Fractures

A fractured bone is a broken bone. It might be partially broken, like a crack in the bone. Or, it might be completely broken. There are lots of ways to fracture a bone: cross-wise, lengthwise, in the middle. All breaks are fractures. All fractures are breaks.

What about bones?

Our skeleton is made of bones. This is the frame for our body. Bones support all of our body weight. Bones protect the softer parts of the body. Bones are made of living tissue. They grow more rapidly when we are young. They begin repairing themselves the moment they are broken.

The center of a bone is called marrow. It is softer than the outer part. Bone marrow has cells that become red and white blood cells. Red blood cells carry oxygen. White blood cells help fight disease.

Bones are rigid, but they can bend a little against certain amounts of force. When the force is gone, the bones return to their original shape.

What causes a fracture?

Fractures can happen in a variety of ways. They occur when the force on the bone exceeds its strength. These are the general causes:

• Direct force: a fall, an auto accident, or a collision while playing sports
• Overuse: stress fractures are common among athletes
• Osteoporosis: thin bones become fragile and easily broken

Classes and types of fractures

The severity of a fracture depends on the force that caused it. If the force pushed the bone just beyond the breaking point, the bone may just crack, and not break all the way through. If the force is extreme, as in a car accident, the bones may actually shatter.

The two major classifications of fracture are

• Simple (or closed): the bone is broken but the skin is not lacerated
• Compound (or open): the bone is broken and the skin has been pierced by the bone

The particular types of fracture are

• Transverse: the fracture is at right angles to the length of the bone
• Greenstick: one side of the bone is broken, the other side is bent
• Comminuted: the break results in three or more bone fragments

Knowing if it's broken

If you have broken a bone, you probably know it! You may hear a cracking sound. The area around the fracture will be swollen and sore. The limb will be deformed. The bone may have popped through the skin. In many cases, fractures hurt so much that most people call the doctor right away. They have to favor the broken bone because it hurts. X-rays help the doctor see broken bones right away. Other times, it isn't so clear that a bone has been broken. Stress fractures are harder to see. They do not show up on an X-ray. But, the pain, swelling, and tenderness will be there.

Treating fractures

As soon as a fracture occurs, the body acts to protect the injured area. It surrounds the area with a protective blood clot and a fibrous tissue called callus. Right away, new threads of bone cells start to grow on both sides of the break. The threads grow toward each other. The fracture closes and the callus is absorbed. This is why it is very important to have the bone set by the doctor as soon as possible.

Holding the fracture in the correct position while the bone heals is very important. This is why if you go to the emergency department, clinic, or doctor's office; the physician usually applies a splint to prevent further damage, to lessen the pain, and to help stop any bleeding. You will be asked to recline and to elevate the injured part. This helps reduce bleeding and swelling.

All forms of treatment of broken bones are designed to do two things: put the broken pieces back into normal position, and prevent these pieces from moving out of place while they heal. To do this, doctors will use

• External fixation methods: plaster and fiberglass casts, cast braces, splints, and other devices
• Functional cast or brace: the cast or brace allows limited movement of nearby joints
• Traction: a gentle, steady pulling action aligns the bone or bones
• Internal fixation methods: metal plates, pins, or screws. Pins and screws are placed into the broken bone above and below the break. The fragments are put back into position and are held there with pins and screws. These are connected to an external frame for stability.

Recovery

The doctor will pick the right treatment method for your fracture. Fractures take several weeks to several months to heal. A lot has to do with the extent of the injury and how well the patient follows the doctor's advice. Keep in mind that the bones of an older person take longer to heal than those of a younger person. At all ages, some bones heal faster than others. An arm may heal in a month. A leg may take up to six months. Once the bone finally mends, it will be stronger along the fracture line than before the injury.

The patient's cooperation plays a key role with successful treatment of a fracture. A cast or external fixation device can be inconvenient and cumbersome. But remember, without one, the broken bone can't heal properly.

Do not rush the healing process. The pain will probably be gone before the fracture is completely healed. However, the bone will not be able to take a full load of stress. Once your cast or brace has been removed, you will notice muscle weakness or maybe stiffness around the injury. Your doctor will give you some exercises to do to strengthen the muscles around the fractured area. Bit by bit, you can increase your activity. Before long, you will be 100% again.