Injury: Fractures

Definition
Description
Demographics
Causes and Symptoms
Diagnosis
Treatment
Prognosis
Prevention
The Future
For more information

Definition

A fracture is a break in a bone. It may extend only partway through the bone (called a partial fracture) or be a complete break that goes the whole way across the bone.

Fractures can be classified in several different ways. They may be categorized by the body part or specific bone that is broken, or by certain characteristics of the fracture:

• Simple fracture: The bone is broken in only one place.
• Multi-fragmentary (also called comminuted) fracture: The bone is broken in several places and there are at least three bone fragments.
• Closed fracture: The skin over the injury is not broken.

• Open (also called compound) fracture: The skin has been cut open over the fracture. The bone may or may not be visible through the wound.
• Greenstick fracture: The bone is broken on one side while the other side is bent. This type of fracture takes its name from the typical breakage pattern of a green tree limb.
• Undisplaced fracture: The pieces of the broken bone are aligned.
• Displaced fracture: The pieces of the broken bone are not in alignment.
• Stress fracture (also called hairline fracture): A thin partial break in a bone caused by repeated stress on the body part. Stress fractures are most likely to occur in athletes.
• Compression fracture: A fracture that occurs in the spine of a person with osteoporosis. The front part of a vertebra collapses because the bone has been weakened by loss of calcium.

Description

The experience of a fracture varies considerably depending on the location of the bone that has broken, the person's age, the cause of the fracture, and the amount of force that was applied to the bone. Most broken bones are caused by a sudden sharp blow, fall, gunshot wound, or other trauma, and the person often hears a snapping or grinding noise as the bone breaks. Stress and compression fractures, however, result from long-term overuse or weakening of the bone, and develop gradually.

Children's bones are more flexible than those of adolescents or adults, and greenstick fractures are more common in their age group. Adults are more likely to break the bone completely. Elderly people are more likely to develop compression fractures; they are also more likely to break bones as the result of falls, and to suffer broken bones from less force than it would take to cause a broken bone in a younger person.

Demographics

Fractures are a common injury in the general American population, although the location of fractures varies somewhat by age group. The average American can expect to suffer two fractures over the course of his or her life. According to the National Center for Health Statistics, there are an average of 1.1 million hospitalizations and 3,450,000 visits to outpatient emergency departments each year for fractures. An additional 2 million fractures are treated in doctors' offices. Some specific annual statistics follow:

• Hip fractures: About 320,000.
• Fractures of the tibia (long bone in the lower leg): About 600,000; most caused by high-speed accidents, with the highest rates in teenaged males.
• Collarbone fractures: About 400,000.
• Stress fractures: More common in women than in men; found in 45 percent of competitive female long-distance runners.
• Fractures of the lower neck: About 11,000.

In people under age seventy-five, the most common fracture is a wrist fracture. In people over seventy-five, hip fractures are the most common injury. In people younger than forty-five, men are more likely to suffer fractures than women; in adults over forty-five, however, women are more likely than men to suffer broken bones. Over age sixty-five, women are three times as likely as men to break a bone.

Basic First Aid for Fractures

The seriousness of a fracture depends partly on its location. A broken back or neck, or head injury, is a medical emergency. If an injured person has a broken neck or back, or if they have a broken bone that is coming through the skin:

• Call for emergency help at once.
• Do not try to move the injured person. Wait for help to arrive.
• If there is bone coming through the wound, have the person lie down. Apply pressure to the wound with a gauze pad or clean cloth, but do not try to push the bone back through the skin or wash the wound.

If the fracture is less serious:

• Remove clothing from the injured limb. Do not try to force an arm or leg backward through a sleeve or pants leg; cut the garment away with scissors.
• Apply a cold compress or ice wrapped in cloth to the injured part.
• Make a temporary splint. Keep the injured limb in the position it is in at the time of injury; then place a towel or other soft padding around the injured part. Then take a board or other firm object and place it next to the injured part outside the padding. Make sure that the board is long enough to cover the joints above and below the fracture. Use first-aid tape to hold the splint in place.
• Do not give the injured person anything to eat, in case they must be taken into surgery when help arrives.

More than two-fifths of fractures in the United States occur at the person's home, 23 percent inside the house, and 19 percent on the grounds outside the house.

Causes and Symptoms

Most fractures result from some kind of trauma, most often a fall, high-impact blow, or other accident. Athletes can develop stress fractures from overexercise, however, and people with osteoporosis can develop compression fractures from the simple weight of the spinal column on the lower back with little or no trauma.

With the exception of stress and compression fractures, people can often hear a bone snap or break when it fractures. The classic symptoms of a fracture are:

• Intense pain
• Affected body part looks misshapen or out of place
• Numbness or a tingling sensation
• Swelling, bruising, or bleeding of surrounding skin
• Difficulty in moving affected part or complete inability to move it

In stress fractures, the patient usually has no history of trauma but complains of pain in the affected part of the body that has come on gradually and gets worse during activity.

Diagnosis

In most cases the patient's history is the key to the diagnosis, including age, sex, occupation, sports participation, and overall health as well as a recent fall or other accident.

The doctor will order an x ray to determine the location and pattern of the fracture. In the case of stress fractures, the doctor will look for swelling or redness in the affected body part, and press gently on the tissues around the bone for signs of increased pain or tenderness.

Treatment

Normal bone heals itself following a fracture. Blood flows into the area of a break and forms a clot. The clot is gradually replaced by a matrix of collagen fibers. Cells called fibroblasts begin to lay down lines of new bone cells on both sides of the fracture line. As these lines of cells grow toward each other, the break in the bone is gradually repaired. Treatment of a broken bone is therefore focused on holding the broken bone in the proper position while the break is healing.

The bone may be held in place by either external or internal fixation methods. External fixation methods include casts, splints, or cast-braces. These are usually made from fiberglass or plaster. Internal fixation methods include pins, screws, or wires inserted by a surgeon to hold larger bones in place. Surgery may also be required to smooth the edges of broken bones or to remove bone fragments in order to prevent infection. Open (compound) fractures require the administration of antibiotics and careful antiseptic cleansing of the wound to prevent infection.

Most fractures require about four weeks to heal. While some use of the injured body part speeds healing, too much activity too soon can cause further damage. Since the pain of a fracture usually stops long before the bone is strong enough to return to normal levels of activity, the patient should limit the use of the injured part according to the doctor's advice. Follow-up x rays are usually ordered to make sure that the bone is in proper alignment and that the fracture is healing normally.

Many people require some form of physical therapy or rehabilitation after the cast or other fixation materials are removed because the muscles have grown weak from lack of exercise and the ligaments near the healing bone may feel tight or stiff.

Prognosis

The prognosis of a fracture depends on its cause and location, the patient's age and overall health, and the severity of the fracture. Most fractures will heal eventually with prompt treatment. The patients at highest risk of lasting complications from fractures are those with osteoporosis or other diseases of the bone; those whose fractures involved crushing as well as breaking of the bone; those with compound fractures that became infected; those who are heavy smokers; those with poor nutrition; and those over sixty years of age. Elderly people with hip fractures are 5–20 percent more likely to die within a year of their injury than others in their age group.

Prevention

Children, adolescents, and young adults can reduce their risk of fractures by:

• Wearing proper protective gear for athletic activities and following appropriate safety measures.
• Eating a nutritious diet rich in calcium.

• Avoiding overexercising and overly restrictive diets. Many female athletes develop stress fractures as a result of trying to lose more weight than is healthy for them.
• Not smoking. Smoking slows down the process of bone healing after a fracture.
• Wearing properly fitting shoes, and replacing athletic shoes as soon as the soles begin to wear unevenly.

WORDS TO KNOW

Fibroblast: A type of cell that provides structure during the healing of a broken bone or other wound.

Fixation: The medical term for holding a broken bone in its correct position to speed healing and prevent further injury.

Vertebra: One of the 33 bones that make up the spinal column in humans.

Elderly people need to take special precautions because of the long-term dangers of fractures resulting from falls:

• A safety inspection of the house or apartment, checking for slippery floors, the lack of hand rails on stairs or in the bathroom, poor lighting, loose rugs, and other features that may increase the risk of falls.
• Asking the doctor whether any medications that are prescribed have drowsiness or loss of coordination as side effects.
• Being very careful about alcohol intake. Alcohol can not only make people dizzy or lose their balance but also encourage risky behaviors that increase the risk of a fall.
• Wearing shoes with low heels that fit properly, and avoiding walking around the home in stocking feet or loose slippers.
• Keeping bones strong by getting enough calcium and vitamin D, and exercising regularly. Women should have a bone density test every few years according to their doctor's recommendations.
• Practicing balance exercises at home to improve flexibility as well as balance.

• Asking the doctor about hip padding. Some doctors recommend it as a way to lower the risk of a hip fracture if the person does fall.

The Future

Fractures are likely to be a commonplace injury for people of all ages, in younger patients as a result of sports or outdoor-related activities and car or motorcycle accidents, and in elderly people as a result of falls. As the population of older adults continues to grow, the number of fractures in this age group is likely to increase as well.

SEE ALSO Osteoporosis; Sprains and strains

For more information

BOOKS

Forgey, William W. Basic Illustrated Wilderness First Aid. Guilford, CT: Falcon Guides, 2008.

Glaser, Jason. Broken Bones. Mankato, MN: Capstone Press, 2007. Landau, Elaine. Broken Bones. Tarrytown, NY: Marshall Cavendish Benchmark, 2009.

PERIODICALS

JAMA Patient Page: Bone Fractures. Journal of the American Medical Association, May 5, 2004. Available online at http://jama.ama-assn.org/cgi/reprint/291/17/2160.pdf (accessed on August 12, 2008).

WEB SITES

American Academy of Orthopaedic Surgeons. Fractures: An Overview. Available online at http://orthoinfo.aaos.org/topic.cfm?topic=A00139&return_link=0 (updated March 2000; accessed on August 12, 2008).

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Preventing Falls and Fractures. Available online at http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/Fracture/preventing_falls.asp (updated August 2005; accessed on August 12, 2008).

National Institute on Aging (NIA). Age Page: Falls and Fractures. Available online at http://www.nia.nih.gov/HealthInformation/Publications/falls.htm (updated February 16, 2008; accessed on August 11, 2008).

National Library of Medicine (NLM). Fractures and Sprains. Available online at http://www.nlm.nih.gov/medlineplus/tutorials/fracturesandsprains/htm/index.htm (accessed on August 12, 2008). This is an online tutorial with voiceover; viewers have the option of a self-playing version, a text version, or an interactive version with questions.

Nemours Foundation. Broken Bones. Available online at http://kidshealth.org/parent/general/aches/broken_bones.html (updated April 2008; accessed on August 11, 2008).