Closed Fracture

Broken Bone the Does Not Penetrate Skin

A broken bone that does not penetrate the skin is called a closed fracture.. Matt Meadows / Getty Images

A closed fracture is a broken bone that does not penetrate the skin. This is an important distinction because when a broken bone penetrates the skin (an open fracture) there is a need for immediate treatment, and an operation is often required to clean the area of the fracture. Furthermore, because of the risk of infection, there are more often problems associated with healing when a fracture is open to the skin.

Closed fractures may still require surgery from proper treatment, but most often this surgery is not an emergency and can be performed in the days or weeks following the injury.  While a closed fracture does not penetrate the skin, there can still be severe soft-tissue injury associated with closed fractures.  The condition of soft-tissues can still alter treatment recommendations, as closed fractures with severe soft-tissue injury may cause concern for surgical intervention.

Examples of the most common closed fractures include:

  • Broken Wrist: A wrist fracture is the most common type of fracture that requires medical treatment.  Often closed wrist fractures can be treated with a cast to hold the healing bones in proper position.  More severe wrist fractures may require surgery, even when the injury is closed.  In these cases, pins, plates, and screws are commonly used for treatment.
  • Hip Fractures: A broken hip is the most common type of closed fracture in the elderly population.  Almost always these are closed fractures, as open hip fractures are exceedingly rare injuries.  Despite being a closed fracture, broken hips almost always require surgical treatment.
  • Ankle Fractures: A broken ankle occurs when the ankle joint is severely twisted in the bone is injured.  While in younger patients a sprain is often the result, as people get older bone is often the injured structure.  Depending on the severity of the injury, surgery may be needed.

Some of the treatments used for closed fractures include:

No Immobilization: Not every fracture requires intervention.  Some broken bones are stable injuries that can be managed without immobilization or other intervention.  Sometimes a sling or walking boot may be enough, and other times some simple reassurance that healing will occur is fine.

Cast Immobilization: Casts are often used for treatment of many types of fractures.  Casts help to hold bones in proper alignment and protect the healing bone.

Internal Fixation Internal fixation is used to realign broken bones, and then hold the healing bones in position with metal plates, pins, rods, or screws.

External Fixation: External fixation is a type of treatment that can hold bones securely without having to operate on the site of most significant damage.  This treatment is often used when soft-tissue injury makes surgery at the site of fracture unsafe.

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