Fractures

A fracture is a break in the continuity of a bone in the body. This may be a small crack or a complete break in the bone where the two ends are no longer in contact. This occurs when the bone is subjected to forces that are higher than what it can handle.

There are different types and classifications of fractures. These are often used by the medical team to facilitate communication, to better understand the condition and gravity of the fracture, as well as be able to select the correct management of each particular type of fracture. Fracture classifications vary according to the location of the fracture, type of bone as well as preference of the medical practitioners. For the purpose of this article we will focus on describing some of the types of fractures but not the different classifications as this can become more complex in nature.

For ease of description we divide fractures into the following groups:

• Closed (or simple): A Broken bone that doesn’t puncture or break through the skin.
• Open (or compound): A broken bone where the bone breaks through or pokes out of skin (even if it moves back into the place and/or it is not visible). There is an increased risk of infection with this type of fracture.
• Displaced: The ends of the bones in the fracture are no longer aligned.
• Non-displaced: The ends of the bones in the fracture maintain alignment.

Types of fracture

• Impacted: a fracture where the bone ends are pushed/jammed into each other.
• Transverse: a fracture that cuts straight across the width of a bone, perpendicular to the length of the bone. It is caused by direct trauma.
• Oblique: a diagonal fracture across the bone, caused by indirect trauma, i.e. twisting/rotation injury.
• Spiral: A fracture that spirals around the bone and at least part of the bone is twisted, caused by a twisting/rotation mechanism to the injury.
• Stress: A fracture caused due to repetitive forces/load on the bone. It is more common in athletes.
• Greenstick: a fracture where the bone breaks on one side only due to a bending mechanism of injury. This is a partial break only found in children due to the elasticity of their bones.
• Linear: a thin fracture along the length of a bone where no splintering occurs.
• Avulsion: a fracture where a piece of bone is broken off due to excessive pulling from a muscle tendon or ligament.
• Segmental: a type of fracture where the bone breaks in more than 2 consecutive places, resulting in a separate segment between the 2 fracture sites.
• Comminuted: A fracture where the bone breaks into more than 2 fragments. It is caused by a high impact, direct trauma.
• Pathological: a fracture caused in an abnormal/weakened bone secondary to a pathological condition. i.e. a tumor or a cyst. This occurs in the absence of trauma.
• Compression: a fracture where the bone is crushed and changes shape, usually due to fall from a height.

Causes

• Trauma: such as an accident, a fall from a height, a tackle, etc.
• Overuse: common in athletes that subject the bodies to high and repetitive loads for an extended period of time.
• Use of excessive force
• Certain health conditions such as osteoporosis, cancers, etc.

Symptoms

• Pain, worse with touch and/or movement
• Inflammation: swelling, redness, heat in the area
• Bruising
• Deformity or distortion in the area of the fracture
• Weakness
• Difficulty or inability to move and use the limb
• Difficulty or inability to bear weight on a limb (particularly a leg)

Diagnosis

The diagnosis of a fracture can be obvious as in some trauma cases, where some people even hear the sound of the bone breaking. The mechanism of injury often helps with the diagnosis, but there are some cases where it may not be so obvious. In such cases, a professional assessment by a medical practitioner is carried out where the practitioner will ask about health status and history, as well as, perform a physical assessment to check for any symptoms. The medical practitioner may choose to do some tests.

In almost all fracture cases, diagnostic imaging is done as it helps not only to confirm the presence of a fracture but also to give information about the type of fracture as well as damage to other tissues. The methods used are: X-rays, MRIs, CT scans and bone scans, in some cases ultrasound may also be used.

Treatment

These are some of the treatment modalities used to treat a fracture:

• Bone realignment (where possible and safe).
• Immobilization of the area or joint, i.e. using a cast.
• Management of pain and inflammation.
• Surgery: metal plates, pins, rods or screws are placed in the fracture to stabilize the area and ensure the bone is aligned and able to heal well without affecting future function.
• Physiotherapy: assists in the management of pain and inflammation in the initial phase. Treatment will then be progressed according to the phase of bone healing to ensure a patient’s rehabilitation focuses on maintaining/regaining strength and mobility after immobilization and/or surgery. This is important to ensure a patient regains optimal use of the affected area again to get them back to the same condition they were in prior to the fracture.

Recovery

Recovery varies according to the injury. Some fractures may take weeks, months and years to heal. Read our article on bone healing for more on this topic. It is always important to follow the treatment protocols advised by the medical team to ensure the bone heals correctly.