Fracture

ExitCare ImageA fracture is a break in a bone, due to a force on the bone that is greater than the bone's strength can handle. There are many types of fractures, including:

  • Complete fracture: The break passes completely through the bone.

  • Displaced: The ends of the bone fragments are not properly aligned.

  • Non-displaced: The ends of the bone fragments are in proper alignment.

  • Incomplete fracture (greenstick): The break does not pass completely through the bone. Incomplete fractures may or may not be angular (angulated).

  • Open fracture (compound): Part of the broken bone pokes through the skin. Open fractures have a high risk for infection.

  • Closed fracture: The fracture has not broken through the skin.

  • Comminuted fracture: The bone is broken into more than two pieces.

  • Compression fracture: The break occurs from extreme pressure on the bone (includes crushing injury).

  • Impacted fracture: The broken bone ends have been driven into each other.

  • Avulsion fracture: A ligament or tendon pulls a small piece of bone off from the main bony segment.

  • Pathologic fracture: A fracture due to the bone being made weak by a disease (osteoporosis or tumors).

  • Stress fracture: A fracture caused by intense exercise or repetitive and prolonged pressure that makes the bone weak.

SYMPTOMS

  • Pain, tenderness, bleeding, bruising, and swelling at the fracture site.

  • Weakness and inability to bear weight on the injured extremity.

  • Paleness and deformity (sometimes).

  • ExitCare ImageLoss of pulse, numbness, tingling, or paralysis below the fracture site (usually a limb); these are emergencies.

CAUSES

Bone being subjected to a force greater than its strength.

RISK INCREASES WITH:

  • Contact sports and falls from heights.

  • Previous or current bone problems (osteoporosis or tumors).

  • Poor balance.

  • Poor strength and flexibility.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Cardiovascular fitness.

  • Muscle strength.

  • Flexibility and endurance.

  • Wear proper protective equipment.

  • Use proper exercise technique.

RELATED COMPLICATIONS

  • Bone fails to heal (nonunion).

  • Bone heals in a poor position (malunion).

  • Low blood volume (hypovolemic), shock due to blood loss.

  • Clump of fat cells travels through the blood (fat embolus) from the injury site to the lungs or brain (more common with thigh fractures).

  • Obstruction of nearby arteries.

TREATMENT

Treatment first requires realigning of the bones (reduction) by a medically trained person, if the fracture is displaced. After realignment if the fracture is completed, or for non-displaced fractures, ice and medicine are used to reduce pain and inflammation. The bone and adjacent joints are then restrained with a splint, cast, or brace to allow the bones to heal without moving. Surgery is sometimes needed, to reposition the bones and hold the position with rods, pins, plates, or screws.

Restraint for long periods of time may result in muscle and joint weakness or build up of fluid in tissues (edema). For this reason, physical therapy is often needed to regain strength and full range of motion. Recovery is complete when there is no bone motion at the fracture site and x-rays (radiographs) show complete healing.

MEDICATION

  • General anesthesia, sedation, or muscle relaxants may be needed to allow for realignment of the fracture. If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Stronger pain relievers may be prescribed by your caregiver. Use only as directed and only as much as you need.

SEEK MEDICAL CARE IF:

  • The following occur after restraint or surgery. ( Report any of these signs immediately ):

  • Swelling above or below the fracture site.

  • Severe, persistent pain.

  • Blue or gray skin below the fracture site, especially under the nails. Numbness or loss of feeling below the fracture site.