Fractures

Treatment

In the field, the initial treatment for fractures of the arms, legs, hands, and feet include splinting the extremity in the position it is found, elevation and ice. Immobilization will be very helpful with initial pain control. For injuries of the neck and back, many times, first responders or paramedics may choose to place the injured person on a long board and in a neck collar to protect the spinal cord from potential injury.

Once the fracture has been diagnosed, the initial treatment for most limb fractures is a splint. Padded pieces of plaster or fiberglass are placed over the injured limb and wrapped with gauze and an elastic wrap to immobilize the break. The joints above and below the injury are immobilized to prevent movement at the fracture site. This initial splint does not go completely around the limb. After a few days, the splint is removed and replaced by a circumferential cast. Circumferential casting usually does not occur initially because fractures swell (edema). This swelling could cause a build-up of pressure under the cast, yielding increased pain and the potential for damage to the tissues under the cast. However, if the fracture required reduction (putting the bones back into alignment) there might be a need for the circumferential cast to keep the bones in place.

A fracture is a broken bone. It requires medical attention. If the broken bone is the result of major trauma or injury, call your local emergency number.

What Causes Bone Fracture?

When outside forces such as a direct blows or falls are applied to bone it has the potential to fail. Fractures occur when bone cannot withstand those outside forces. Fracture, break, or crack all mean the same thing. One term does not imply a more or less severe injury. The integrity of the bone has been damaged, causing the bone structure to fail, which results in a fracture or broken bone.

Broken bones are painful for a variety of reasons:

  • The nerve endings that surround bones contain pain fiber. These fibers may become irritated when the bone is broken or bruised.
  • Broken bones bleed, and the blood and associated swelling (edema) causes pain.
  • Muscles that surround the injured area may go into spasm when they try to hold the broken bone fragments in place, and these spasms may cause further pain.

Often a fracture is easy to detect because there is obvious deformity. However, at times it is not easily diagnosed. It is important for the physician to take a history of the injury to decide what potential problems might exist. Moreover, there may be associated injuries that need to be addressed.

Fractures can occur because of direct blows, twisting injuries, or falls. The type of forces or trauma applied to the bone determine what type of injury that occurs. Some fractures occur without any obvious trauma due to osteoporosis, defined as the loss of bone mass or a congenital bone cyst that has been present since birth, which causes a weak area in the bone.

Descriptions of fractures can be confusing. They are based on:

  • Where in the bone the break has occurred
  • How the bone fragments are aligned
  • Whether any complications exist
  • Whether the skin is intact

The first step in describing a fracture is to decide if it is open or closed. The skin protects the inside of the body, including bones, from the outside world. If the skin over the break is disrupted, then an open fracture exists. The skin can be cut, torn, or abraded (scraped), but if the skin’s integrity is damaged, the potential for an infection of the bone exists. Because the fracture site in the bone is exposed to the outside world, these injuries often need to be cleaned out aggressively and often require anesthesia in the operating room to do the job effectively. Compound fracture was another term used to describe an open fracture.

Next, there needs to be a description of the fracture line. Does the fracture line go across the bone (transverse), at an angle (oblique) or does it spiral? Is the fracture in two pieces or is it comminuted, in multiple pieces?

A greenstick fracture describes the situation when the bone partially breaks. This often occurs in infants and children where the bone hasn’t completely calcified and has the potential to bend instead of breaking completely through. It is similar to trying to break off a young branch or shoot from a tree (a green stick). Other fracture terms include torus or buckle fracture, again when only part of a bone breaks, which may occur in adults as well.

What Are Bone Fracture Symptoms and Signs?

  • When bones break, they cause pain, swelling, and inflammation. The ability to move the joint above or below an injury does not guarantee that the bone is not broken. Instead, it means that the muscles and tendons that move the joint still work.
  • Unless there is a previous underlying condition that prevents the patient from feeling pain (such as a spinal cord injury or diabetic neuropathy) all broken bones hurt. The pain may or may not be felt at the site of the break but can be referred elsewhere. For example, hip injuries, especially in children, can have knee pain.
  • Other structures can be damaged when a bone breaks. Numbness and tingling can result if there is nerve inflammation or injury. A limb may be cool and without pulse, if the artery at the fracture site is torn, kinked or clots off, preventing blood from circulating.

What Are Common Types of Bone Fractures?

There are several types of bone fractures for example,

  • stress fractures,
  • compression fractures,
  • open fractures,
  • skull fractures,
  • rib fractures,
  • wrist fractures,
  • hip fractures,
  • arm fractures,
  • foot fractures,
  • elbow fractures,
  • broken nose,
  • leg fractures,
  • ankle fractures, and
  • hand,
  • toe, or
  • finger fractures.