does not tear through surrounding tissues. If the tissues are torn, it is called a compound fracture (or open fracture). Compound fractures are usually more serious and raise the risk of infection.

What Are The Symptoms?

The symptoms will depend on the severity of the fracture - if it is partly cracked, or completely broken; which bone is affected and whether the skin is broken. Common symptoms and signs include:

• Swelling.
• Pain.
• Bruising and discoloration in the skin around the affected area.
• Bone may be bent at an unusual angle.
• Unable to move the area.
• Bone or joint may produce a grating sensation when you move it.
• Bleeding if there is an open fracture.
• If a large bone is affected there may be dizziness, paleness and feeling of nausea.

What Causes Fractures?

Most fractures are caused by a bad fall or car accident. Healthy bones are remarkably tough and can withstand surprisingly powerful pressure and impacts. As we age however, our bones weaken and our risk of falling increases, making the risk of fractures greater. People with underlying conditions such as osteoporosis or tumors that weaken the bones are particularly prone to fractures. Every year osteoporosis causes 700,000 spine fractures and 250,000 wrist fractures in the United States. Sometimes the bones become so weak that no obvious trauma is needed to cause a fracture - for example, an abrupt halt or stepping off a curb may provide enough impact to fracture a weak hip bone. Any fracture that occurs as a result of normal activity is called a fragility fracture.

Types Of Fractures

Different types of fractures include:

Comminuted fracture: Bone is shattered in several places.
Compound (open) fracture: Open fracture is where the skin around a broken bone is damaged. In order for an injury to be classified as a compound fracture, bacteria and dirt from the outside air must be able to get to the site of fracture without the barrier of skin. The bone does not have to protrude through the skin (although it may) to be diagnosed with a compound fracture. Open fractures are the most serious type of fracture because of the risk of infection.
Closed (simple) fracture: A clean fracture that does not break the surrounding skin.
Compression (crushed) fracture: Usually occurs in the spongy bone of the spine. The bone may weaken and eventually collapse due to osteoporosis. It can lead to loss of height or stooping known as dowagers hump (see spine curves in our osteoporosis pictures).
Fragility fracture: Technically defined as a fracture that occurs from any fall from a standing height or less. Our body should be able to sustain a fall from this height, so if injury does occur, it means you are likely to have a bone disorder like osteoporosis.
Hairline fracture: A very fine crack that appears in a bone. Hairline fractures are common in older people with weakened bones. Most stress fractures also tend to be hairline fractures.
Greenstick fracture: The bone fractures partly on one side but does not break completely. This is more common in children because their bones are more elastic.
Pathological fracture: When an underlying disease or condition has already weakened the bone, and a fracture occurs. Most pathological fractures are fragility fractures.
Spiral fracture: Fracture caused by a twisting motion which results in a spiral break. Sometimes referred to as torsion fractures.
Stress fracture: A fracture that occurs in a bone weakened by overuse. Commonly seen in athletes. A march fracture is a fracture in the long bones of the foot, seen in tennis players and footballers (called march because it was common in marching foot soldiers). Shin splints are not related. Shin splints are caused by inflammation of the lining of the bone (although also due to overuse).
Transverse fracture: Straight break across the bone.

How Is A Fracture Diagnosed?

Your doctor will perform a physical examination looking for obvious signs of injury. An X-ray will probably also be ordered. Occasionally an MRI scan or CAT scan will be ordered to locate hidden fractures. Skull, ribcage and spine fractures have their own unique diagnosis and treatment process.

How Is It Treated?

Bones naturally repair themselves after injury. Most treatments therefore focus on providing the injured bone with the best conditions for healing itself naturally. This may mean lining up the ends of broken bones (a process called reducing the fracture which is normally done by surgery under general anesthetic), and holding the bone in place while it heals (immobilization with splint of plaster cast for example for 2 to 8 weeks). If the bone is properly aligned and kept immobile for a suitable period of time, healing is usually straight forward. Sometimes the bone will need to be immobilized with screws (internal fixation, see hip fracture) until it heals. These screws may be removed later by further surgery, or in some cases they are left in permanently. The patient may begin working with a physiotherapist soon after surgery to help strengthen muscles. Some hospitals even have specialized geriatric-orthopedic rehabilitation wards for elderly people who sustained injuries. Note: not all fractures require surgery. Surgery is only performed if your doctor thinks the bone is not aligned and is likely to heal in the wrong position. In some instances however, bones that appear to be aligned normally and are splinted turn out to need to surgery when they are found to be unstable on further doctor visits.

How Long Do Fractures Take To Heal?

The following is an estimate of healing times - however if you required surgery (reducing the fracture) to align the bone, healing may be longer.

Injury Time to heal
Collar bone
Shoulder blade (scapula)
Upper arm (humerus)
Lower arm (radius or ulna)
Upper leg (femur)
Knee (patella)
Lower leg (tibia or fibula)
3 to 8 weeks
6 weeks
4 weeks
4 to 10 weeks
6 weeks
4 to 12 weeks
4 to 6 weeks
4 to 6 weeks
12 weeks
4 to 6 weeks
10 to 24 weeks
6 weeks
3 to 12 weeks
3 weeks

What Can Go Wrong With A Bone Fracture?

Heals in wrong position: Known as malunion, the fracture heals in the wrong position.
Infections: With compound fractures bacteria can get into and infect the bone and bone marrow. This can lead to a persistent infection called osteomyelitis. Treatment may require hospitalization and antibiotics and occasionally surgery.
Bone death (avascular necrosis or osteonecrosis): The bone loses some of its blood supply due to injury and dies. After a while the bone collapses and nearby joints become arthritic. It is more common in the shoulder and hip.

  Related Articles on Bones

Symptoms of osteoporosis: Know the warning signs.
Osteopenia: First sign of bone problems?
Losing height with age: What is normal?
Osteoporosis prevention: How to protect your bone health.

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