Broken Bone Bone Fracture

Overview, Causes, & Risk Factors

A bone fracture is a break in a bone. The surrounding tissues are usuallyinjured as well. Bone fractures are classified as:

  • simple or closed fracture, in which the broken bone does not come throughthe skin
  • compound or open fracture, in which the bone pierces the skin or theskin is torn or scraped
  • Bone fractures are also classified by the position of the bone fragments, asfollows:

  • comminuted, in which the bone breaks into small pieces
  • impacted, in which one bone fragment is forced into another
  • angulated, in which fragments lie at an angle to each other
  • displaced, in which the fragments separate and are deformed
  • nondisplaced, in which the 2 sections of bone keep their normalalignment
  • overriding, in which fragments overlap and the total length of the boneis shortened
  • segmental, in which fractures occur in 2 nearby areas with an isolatedcentral segment
  • avulsed, in which fragments are pulled from their normal positions bymuscles or ligaments
  • What are the causes and risks of the injury?

    A bone fracture occurs when the force against a bone is greater than thestrength of the bone. Most fractures result from an injury, such as that causedby an automobile accident or a fall. Factors that increase a person’s risk ofbone fracture include:

  • normal aging, whichcauses the bones to become more brittle
  • osteoporosis, or excess bone thinning that results from loss ofcalcium in the bone
  • menopause. During menopause, the ovaries stop making estrogen,which normally protects against bone loss.
  • removal of the ovaries
  • diet low in calciumor vitamin D
  • sedentary lifestyle
  • eating disorders such as anorexia and bulimia
  • family history of osteoporosis
  • medications such as corticosteroids, certain medications for seizures, and some medications used forhigh blood pressure
  • excess alcoholintake
  • smoking
  • hyperthyroidism, a condition in which the thyroid gland makes toomuch thyroid hormone
  • hypogonadism, acondition in which the ovaries in women or testes in men do not functionnormally
  • hyperparathyroidism, a condition in which the parathyroid glandmakes too much parathyroid hormone. This hormone can affect calcium levels inthe bloodstream and weaken bone further.
  • rheumatoid arthritis, acondition in which the body attacks its own joint tissue
  • cancers affecting thebone
  • physical abuse,including child abuse, elderabuse, and spousalabuse. Bone fractures are often seen in abused children andadults.
  • Symptoms & Signs

    What are the signs and symptoms of the injury?

    Signs and symptoms of a bone fracture include:

  • pain that is usually severe and gets worse with time and movement
  • swelling
  • bruising
  • a limb or joint that is visibly out of place
  • limitation of movement or inability to bear weight
  • numbness and tingling
  • paleness of the injured area
  • Diagnosis & Tests

    How is the injury recognized?

    A bone fracture is recognized by a history of the injury and the results of thephysical examination. An X-ray of the area is done to confirm the diagnosis.Special imaging tests such as a CT scan or MRI may be needed to view thedamaged area more clearly.

    Prevention & Expectations

    What can be done to prevent the injury?

    Some fractures can be avoided by following sports safety guidelines forchildren, adolescents, and adults.

    Bone loss, which increases a person’s risk of fractures, can be slowed by doing30 minutes of moderate weight-bearing exercise a day.Weight-bearing exerciseincludes low-impact aerobics, walking, running, lifting weights, tennis, andstep aerobics. A person doing moderate exercise can talk normally withoutshortness of breath andis comfortable with the pace of the activity. The 30 minutes a day can be doneall in 1 session, or it can be broken up into smaller segments of time.

    Low-impact aerobics and wateraerobics are examples of exercises that minimize joint stress inelderly individuals or people with arthritis. Recent research has shown that people who dohigh-impact activities such as jogging have less bone loss as they age.

    Individuals can lower their risk of bone fractures followingosteoporosis by:

  • eating a well-balanced diet, following the food guide pyramid. A diet with adequatecalcium and vitamin D can help slow bone loss.There is some evidence that too much bone thinning is hastened by a diet highin fat.
  • eating 25 grams of soy protein daily
  • avoiding smoking
  • limiting alcoholintake
  • for women who have reached menopause, using hormonereplacement therapy
  • getting effective treatment for conditions such as hypogonadism, rheumatoid arthritis, and hyperthyroidism
  • Treatment & Monitoring

    What are the treatments for the injury?

    Emergency treatment consists of splinting the limb above and below thesuspected fracture. This keeps the area from moving. Ice should be applied. Theinjured area should be elevated to reduce swelling and pain.

    Repairing the bone can prevent a deformity of the bone as it heals. The bonerepair may be classified as a closed repair, which is done without cutting intothe skin, or an open repair, which involves surgery.

    A closed repair is used if the bone is cracked completely, but the pieces arenot quite in the right place. The healthcare provider pulls on the bone to getthe bone pieces back in their proper position. For some fractures, splints orcasts that restrict motion are used. Fractures of thecollarbone, shoulder blades, ribs, toes, and fingers generally healwell with such treatment.

    An open repair is done for more serious fractures, including:

  • fractures in which the 2 ends of the broken bone can’t be lined upcorrectly
  • fractures that extend into a joint
  • broken bones that are visible or stick out through the skin
  • An open repair is done in the operating room. A variety of tools are usedto repair the fracture and hold it in place. These include surgical nails,screws, wires, rods, and metal plates. The surgeon may need to clean out thearea around the fracture. This will reduce the risk of infection from the openwound.

    Sometimes a fracture must be completely immobilized in order to heal. This can be donewith a splint, brace, cast, traction, or open repair.

  • A splint is a firm object that is affixed to the areas surrounding thebone. A fractured finger is an example of a fracture that can be splinted.
  • A cast is a firm material made of either plastic or plaster. The cast iswrapped around the area of the broken bone. A layer of softer material isplaced against the skin to protect it from injury and irritation. A fracturedwrist is an example of a fracture that could be casted.
  • Traction holds a limb in alignment using pulleys and weights. It is notused very often anymore. However, it is sometimes used as a temporary measure untilsurgery can be done on a hip fracture.
  • Open repair uses a variety of tools to hold the bone pieces in place.These include surgical nails, screws, wires, rods, and metal plates.
  • What are the side effects of the treatments?

    A closed repair may have complications. The bone may not heal properly or itmay not function properly. An open repair carries the same risks as anysurgery. These include infection, bleeding, damage to blood vessels or nerves,and allergic reactions to the anesthesia.

    What happens after treatment for the injury?

    Fractured bones need at least 4 weeks to heal solidly. In the elderly orsomeone with diabetes, healing may take longer. A cast may be worn to preventmovement of the bone while it heals. Muscles in a leg or arm can become weakand tight while the bone heals. Therefore, many people who have a bone fractureneed physical therapy. The therapy begins while the bone is immobilizedand continues after the splint, cast, or traction has been removed.

    A person who has had an open repair needs to watch for signs of infection,swelling, or numbness. Any new or worsening symptoms should be reported to thehealthcare provider.

    The bone is usually strong and fully functional once it has completely healed.The healthcare provider should be consulted about an appropriate weight-bearingexercise program to minimize the risk of future bone fractures.

    To avoid further bone fractures in elderly individuals, the homeshould be made safe to prevent accidents. Ways to increase safety include:

  • keeping areas safe, well-lit, and uncluttered to prevent falls
  • avoiding the use of throw rugs on floors
  • taking care with icy, wet, or slippery surfaces
  • using nonskid mats in the shower and bathtub
  • wearing comfortable shoes with nonslippery soles
  • using a cane if needed
  • trying not to lift heavy objects
  • using proper back support and lifting methods
  • wearing undergarments that have a protective pad around the hips toprevent hip fractures
  • Intriguing new research done in older individuals witharthritis found that brisk walking or weight training improved balance in thoseindividuals. Improved balance could very well help such individuals avoid hip fractures and wrist fractures resulting from falls.

    Article type: xmedgeneral