Fracture - Broken Bone - Diagnosis and Treatment

A broken bone, or a bone fracture, is a term used to describe a crack or a break in a bone. A fracture can be complete or partial. If the broken bone punctures the skin, it is called an open or compound fracture.

What Causes a Bone Fracture

Fractures commonly occur from a high impact or trauma to the bone, although some diseases can weaken bones and cause them to break. Very small cracks in the bone called stress fractures can be caused by overuse.

The most common causes include:

• High impact sports injuries
• Traumatic, forceful and unnatural movements
• Overuse - prolonged long-distance walking or running
• Falls
• Accidents
• Osteoporosis
• Tumors growing near the bone

The Symptoms of a Bone Fracture

• Out-of-place or misshapen limb or joint
• Swelling, bruising or bleeding
• Intense pain
• Numbness and tingling
• Limited mobility or inability to move a limb

Bone Fracture Types and Descriptions

• Simple Fracture: the bone is broken in one place
• Closed Fracture:  the skin over the broken bone has not been pierced
• Comminuted Fracture: the broken bone has three or more bone fragments
• Open or Compound Fracture: the skin over the fracture has been pierced, and the broken bone is exposed.
• Oblique Fracture: The break is angled across the long axis of the bone.
• Undisplaced Fracture or Stable Fracture: the broken bone pieces are aligned
• Displaced Fracture: the broken bone pieces are not aligned

• Transverse Fracture: the fracture is at a right angle to the long axis of the bone
• Greenstick Fracture: the fracture is on one side of the bone, causing a bend on the other side of the bone

Immediate Treatment for a Fracture

If you suspect you have a fractured bone, you should seek immediate emergency medical care.

X-rays are often used to located and assess fractures. The broken pieces may need to be put back in place and then immobilized until the bones can heal as new bone forms around the break. This is called stabilization.

You may need to wear a cast or splint, or possibly have surgery to put in plates, pins or screws to keep the bone in place.

Bone Healing

Immediately after a bone fracture, the body forms a protective blood clot and callus or fibrous tissue to protect the injured area. Bone-forming cells start forming new bone at the edges of the fracture site and grow toward each other. Over time, the fracture closes completely, and the bony callus is absorbed.

Treatment for Fractures

The type of treatment will depend on the kind of fracture and the specific bones involved.

• Casting: After the broken bones have been manipulated back into their proper positions, a plaster or fiberglass cast is applied to keep the bones from moving while they heal.
• Traction: For some broken bones, a system is set up to apply a gentle but steady pulling action so the bones are aligned.

• External fixation: Pins or wires are set into the bone through the skin above and below the fracture. These are connected to a ring or a bar outside the skin that holds the pins in place. After the bones have healed, the pins are removed.
• Internal fixation: In a surgical procedure, metal rods, wires, or screws are inserted in the bone fragments to keep them together.

Rehabilitation for Fractures

Fractures usually heal in about four to six weeks, but some can take several months depending on the extent of the injury and how well you follow rehab instructions.

Casts or braces are often removed before complete healing to prevent joint stiffness. Pain usually decreases before the fracture is solid enough to handle a complete return to sports, so working with a therapist on a rehab protocol is important to avoid further injury.

Once the bone is healed and strong, it's safe to begin muscle building. During the disuse, the muscles will have atrophied and be extremely weak. Tendons and ligaments may also be stiff from a lack of use. Rehabilitation involves flexibility, balance and strengthening exercises and a gradual increase of activity. Physical therapy is the preferred method of safely getting back into sports.

Also See: Guidelines for Returning to Sports After an Injury

_Source:

_{Fractures (Broken Bones), OrthoInfo, American Academy of Orthopaedic Surgeons, October, 2012.}