What is a fracture?

Fractures

A fracture is a break in the bone, and they most frequently happen following an injury of some kind or after prolonged stress on the bone, such as may happen after very prolonged walking or running. There are many different types of fractures that can occur:
* Simple fractures – when the ends of the bones do not pierce the skin. Usually caused by a direct blow to the bone or by prolonged stress on the bone.

* Compound fracture – when the bone parts and one, or both, ends of the bone protrude through the skin.

* Transverse fracture – the bone breaks straight across and the two ends part. Usually caused by a direct blow.

* Spiral fracture – the bone is broken by a violent twisting movement, resulting in a spiralling break. Usually affects the long bones in the arm or leg, such as when the foot is caught and the leg twisted.

* Comminuted fracture – when the bone is shattered in to many pieces. Usually the result of severe forces, such as happens during a car accident.

* Crush fracture – when cancellous (spongy) bone, such as that in the vertebrae of the spine, is crushed. Most common following an accident.

* Greenstick fracture – when the break only affects one side of the bone. Most common in children, usually when the long bones in the arm or leg have been put under sudden stress.

A fracture can be classified as more than one type, so that you could have a compound spiral fracture, for example, when the break spirals and one end of the bone pieces the skin.

Who is at risk of fracturing a bone?
Anyone can be, but the elderly are particularly at risk of fractures because their bones are relatively brittle and they tend to be prone to falling. In addition, children who tend to be very active and those adults who take part in sporting activities can also be at increased risk.

Whereabouts in the body do fractures most commonly occur?
Bones tend to fracture at their weakest point or where the most strain is being put upon them, so the most common areas for them to fracture are:
* Long bones of the leg and arm – these are common places for fractures that are the result of sports injuries.

* Ankle – common in those who are involved in sport.

* Collarbone – usually happens as a result of a fall or a sport accident.

* Wrist – common following a fall when the weight of the person’s body is taken on the hand. There are two places in the wrist area that are prone to fracturing; the end of the radius bone (one of the two long bones of the forearm) just where it meets the wrist, and the scaphoid bone, which lies near the base of the the thumb. A scaphoid fracture can be particularly slow to heal.

* Rib – most frequently caused by a fall or blow to the side of the chest. If you also suffer severe pain and shortness of breath, you may have a punctured lung, which needs hospital treatment.

* Hip – the neck of the femur (at the top of the long thighbone, where it goes into the hip socket) is a common place for fractures to occur in the elderly, usually as a result of a fall. Surgery is almost always necessary to fit the ends of the bone back together, and a metal pin may have to be inserted to keep the bone stable. A hip replacement joint may be required if the bone is badly affected by osteoporosis.

How quickly does a fracture heal?
The speed at which a fracture heals depends on many factors:
* Where it is – in adults, ribs and collarbones usually heal in about six to eight weeks, wrists can take three months or more, and weight-bearing bones, such as hips and ankles, can take as long as six months to completely mend.

* How bad it is – a clean, simple fracture that doesn’t need an operation to fix will tend to heal a lot faster than a spiralling or shattered compound fracture.

* How old you are – the older you get, the slower your bones are to heal; so a baby’s fracture might heal in as little as two weeks, while an elderly person’s fracture may take half as long again to heal as that of a young adult.

* Your state of health – if you are fit and healthy and the fracture is your only injury, you can expect it to heal a lot quicker than it would if you unfit, unhealthy, or if you had multiple injuries, perhaps as the result of a car accident.

* Mobility – with fractures that affect weight-bearing bones, such as the spine, hip, leg or ankle, it can be difficult to get mobile again quickly. This can then lead to other problems in the area, such as swelling in the tissues and stiffness in nearby joints, which can further hinder the recovery process. This is especially likely in elderly people.

What will be done about a fracture?
Bone begins to heal immediately after a fracture, so the first aim is to ensure that the ends of he bone are cleanly fitted together so that the bone does not heal distortedly. If the bone has not pierced the skin (it is a simple fracture rather than a compound one), and the bone has broken cleanly without shattering or moving apart (this will be checked by X-ray) then the affected area will probably just be strapped up or put in a plaster cast to hold it still while the bone knits together. If the ends of the bones have separated, they will need to be manipulated back into place. This might be done through the skin or might need to be done during an operation. If the fracture is very unstable, then the bone will probably need to be fixed in place while it heals, either by internal fixation, when a metal pin is screwed across the ends of the bone to hold them in place, or external fixation, when metal rods are inserted into the bone through the skin, and locked into position on the outside using a metal bar.

What sort of problems might occur?
Pain can be severe in fractures, and achiness may linger long after the original fracture has healed. The need to immobilise the fractured bone for a long period can lead to muscle weakness and the loss of muscle bulk, as well as stiffness in nearby joints (because of under use) and swelling of the tissues. This last is known as oedema, and it happens because the fluid that accumulates at the site of an injury as part of the healing process doesn’t drain away as normal, but stays put because of the lack of movement. To minimise these problems, you will be encouraged to use the affected part as soon as it is safe to do so, and you may be given exercises to do or be referred to a physiotherapist. If the bone has been exposed to the air, then infection is a real risk and antibiotics will normally be given.

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