Table of Contents
Fracture is a break in a BONE. The most common cause of bone fracture is traumatic injury. Spontaneous fracture may occur in people who have health conditions such as OSTEOGENESIS IMPERFECTA, severe OSTEOPOROSIS, or BONE CANCER. Fractures may take various forms, including
Types of Fractures
- avulsion, in which a small chip of bone breaks away
- closed (simple), in which the bone ends remain relatively in alignment and do not penetrate through the SKIN
- comminuted, in which the bone fragments into multiple pieces
- compression, in which the bones collapse onto one another (such as vertebrae in the back) • greenstick, which typically occur in young children whose bones are still supple and appear as a bend or curve rather than an outright break in the bone
- open (compound), in which the bone ends are significantly separated and protrude through the skin, causing an open wound
- spiral, which occur when sudden force twists the bone and the break runs in line with the bone’s axis
- stress, in which hairlike cracks develop in bones subject to repetitive stress (such as the tibia, the long bone in the lower leg, with running)
Bone fractures require prompt care from a doctor. Nearly always it is necessary to immobilize the bone ends so they remain aligned and can heal back together.
Do NOT move a person who may have a fractured neck or back. Summon emergency medical aid and keep the person still, calm, and as comfortable as possible.
Symptoms and Diagnostic Path
Severe PAIN and rapid swelling after trauma are the most common symptoms of bone fracture. Most often, the person cannot bear weight or put pressure on the involved area. The limb or digit may appear distorted or a bone end may protrude through the skin. X-RAY nearly always confirms the diagnosis, though more sophisticated imaging procedures such as MAGNETIC RESONANCE IMAGING (MRI) and bone scan are occasionally necessary to confirm stress fractures and some spiral fractures.
Treatment Options and Outlook
Treatment immobilizes the bone ends. The most common method of immobilization is a plaster or fiberglass cast, applied as a wet wrap around the fracture and usually spanning the joints above and below the break in the bone. The cast hardens as it dries, and remains in place for three to six weeks for most fractures. Other methods of external immobilization include splints and braces.
Sometimes the doctor must move the bone ends into alignment, a procedure called reduction. For most fractures that require reduction, the doctor first administers a strong sedative or ANESTHESIA, then manipulates the bones. When no incision is necessary the reduction is a closed reduction; when the doctor must open the fracture site to realign the bones the reduction is an open reduction (surgery). During an open reduction the doctor generally places pins, plates, screws, or nails to hold the bone ends in place. Fractures set via open reduction generally do not require casting and the person can return to movement as tolerated because the hardware holds the bone together.
Most fractures heal within 6 to 10 weeks. Immobilized muscles atrophy (shrink), and the person may need PHYSICAL THERAPY to restore MUSCLE STRENGTH and JOINT range of motion after the doctor removes the cast or other immobilizing device. The area of HEALING remains thicker than the rest of the bone for up to a year. Refracture at the same site is very unlikely.
Risk Factors and Preventive Measures
MOTOR VEHICLE ACCIDENTS and athletic or recreational activities that expose a person to impact or falling present the greatest risk for fractures. Older people are vulnerable to fractures with falls, primarily as a consequence of OSTEOPENIA or osteoporosis (conditions in which the bones become thin and weak). Proper protective equipment-for example seat belts, pads, braces, and helmets-can prevent many fractures and other injuries.