Definition

A fracture is a break in a bone. It can involve any bone in the body.

	The Bones of the Body
	© 2008 Nucleus Medical Art, Inc.

Fractures may be:

Open—There is a break in the skin over the fracture.

Closed—The skin is not broken.

Fractures may also be described as:

• Chip (avulsion fracture)—A small piece of bone is broken away from the main bone.
• Compression—The bone is compressed together (ie, vertebrae).
• Comminuted—The bone is fragmented.
• Greenstick—This is a fracture in which one side of the bone is broken, and the other side is bent but not broken.
• Intra-articular—The joint is affected.
• Transverse—The bone is broken in a horizontal line that is perpendicular to the surface of the bone cortex.
• Oblique—The bone is broken in a line that is less than a 90° angle to the surface of the bone cortex.
• Spiral—The line of the fracture forms a spiral.
• Stress—A thin fracture line occurs due to overuse rather than a single traumatic incident.

Causes

Fractures are caused by trauma to the bone. Trauma includes:

• Falls
• Twists
• Blows
• Collisions

The trauma is a physical force applied to the bone that the bone cannot withstand. Stronger bones can withstand more physical force than weaker bones.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for a fracture include:

• Advancing age
• Postmenopause
• Decreased muscle mass
• Osteoporosis —decreased bone mass, which weakens bones– this can affect men and women
• Certain congenital bone conditions (rare)
• Accidents or violence

Symptoms

Symptoms of a fracture include:

• Pain, often severe (primary symptom)
• Instability of the area around the break
• Inability to use the limb or affected area normally (there may be full or partial restriction in movement)
• Swelling or bruising caused by the bleeding from the bone and surrounding tissues
• Numbness caused by damage to a nearby nerve (rare)
• Fainting or even shock (rare–only in a severe trauma)

Diagnosis

The doctor will ask about your symptoms and how you injured yourself, and examine the injured area.

Tests may include:

• X-rays —to look for a break in the bone.
• CT scan CT scan—uses computerized x-rays to make pictures of structures inside the body.
• MRI scan —a test that uses a strong magnetic field and radio waves to make pictures of structures inside the body.
• Bone scan —typically for stress fractures.

Treatment

Treatment involves:

• Putting the pieces of bone together (may require anesthesia and/or surgery)
• Keeping the pieces together while the bone heals itself

Devices that can hold a bone in place while it heals include:

• A cast (may be used with or without surgery)
• Metal pins across the bone with a frame holding them outside the bone (requires surgery)
• A metal plate with screws (requires surgery)
• Screws alone (requires surgery)
• A rod down the middle of the bone (requires surgery)

Healing and Rehabilitation

Healing time ranges from three weeks for a simple finger fracture to many months for a complicated fracture of a long bone. All fractures require rehabilitation exercises to regain muscle strength and joint motion.

Possible Complications

• Delayed union—It takes longer than usual to heal but does heal.
• Nonunion—The bone does not heal and needs some special treatment.
• Infection—This is more likely to happen after an open fracture or surgery.
• Nerve or artery damage—This usually occurs as result of a severe trauma.
• Compartment syndrome—Severe swelling in the spaces of the limbs that causes damage to body tissues.
• Late arthritis—This may happen if the surface of a joint is badly damaged.

Prevention

You can reduce your chances of getting a fracture by:

• Not putting yourself at risk for an accident or other trauma to the bone
• Eating a diet rich in calcium and vitamin D
• Regularly doing weight-bearing exercise to build and maintain strong bones
• Regularly doing strengthening exercises to build strong muscles and prevent falls
• Patients with osteoporosis may benefit from bisphosphonate medications

RESOURCES:

American Academy of Orthopaedic Surgeons
http://www.aaos.org

American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org

References:

American Academy of Orthopaedic Surgeons website. Available: http://www.aaos.org .

Browner: Skeletal Trauma: Basic Science, Management, and Reconstruction 3rd ed. Philadelphia; Elsevier; 2003.

Fractures in Adults . Vol 4. Lippincott, Williams, and Wilkins; 1994.

Gruntmanis U. Male osteoporosis: deadly, but ignored. American Journal of the Medical Sciences . 2007;333(2):85-92.

McCarus DC. Fracture prevention in postmenopausal osteoporosis: a review of treatment options. Obstetrical & Gynecological Survey . 2006;61(1):39-50.

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