How to best treat a fracture

Bones are the hardest tissues in your body. Although bones are strong, they can split or break under too much pressure or force. If the external force is greater than the strength of the bone it will break. A broken bone is called a fracture. A fracture can occur in a variety of ways. The most common causes of fractures are injuries, prolonged stress from overuse, and bone weakening diseases, such as Osteoporosis or tumors. There are many types of fractures. They can range from a hairline crack to a bone that has broken into several pieces. Simple fractures may only require casting or splinting treatments. More complex fractures may need surgical intervention to align the bones for proper healing.

As an adult, you have over 200 bones in your body. Your bones vary in size and shape. For instance, your arms and legs contain long bones. A series of small bones, called vertebrae, make up your spine. Very small bones form your hands and feet. Some of your bones have curves, including your ribs and skull. All of your bones line up and connect to form your skeleton. In addition to creating your body structure, your bones produce blood cells, form joints with muscles for movement, and protect your internal organs.

The image above is of two x-rays of the same wrist fracture. The image on the left was taken at the time of injury and the image on the right was taken ten weeks later and shows the healing of the bone during the remodeling phase.

The structure of bones

Did you know that you have 26 bones in each foot, 19 bones in each hand, and 8 bones in your wrist? Our extremities are more complex structures which allows us to do all the intricate functions and activities with our hands and feet.

Your bones are live tissues. They change and grow like the other parts of your body. Most of the bones in your body are composed of the same layered materials.

The outer layer of a bone is called the periosteum. It is considered the life support system for the bone because it provides the nutrient blood for bone cells. The periosteum also produces bone-developing cells during growth or after a fracture. Underneath the periosteum is compact bone, known as the cortex. Compact bone is solid and hard. It covers the cancellous “spongy” bone. The cancellous bone looks like a sponge because it contains many pores. It can resist the stresses of weight, postural changes, and growth. In many bones, the cancellous bone contains or protects the red marrow or bone marrow. Red marrow contains developing and mature blood cells.

Causes of a fracture

The most frequent causes of fractures are falls and motor vehicle crashes. There is a higher incidence of fractures in some sports that involve prolonged impact, high impact, balance, or high speeds. Stress fractures can result from prolonged impact or repetitive forces. For example, stress fractures can occur in the leg, foot, ankle, or hip if  the intensity of activity is not gradually introduced; too much, too soon. High impact fractures can occur during contact sports, including tackles in football or players colliding in soccer. Skateboarding, bicycle riding, and snow skiing are sports that involve balance and speed, thus making them prone to fractures during falls.

Although the majority of fractures result from motor vehicle crashes and falls, some fractures occur because of diseases. Osteoporosis is a medical condition that causes more bone calcium to be absorbed than is replaced. Calcium is necessary for hard, healthy bones. Osteoporosis causes a reduction in bone density and brittle or fragile bones that are vulnerable to fractures. Type I Osteoporosis usually affects women between the ages of 51 and 75 and is associated with spine and wrist fractures. Type II Osteoporosis usually affects people between the ages of 70 and 85 and is associated with hip, pelvis, arm, and leg fractures.

Bone tumors are another disease-related cause of fractures. Most bone tumors originate elsewhere in the body and metastasize or spread to the bone. Very rarely do cancerous tumors begin in the bone. Tumors can weaken bones making them susceptible to fractures.

Symptoms of a fracture

In some cases, a snap or cracking sound may be heard when a bone fractures. You may feel sharp, deep, or intense pain along with numbness or tingling. Your skin may swell, bruise, or bleed.

The place where your fracture occurs may look odd, bent, or out of place. Sometimes a broken bone may come through the skin. You may not be able to move or put weight on your limb or joint, or you may do so with difficulty.

Diagnosis

Your doctor will start by asking you to describe your injury and your symptoms. Your doctor can diagnose a fracture with a physical examination and in most cases imaging tests are ordered to confirm the fracture.

An X-ray will be ordered to identify the type and location of your fracture. Some fractures, such as stress fractures, may not show up on an X-ray. In such cases, Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI) scans may be used to take a more detailed look at your bones.

A bone scan is useful for identifying bone abnormalities from Osteoporosis or cancer. A bone scan may be used to show fractures, tumors, infection, and bone deterioration. A bone scan requires that you receive a small, harmless injection of a radioactive substance several hours before your test. The substance collects in areas where the bone is breaking down or repairing itself.

In addition to diagnosing your fracture, your doctor will classify the type of fracture that you have in order to plan treatment appropriately. Fractures are classified by a combination of general terms used to describe their features. Fractures are categorized by the characteristics of the broken bone, including the position of the fragments or broken bone and the direction of the fracture line.

Treatment

The treatment for a fracture depends on the type of fracture and the bones that are involved. The goal of treatment is to align the fractured bones to allow them to heal. A fractured bone is able to grow back together. When a bone is fractured, it produces a protective blood clot and callus at the end of the bones. The callus includes cells that go through phases leading to eventual bone formation and healing.

Your doctor will use your X-ray as a guide to “set” or position your bones. Some bones can be kept in place with a cast while they heal. The cast keeps the bones from moving. The hard surface of the cast protects the injury. Casts are made of a variety of materials. They are usually worn for about one to two months, depending on the type of fracture and the bone involved.

A fracture which does not heal or “unite” within the usual period of time for that fracture is said to have delayed union. The reason for the delay is not always known, but usually results from excess motion at the fracture during healing or a poor blood supply. When healing does occur, it has taken longer than normal.

A nonunion is a fracture that just won’t heal. This is usually determined by time and x-rays, which show that there is no possibility that the fracture will heal without additional intervention.

A malunion is a fracture that has healed in a position outside acceptable parameters. This can be any combination of angulation, displacement, malrotation or length differences.

Delayed unions, nonunions and malunions generally require additional treatment. Bone stimulators may be used to enhance fracture healing. These are usually used externally, but sometimes are placed surgically at the fracture site. They use either electricity or ultrasound which have been shown to enhance bone generation.

Malunions and many nonunions require surgery to heal properly. Direct access to the fracture is necessary to straighten the bone, in the case of a malunion, or to remove soft tissues and stimulate blood flow at the site of a nonunion. Bone grafts are typically placed to further enhance healing.

Your pain will probably cease before your fracture has completely healed. Your doctor will limit your activity while your bone is healing. An immobilized joint will become stiff and be difficult to move. Because of this, physical or occupational therapy usually follows fracture treatment. Your therapists will work with you to regain movement, strength, and flexibility that may have decreased while your bone or joint was immobile. Your therapists may apply modalities, such as heat or ultrasound, to improve blood flow, ease pain, and improve flexibility. Initial goals include pain relief and range of motion. This is followed by strengthening, and when necessary, balance retraining and sports or activity specific exercises. Your therapists can also recommend safety equipment that you can wear or use during sports, on the job, or with activities at home to support and protect your bones and joints.

What do you do if you suspect a fracture

Injuries and accidents happen quickly and unexpectedly. It is important to get quality medical care at the time of your fracture to make sure that your bones will heal effectively. Missoula Bone & Joint offers a walk-in Urgent Care that specializes in the treatment of fractures and orthopedic injuries because we understand it is never a good time to be injured.

Article content modified from iHealthspot Patient Education

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