Fractures occur when the force applied to a bone is stronger than the structural integrity of the bone itself. The most common sites for bone fractures are joints, the ankle, and the hip. Fractures are typically caused by traumas such as falls, traffic accidents, or sports injuries. However, certain medical conditions and repetitive stress on the bones (such as running) can increase the risk of specific types of fractures.
Treatment involves immobilization of bone with plaster cast or surgical insertion of metal rods or plates, and sometimes a complex surgery is required. The time required for complete recovery depends on which bone is fractured, the location of the fracture, and what caused it.
In most cases, treatment requires a plaster that is worn for several weeks, but the recovery period after cast removal takes about a month, sometimes longer.
What are fractures?
A bone fracture is the medical term for a broken bone. If a bone is subjected to more pressure than it can withstand, it will crack or break. Any size of a broken bone is called a fracture. If the broken bone pierces through the skin, it is called an open fracture, often a complex fracture. Stress fracture is a type of fracture that occurs due to repeated or prolonged forces acting on the bone. Repeated stress weakens the bone until it eventually breaks.
Different types of fractures
There are many different classification systems used for fractures, and we will list the most basic ones.
Stable Fracture
A bone that is broken, but with minimal damage. The ends of the bones are arranged, almost the same as before the trauma, which allows for easier healing than with severe fractures.
Open Fracture
A fracture in which there is an open wound or break in the skin near the site of the bone fracture. Often, this wound is caused by a fragment of the bone piercing through the skin at the time of injury. It falls into the category of more severe, complex fractures that require surgical treatment.
Closed Fracture
In closed fractures, the surrounding skin remains intact.
Incomplete Fracture (cracks)
Incomplete fractures such as cracks are fractures that do not pass through the entire bone.
Longitudinal Fracture
These fractures occur along the length of the bone.
Transverse Fracture
The fracture is in a straight line across the bone (perpendicular to the bone’s direction) and can be complete.
Spiral fracture
It occurs in a twisting motion around the bone and is common in twisting injuries. The fracture line resembles a spiral shape. Spiral fractures can be complete fractures and usually occur in long bones (such as the femur, tibia, or humerus).
Greenstick Fracture
A crack or fracture on one side of a long bone in the arm or leg that does not extend all the way through the bone. This means that the bone bends under pressure and cracks but remains in one piece. Children are more likely to have these fractures because their bones are softer and less brittle than adult bones. Treatment involves immobilizing the bone, or in some cases, surgical intervention.
Oblique Fracture
These occur when a bone is broken at an angle. They can also be complete fractures. Oblique fractures are almost always caused by falls or other traumas. Most people require several months to recover from an oblique fracture.
Oblique Fracture
These refer to a bone fracture where the fragments of the bone are crushed or splintered at the site of the fracture.
Fractures with Dislocation
There is a displacement or separation between the fractured bone fragments.
Segmental fractures
These occur when one of the bones is broken in at least two places, leaving a part of the bone completely separated by the fractures. Segmental fractures are almost always caused by severe traumas such as car accidents or falls from heights. They are very serious and often require surgical treatment. Most people take about a year to recover from a segmental fracture.
Stress fractures
Fractures in the form of very small cracks in the bone. The result is trauma that occurs by repeating certain actions and movements. It is usually seen in athletes – especially in long-distance runners. Stress injuries can be found in the lower leg, foot, heel, hip, and lower back.
Avulsion fractures
They occur when a bone moves in one direction while the attached tendon or ligament moves in the opposite direction, causing the bone fragment to break off. The trauma often occurs during sudden changes in direction.
Compression Fractures
The bone is crushed, resulting in a wider or flatter fracture.
Who can get a fracture?
- Individuals involved in sports or accidents.
- Individuals with osteoporosis or other bone diseases.
- Elderly people with an increased risk of falls.
The most injured body parts and common fractures
Fractures of the hand/wrist joint
A broken wrist joint is a fracture or crack in one or more of the bones in your wrist joint. The most common of these injuries occur in the wrist joint when people try to catch themselves during a fall and land on an outstretched hand. The risk of this fracture is higher in athletes involved in skating or snowboarding or individuals with osteoporosis.
Distal radius fracture – The wrist joint consists of two forearm bones called the radius and ulna. The distal radius fracture is the most common type of wrist fracture and is often the result of a fall on an outstretched hand. There are different ways in which the distal radius can break, and it is important to classify the type of fracture in order to treat it effectively.
Scaphoid bone fractures are the second most common type of wrist fracture, but they are difficult to identify and treat. They often occur due to trauma, for example when a person uses an outstretched arm in an attempt to break a fall, but they can also be the result of injuries during sports and car accidents. Treatment depends on the location of the fracture. Fractures closer to the thumb have a higher chance of successful non-surgical measures such as using cast. The healing process becomes more challenging as the fracture moves away from the thumb because that area does not receive the sufficient blood supply necessary for healing. Surgical intervention may also be necessary.
Less common wrist fracture – Barton’s fracture – a fracture of the distal radius with an additional dislocation in the radiocarpal (wrist) joint. Barton’s fracture often requires surgical treatment.
Upper arm fracture
Humerus is the only bone in your upper arm. Because it is strong, it usually takes a strong force of trauma such as a serious fall or car accident to break it. .
Elbow fracture
A fracture of the elbow occurs at the top of the elbow. This can occur as a result of trauma such as a direct blow, a fall on the elbow or a fall on an outstretched arm.
Fractures of the vertebrae
Small fractures or cracks in the vertebrae (bones that make up the spinal column). Fractures in the bones cause weakening and collapse of the spine. Over time, these fractures affect posture. The spine bends forward and the person looks “hunched over” (kyphosis). They are more common in women over 50 years of age. As bones weaken with age and osteoporosis, fractures are more likely to occur. Over time, fractures of the vertebrae lead to collapse and curvature of the spine. Treatment includes rest, medications, braces, and minimally invasive surgery.
Fractures of the vertebrae
Fractures of the clavicle (collarbone) are common and occur due to falls, sports injuries, or car accidents. Although a broken clavicle is painful, most people do not require surgery. Physical therapy can help reduce stiffness and restore strength.
Shoulder fracture
Most of these injuries can be treated without surgery with good long-term outcomes. However, some fractures are better treated with surgery because they may carry a high risk of arthritis or improper healing.
Fractures of the ankle joint
An ankle fracture may involve the fracture of one or more bones that make up the ankle joint. An ankle fracture can range from a simple fracture of one bone to multiple fractures that may require surgery.
Ankle fractures can be classified based on how the bone fragments have shifted from their normal position.
Non-displacement fracture – A non-displaced ankle fracture is a fracture where the bones are not out of place. These fractures do not require surgery.
Dislocation with fracture: An ankle fracture with dislocation is a fracture where the fragments of the broken bone are separated. It can involve a fracture in one, two, or three areas, and the ankle joint can also be dislocated. Most ankle fractures with dislocations require surgical treatment.
Open fracture – When broken bones pierce the skin, the injury is called an open or complex fracture. An open fracture is an emergency and should be surgically treated as soon as possible, to reduce the risk of infection.
Leg fractures
A broken leg (leg fracture) is a fracture or crack of one of the bones of the leg. Common causes include falls, traffic accidents and sports injuries.
The lower leg – The tibia and fibula are the two bones of the lower leg. The tibia is the most fractured long bone in the body. It usually requires significant force to cause this type of fracture. Open fractures are common and require surgical intervention.
Hip fractures
A hip fracture is a serious injury with potentially life-threatening complications. The risk of hip fractures increases with age. The risk is heightened because bones tend to weaken with age (osteoporosis). A combination of medication therapy, poor vision, and balance issues also increases the likelihood of falls in older people, which is one of the most common causes of hip fractures. Hip fractures almost always require surgical intervention or replacement, followed by physical therapy.
Facial fractures
It represents broken bones on the face, which can include the jaw, nose, and eye sockets. Common causes of these fractures are traffic accidents, falls, physical assault and gunshot wounds. Treatment is typically surgical.
Symptoms and Causes
Causes of fractures (bone fractures)
The following are common causes of bone fractures:
- Falls
- Trauma (injuries) or traffic accidents
- Direct kick/impact
- Overload, caused by running, for example, can cause fractures of the foot, ankle, tibia, or hip.
- Osteoporosis or bone conditions such as osteoporosis and certain types of cancer that lead to weakened bones, meaning even minor traumas and falls can become serious.
Fracture symptoms
- Visible deformity of the joint or limb
- Swelling, bruising, or bleeding
- Intense pain
- Numbness and burning sensation
- Pierced skin in the place where the bones protrude (open fracture)
- Limited mobility or inability to move the limb or put weight on the leg
Diagnosis and tests for bone fractures
Physical examination
During a physical examination when assessing bones, if a fracture is suspected, the doctor may notice that the affected part (such as an arm or leg) is swollen or deformed, indicating that the bone segments are not aligned. The doctor may palpate the surfaces of bones and joints to detect any sensitivity, heat, fluid in the joints or abnormal shape.
The doctor also collects detailed information about the manner of injury and data on previous injuries.
Diagnostic imaging (X-ray, CT scanner, MRI)
Diagnostic imaging (X-ray, CT scanner, MRI)
- X-rays will confirm the presence of fractures and show the extent of bone damage.
- Magnetic resonance imaging (MRI): An orthopedist can use MRI to get a complete picture of the bone damage and the surrounding area. MRI will also show soft tissues like cartilage and ligaments around the bones.
- A CT scan will give the doctor or surgeon a more detailed image of the bones and surrounding tissue compared to an X-ray.
Management and treatment of fractures
The treatment of a fracture depends on the type of fracture, the cause, and the extent of bone damage. It may involve the following measures:
Immobilization
If the fracture is minor and the bones have not moved far from their place (or not moved at all), only splints or cast splints worn for five to eight weeks may be required. In both cases, it is likely that subsequent X-rays will be required to confirm that the bones are healing properly.
Orthoses
Orthopedic devices that support fractured bones. The goal of using orthoses for a fracture is to stabilize the fracture and enable early mobilization, which helps the healing process.
Closed Reduction
Reposition involves gentle maneuvers to help the bones return to their proper alignment. This procedure is performed using a local anesthetic or while the patient is under general anesthesia. After closed reduction, the doctor will apply a splint or cast.
Surgery
Some bone fractures require surgery. Depending on the type of fracture and the extent of bone damage, there are several techniques that a surgeon can employ.
Internal fixation
The Surgeon will align (reposition) the bones into the correct position and then secure them in place to allow for healing and regrowth. This often involves the surgeon inserting metal pieces into the bone to hold it in place during the healing process. Internal fixation techniques include rods – inserted through the center of the bone from top to bottom; plates and screws – metal plates screwed into the bone to hold the parts together in place; wires – holding bone fragments in place that are too small for other fixation devices. They are typically used in conjunction with rods or plates. Additional surgeries may be required to remove these elements.
External fixation
The surgeon will place screws into the bone on both sides of the fracture and then connect them with a brace or frame outside the body. This is usually a temporary way to stabilize the fracture.
Arthroplasty
If you fracture a joint (such as the shoulder, elbow, knee, or hip), arthroplasty (joint replacement) may be necessary. The surgeon will remove the damaged joint and replace it with an artificial joint.
Physical therapy and rehabilitation
Physical therapy after a fracture often focuses on overcoming the negative effects of immobilization. Immobilization can result in loss of movement and strength, as well as reduced functional mobility. Physical therapy after a fracture can also help improve functional mobility and typically lasts for several weeks.
Pain control (medications, ice, elevation)
Fractures are often accompanied by pain, for which the doctor may recommend anti-inflammatory medications. Ice packs can also help reduce pain and swelling. Rest is essential for fractures, which includes elevation. This means raising the injured part of the body above the level of the heart. By doing so, pain, pulsation, and swelling are reduced. It is recommended to keep the injured area elevated whenever possible.
Fracture prevention
Use equipment and protection
Always wear a seatbelt when driving. Wear appropriate protective gear for all activities and sports. Ensure that your home and workplace are free of scattered objects that you or your household members could trip over. Always use the appropriate tools or equipment at home to reach things. Never stand on chairs, tables, or work surfaces.
Follow a healthy diet and exercise plan
This will help you maintain good bone health. Talk to your doctor about a bone density test if you are over 50 years or if you have a family history of osteoporosis.
Use a cane or walker
It will help if you have difficulty walking or have an increased risk of falls.
Adequate intake of calcium and vitamin D
Vitamin D reduces bone loss and lowers the risk of fractures, especially in older men and women. Along with calcium, vitamin D also aids in the prevention and treatment of osteoporosis. This vitamin should be part of your diet to promote faster fracture healing.
Prognosis / Perspective
Most people who experience a fracture fully recover and can resume their usual activities once the bone has healed. Some fractures may have a long-term impact on life, especially if other injuries have occurred alongside them. Patients should consult with their surgeon or doctor before engaging in any physical activities or sports during the recovery period.
Factors Affecting Recovery
The time required for bone fracture healing depends on several factors, including:
- The cause of the fracture
- The specific bone that is fractured
- The type of fracture
- The diagnostic and treatment approach required
- Any additional previous injuries
- Age
- Bone conditions (osteoporosis)
Expected Timeframes for Recovery from Different Types of Fractures
Depending on the type of immobilization or surgery, the patient should be able to start moving again in a few weeks. It may take a year or more to heal severe fractures.
Talk to your doctor immediately if you experience intense pain that does not lessen or does not pass!
The importance of following medical advice and treatment plans
To promote faster healing and regain mobility through physical therapy, it is crucial to strictly follow the doctor’s instructions for recovery.
Living with a Fracture
Here are a few things you can do to help your broken bones heal well and faster:
- Immobilization – Resting and maintaining fragments of broken bone in place is an essential factor in facilitating rapid and safe healing.
- A diet rich in vitamins and minerals will contribute to faster bone mineralization.
- Avoid smoking cigarettes and alcohol
- Physical therapy – after removing the plaster or after surgery, physical therapy will be necessary, which restores movement and accelerates recovery.
- Taking vitamin D can help treat broken bones, as well as vitamins C and E.
Adapting daily activities and routines during the healing process
If you are using a cane, crutches, or a walker, you may be moving at a slower pace, so ask your family members to provide assistance for easier and safer mobility.
Ensure adequate lighting in your living space. Keep the lights on at night. Additionally, install grab bars in the shower. Make sure to use them! Learn the basics of bathing. Use a long-handled sponge to reach and clean your feet, lower legs, and back. Place a non-slip rubber mat in the bathtub or shower. Use a shower chair.
Keep the phone nearby. If you live alone, always keep a mobile or cordless phone within reach so you can call for help if needed.
When to seek additional medical attention or check-up
– Intense pain. You are unable to move a body part as you normally would.
– The affected area looks visibly different.
– New bruises that appear simultaneously with any of these other symptoms.
– Bone fractures themselves don’t cause fever. However, if you have a fever or if the area around the broken bone is warm or hot, contact your doctor immediately. This may be a sign of a serious infection that a doctor needs to examine immediately.
Tips for self-care in managing pain and swelling after a fracture
Moving broken bones can increase pain, and bleeding often with an open fracture can damage the tissues around the injury. This can lead to complications in the treatment and subsequent healing of the injury.
First aid for fractures involves immobilization (restriction of movement) of the injured area. Splints can be used for this.
If you suspect a bone fracture, you should:
- Stay calm if you are injured or keep the injured person in one position – do not move them, especially if there is suspicion of a skull, spine, rib, pelvic, or femur fracture.
- First, pay attention to any bleeding wounds. Stop the bleeding by applying firm pressure on the site with a clean dressing. If the bone sticks out, press around the edges of the wound. If the bleeding is controlled, it would be good to process the wound or at least cover it with a sterile bandage.
- Never try to straighten broken bones. At a fracture of the extremities, place a pillow under the lower leg or forearm to make the injured site more comfortable and less painful.
- Avoid causing further pain or unnecessary movement of the broken bone.
- Elevate the area of the fracture if possible and apply a cold compress to reduce swelling and pain. Do not allow the person to eat or drink anything until they are seen by a healthcare professional, especially in the case of an open fracture where surgery may be required.
- Apply a splint to support the leg or arm. Splints do not have to be professionally produced. Objects such as wooden boards and folded magazines can be effective for some fractures. You should immobilize the limb above and below the fracture.
- Complicated fractures with significant deformity of the limb may need to be realigned before splinting – do not attempt this, as it should only be done by doctors and medical personnel!
