Definition

A fracture is a break in any bone in the body. Fractures are usually caused by trauma. This may be falls, twists, blows or collisions. There are different kinds of fracture:

  • The bone may be fractured but stable (simple fracture)
  • Bone fragments may be sticking through the skin (open)

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 in pieces.
  • 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.

The Bones of the Body

Nucleus factsheet image
© 2009 Nucleus Medical Art, Inc.

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)
  • Taking glitazones (medication used to treat type 2 diabetes )
  • 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.

If you are diagnosed with a fracture, follow your doctor's instructions .

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