fracture

DIFFERENT TYPES OF FRACTURES

What is Bone Fracture? Causes and Treatment

When you break a bone, healthcare providers call it a bone fracture. A bone may be completely fractured or partially fractured in any number of ways (crosswise, lengthwise, in multiple pieces). This break changes the shape of the bone. These breaks may happen straight across a bone or along its length. A fracture can split a bone in two or leave it in several pieces.
As there are over 200 bones in the body there are many variations and different types of fractures, and the course of your treatment and recovery will depend on which bone(s) broke and how. In this article, we look at the three primary types of fractures: open, closed, and displaced fractures.

Who gets a bone fracture?

Anyone can break a bone, with certain situations making it more likely. Many people break bones from falls, car accidents, and sports injuries. Medical conditions such as osteoporosis can also play a role. Osteoporosis causes at least one million fractures each year. Healthcare providers call these injuries fragility fractures.

What causes broken bones?

While bones are very strong, they can break. Most often, breaks happen because the bone runs into a stronger force (getting thrown forward in a car crash, say). Also, repetitive forces – like running — can fracture a bone. Healthcare providers call these types of injuries stress fractures.

The most common causes of fractures are:

⦁ Trauma. A fall, a motor vehicle accident, or a tackle during a football game can all result in fractures.

⦁ Overuse. Repetitive motion can tire muscles and place more force on bone. This can result in stress fractures. Stress fractures are more common in athletes.

Another reason for fractures is osteoporosis, which weakens bones as you age. It’s a serious condition, so older adults should speak to a healthcare provider about their risk. The symptoms of a fracture depend on which bone breaks. For example, you’ll likely know right away if you have a problem with your arm, leg, or finger. If you’re not sure, consider these possible symptoms:

⦁ Difficulty using the limb.
⦁ Noticeable and unusual bumps, bends, or twists.
⦁ Severe pain
⦁ Swelling and tenderness around the injury
⦁ Bruising
⦁ Deformity — a limb may look “out of place” or a part of the bone may puncture through the skin.

Types of Fracture

Healthcare providers can usually categorize a bone fracture based on its features. Bones are rigid, but they do bend or “give” somewhat when an outside force is applied. However, if the force is too great, the bones will break, just as a plastic ruler breaks when it is bent too far.

Closed or open fractures: If the injury doesn’t break open the skin, it’s called a closed fracture. If the skin does open, it’s called an open fracture or compound fracture.

Complete fractures: The break goes completely through the bone, separating it in two.

Displaced fractures: A gap forms where the bone breaks. Often, this injury requires surgery to fix.

Partial fractures: The break doesn’t go all the way through the bone.

Stress fractures: The bone gets a crack in it, which is sometimes tough to find with imaging.

In addition, to open, closed, and displaced fractures, broken bones are further categorized by other measures. These include:
• Greenstick fractures – Exclusive to children, greenstick fractures describe bones that have bent but not completely broken.
• Comminute fracture – A fracture that shatters into three or more pieces.
• Pathologic fracture – A fracture caused by a disease that weakened the bone, such as osteoporosis.
• Transverse fracture – a horizontal fracture in the long segment (shaft) of the bone.

The severity of a fracture usually depends on the force that caused the break. If the bone’s breaking point has been exceeded only slightly, then the bone may crack rather than break all the way through. If the force is extreme, such as in an automobile crash or a gunshot, the bone may shatter. If the bone breaks in such a way that bone fragments stick out through the skin, or a wound penetrates down to the broken bone, the fracture is called an “open” fracture. This type of fracture is particularly serious because once the skin is broken, infection in both the wound and the bone can occur.

Diagnosis

Your doctor will do a careful examination to assess your overall condition, as well as the extent of the injury. He or she will talk with you about how the injury occurred, your symptoms, and your medical history.

You will also likely have one or more imaging tests. These tests can include:

X-rays: This tool produces a two-dimensional picture of the break. Healthcare providers often turn to this imaging first.

Bone scan: Healthcare providers use a bone scan to find fractures that don’t show up on an X-ray. This scan takes longer — usually two visits four hours apart — but it can help find some fractures.

CT scan: A CT scan uses computers and X-rays to create detailed slices or cross-sections of the bone.

MRI: A MRI creates very detailed images using strong magnetic fields. MRI is often used to diagnose a stress fracture.

Treatment

Functional Cast or Brace: The cast or brace allows limited or “controlled” movement of nearby joints. This treatment is desirable for some, but not all, fractures.

Traction: Traction is usually used to align a bone or bones by a gentle, steady pulling action.

External Fixation: In this type of operation, metal pins or screws are placed into the broken bone above and below the fracture site. The pins or screws are connected to a metal bar outside the skin. This device is a stabilizing frame that holds the bones in the proper position while they heal.

In cases where the skin and other soft tissues around the fracture are badly damaged, an external fixator may be applied until surgery can be tolerated.

Open Reduction and Internal Fixation: During this operation, the bone fragments are first repositioned (reduced) in their normal alignment, and then held together with special screws or by attaching metal plates to the outer surface of the bone. The fragments may also be held together by inserting rods down through the marrow space in the center of the bone.

Recovery

Fractures take several weeks to several months to heal, depending on the extent of the injury and how well you follow your doctor’s advice. The pain usually stops long before the fracture is solid enough to handle the stresses of normal activity. Even after your cast or brace is removed, you may need to continue limiting your movement until the bone is solid enough for normal activity.

During your recovery, you will likely lose muscle strength in the injured area. Specific exercises will help you restore normal muscle strength, joint motion, and flexibility.

Are there complications with bone fracture?

As with many injuries, a fractured bone can lead to complications. These can include:

Blood clots: Blockage of a blood vessel that can break free and move through the body.

Cast-wearing complications: Can include pressure ulcers (sores) and joint stiffness.

Compartment syndrome: Bleeding or swelling within the muscles surrounding the fracture.

Hemarthrosis: Bleeding into the joint, causing it to swell.

Prevention

You can prevent many fractures by avoiding falls, staying in shape, and getting the right vitamins and minerals.

Avoiding falls: Following certain tips can help you stay upright indoors and out.

Indoors:

Balance: Consider balance training and physical therapy if your body feels off. Use a cane or walker if you need to.

Clutter removal: Keep your rooms picked up. Make sure wires and cords don’t cross walkways.

Lights: Make sure your rooms all have good lighting.

Rugs: Use skid-free mats under any rugs you need.

Shoes: Wear shoes – not just socks – when you’re home.

Vision: Check your eyesight with an eye exam by an optometrist.

Outdoors:

Attention: Pay attention to your surroundings. Watch for anything that could turn into an obstacle or cause you to trip.

Balance: Use a cane or walker and wear rubber-soled shoes for a better grip.

Curbs: Take care of curbs. Watch your footing as you step up.

Lights: Leave a porch light on if you will come home after dark.

Weather: Keep sidewalks, driveways, and steps free of ice and snow. Use salt to help keep them clear.

Staying fit

Weight-bearing exercise such as walking helps keep bones healthy and strong. Exercises that build or maintain muscles can also improve balance.

Eating right

To promote bone strength, watch your diet. Make sure to get 1200 to 1500 milligrams (mg) of calcium each day. Also, get 800 to 1000 international units (IU) of vitamin D. Certain foods provide good sources of these nutrients:
⦁ Almonds.
⦁ Beans such as chickpeas, black beans, and tofu.
⦁ Dairy such as milk and yogurt.
⦁ Eggs.
⦁ Vegetables such as broccoli, spinach, and kale.
⦁ Whole grains such as brown rice, oats, and rye.

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