Fracture

Definition

A fracture is a break in a bone. It can involve any bone in the body.

The Bones of the Body

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Fractures may be:

Open—There is a break in the skin over the fracture.

Closed—The skin is not broken.

Fractures may also be described as:

  • Chip (avulsion fracture)—A small piece of bone is broken away from the main bone.
  • Compression—The bone is compressed together (ie, vertebrae).
  • Comminuted—The bone is fragmented.
  • Greenstick—This is a fracture in which one side of the bone is broken, and the other side is bent but not broken.
  • Intra-articular—The joint is affected.
  • Transverse—The bone is broken in a horizontal line that is perpendicular to the surface of the bone cortex.
  • Oblique—The bone is broken in a line that is less than a 90° angle to the surface of the bone cortex.
  • Spiral—The line of the fracture forms a spiral.
  • Stress—A thin fracture line occurs due to overuse rather than a single traumatic incident.

Causes

Fractures are caused by trauma to the bone. Trauma includes:

  • Falls
  • Twists
  • Blows
  • Collisions

The trauma is a physical force applied to the bone that the bone cannot withstand. Stronger bones can withstand more physical force than weaker bones.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for a fracture include:

  • Advancing age
  • Postmenopause
  • Decreased muscle mass
  • Osteoporosis—decreased bone mass, which weakens bones– this can affect men and women
  • Certain congenital bone conditions (rare)
  • Accidents or violence

Symptoms

Symptoms of a fracture include:

  • Pain, often severe (primary symptom)
  • Instability of the area around the break
  • Inability to use the limb or affected area normally (there may be full or partial restriction in movement)
  • Swelling or bruising caused by the bleeding from the bone and surrounding tissues
  • Numbness caused by damage to a nearby nerve (rare)
  • Fainting or even shock (rare–only in a severe trauma)

Diagnosis

The doctor will ask about your symptoms and how you injured yourself, and examine the injured area.

Tests may include:

  • X-rays—to look for a break in the bone.
  • CT scan CT scan—uses computerized x-rays to make pictures of structures inside the body.
  • MRI scan—a test that uses a strong magnetic field and radio waves to make pictures of structures inside the body.
  • Bone scan—typically for stress fractures.

Treatment

Treatment involves:

  • Putting the pieces of bone together (may require anesthesia and/or surgery)
  • Keeping the pieces together while the bone heals itself

Devices that can hold a bone in place while it heals include:

  • A cast (may be used with or without surgery)
  • Metal pins across the bone with a frame holding them outside the bone (requires surgery)
  • A metal plate with screws (requires surgery)
  • Screws alone (requires surgery)
  • A rod down the middle of the bone (requires surgery)

Healing and Rehabilitation

Healing time ranges from three weeks for a simple finger fracture to many months for a complicated fracture of a long bone. All fractures require rehabilitation exercises to regain muscle strength and joint motion.

Possible Complications

  • Delayed union—It takes longer than usual to heal but does heal.
  • Nonunion—The bone does not heal and needs some special treatment.
  • Infection—This is more likely to happen after an open fracture or surgery.
  • Nerve or artery damage—This usually occurs as result of a severe trauma.
  • Compartment syndrome—Severe swelling in the spaces of the limbs that causes damage to body tissues.
  • Late arthritis—This may happen if the surface of a joint is badly damaged.

Prevention

You can reduce your chances of getting a fracture by:

  • Not putting yourself at risk for an accident or other trauma to the bone
  • Eating a diet rich in calcium and vitamin D
  • Regularly doing weight-bearing exercise to build and maintain strong bones
  • Regularly doing strengthening exercises to build strong muscles and prevent falls
  • Patients with osteoporosis may benefit from bisphosphonate medications

RESOURCES:

American Academy of Orthopaedic Surgeons
http://www.aaos.org

American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org

References:

American Academy of Orthopaedic Surgeons website. Available: http://www.aaos.org .

Browner: Skeletal Trauma: Basic Science, Management, and Reconstruction 3rd ed. Philadelphia; Elsevier; 2003.

Fractures in Adults . Vol 4. Lippincott, Williams, and Wilkins; 1994.

Gruntmanis U. Male osteoporosis: deadly, but ignored. American Journal of the Medical Sciences . 2007;333(2):85-92.

McCarus DC. Fracture prevention in postmenopausal osteoporosis: a review of treatment options. Obstetrical & Gynecological Survey . 2006;61(1):39-50.



Last reviewed January 2008 by John C. Keel, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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