What is a Fracture?
A fracture, also known as a broken bone, is a condition that alters the contour in the bone. There are many types of fractures. Fractures often occur when there is a high force or impact put on a bone. Fractures are common and can be caused by a number of things. People break bones in sports injuries, car accidents, falls or from osteoporosis (bone weakening due to aging). Although most fractures are caused by trauma, they can be “pathologic” caused by an underlying disease such as cancer or severe osteoporosis. Medical care is needed immediately after a bone is fractured.
What causes a Broken Bone?
When a bone has an outside force exerted upon it, like a blow or a fall, there is potential that it cannot withstand the amount of force and it breaks. That loss of integrity results in a fracture. It is important to remember that a fracture, break or crack all describe the same situation, an injury to the bone where it has been damaged. Fracture, break and crack all mean the same thing.
Depending upon the situation, the amount of force required may not be very great. People with osteoporosis, the bones lack calcium and are brittle, a minor injury or even gravity may create enough of a force to cause a vertebral compression fracture of the back of a hip fracture.
What are the Symptoms of Fracture?
- An out-of-shape limb or joint that is visible to the eye
- Unbearable or intense pain, especially on movement
- Inability to move the affected bone or joint
- Muscle spasms
- The feeling of numbness or a tingling sensation
- Skin discoloration around the affected area
- In some cases, the broken bone can be seen protruding out of the skin surface
- Bleeding in case of open fracture.
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How is a Fracture Diagnosed and Treated?
Bone Fracture The diagnosis of fracture is made by physical examination by identifying the signs and symptoms of the patient.
An X-ray and sometimes CT-scan or MRI may be advised.
The treatment of bone fractures is broadly classified as –
- Conservative treatment– This involves pain management, immobilization or other non-surgical stabilization.
- Surgical intervention
After reduction of the fracture i.e. lining up the ends of the broken bone, it is necessary to ensure that they stay aligned while the healing process occurs. The joints above and below the site of injury are immobilized to prevent movement at the fracture site. It is done with the help of
- Metal plates and screws
- Intra-medullary nails
- External fixations
Physical therapy (Physiotherapy)
Physiotherapy is essential to restore muscle strength.
Surgery is done only if conservative treatment has failed, is very likely to fail, or likely to result in a poor functional outcome.
Sometimes, bone grafting is used to treat a fracture. Bones may also be reinforced with metal implants.
What first aid should be administered to a patient with a fracture?
First Aid Treatment if a person is suspected of having a fracture, the following measures should be undertaken –
- Try to maintain the patient still and composed. Prevent unnecessary movement arising out of anxiety or fear.
- Examine the person closely for the presence of other injuries and call for medical help. If medical help is quickly available, hand over the patient to them for further treatment.
- If there is a break in the skin surface, it can be rinsed to remove any visible dirt or other potential contamination. However, vigorous flushing or scrubbing of the wound should be avoided.
- The broken bones can be immobilized with either a splint or string. Rolls of newspaper or strips of wood can be used. It is important to immobilize the area both above and below the injured bone.
- Ice packs can be applied to reduce pain and swelling (not to be placed directly over the wound).
What is the treatment for a broken bone?
The initial treatment of a fracture begins with stabilization and immobilization. In the field, RICE (rest, ice, compression, and elevation) may help make the patient more comfortable and prevent the fractured bones from moving. Often the pain associated with a fracture is due to spasm of the muscles surrounding the fracture site trying to prevent movement. Splinting may help relieve some of that pain. Depending upon the injury, EMS providers may consider traction to help with stabilization and pain control.
For non-open fractures or other fractures that can be treated without emergency surgery, the goal is to immobilize the injury to maintain anatomic alignment to allow the bone to heal.
Bone heals in three stages.
- Reactive stage: The blood clot that forms at the fracture site begins to organize and the body’s building blocks start to bridge the gap between the two ends of the broken bone.
- Repair stage: Specialized cells located in the outer lining of the bone (periosteum), begin to form a latticework or grids of cartilage and bone, called a callus, which spans the fracture. More bone is laid down to provide strength to the area.
- Remodeling phase: Over the next few years, the body will attempt to resculpt this mass of bone into its original size and shape.
In the emergency department, walk-in clinic, or doctor’s office, the extremity is usually splinted using a combination of soft padding, casting material (plaster, fiberglass), and ace wraps. This splint is not circumferential like a cast, because a fracture has the potential for swelling of the surrounding tissues, and if a tight cast were in place, that swelling could cause complications including significant pain and potential blood supply issues.
Once the patient is discharged, their instructions are to elevate the injury and ice the area, even with the splint, to help decrease swelling and inflammation.
After a few days, once the initial swelling has resolved, a circumferential cast may replace the splint and will be worn until the fracture is healed. The time frame for healing depends upon the type of fracture and its location. X-rays may be used to help determine when it is time for the cast to be removed.
What are the most common bones that are broken?
The most common fractures involve the clavicle (collarbone), the forearm (radius and ulna), the wrist, the ankle, and the hip. Closed fractures are more common than open fractures (the skin overlying the injury is intact and not damaged).
In children, a fracture of the distal radius is most common. The break occurs in the radius near the wrist but usually does not involve the joint itself.
What types of closed management of fractures and dislocations are available for emergency physicians?
There are 4 different forms of closed management of fractures and/or dislocations for emergency physicians:
- Closed treatment of fracture without manipulation (e.g. 23500—closed treatment of clavicular fracture, without manipulation)
- Closed treatment of fracture with manipulation (e.g. 26755—closed treatment of distal phalangeal fracture, finger or thumb; with manipulation)
- Closed treatment of dislocation with a fracture with manipulation (e.g. 23665—shoulder dislocation, with fracture of greater humeral tuberosity)
- Closed treatment of dislocation without fracture, with manipulation (e.g., 23650—closed treatment of shoulder dislocation, with manipulation, without anesthesia)
How can fractures be prevented?
Many broken bones occur because of accidents in the home, at work or at play, and not all may be preventable. Using proper safety equipment and precautions may minimize the risk of injury, but it cannot be completely eliminated.
As we age, there is an increased risk for falls at homes and some preventive steps may help reduce fall risks. These include:
- Make certain that lighting is adequate
- Shoes should not be slippery
- Loose rugs or uneven floors should be repaired
- High traffic areas like from the bed to the bath or from the kitchen to the living area need to be clear from hazards like excess furniture, extension cords, or boxes
- Bathrooms should have nonslip mats on the floor and in the bathtub or shower
- Install handrails for stairs and grab bars in the bathroom
Bones also get old as we age and the management of osteoporosis is a life-long commitment. Increasing calcium content in the bone will decrease the risk of spontaneous fracture, and also may make bone strong enough to potentially withstand an injury that otherwise would result in a fracture.
Broken Bones from Falls Are Not Related to Osteoporosis
Fractures in individuals over the age of 50 can be the first sign of weak bones from osteoporosis or low bone mass. Each year, 1.5 million older Americans suffer a bone fracture due to osteoporosis. Half of all women over 50 and a quarter of all men will suffer an osteoporosis-related fracture sometime in their remaining life.
If you are over 50, any broken bone should be taken very seriously. You may think to yourself, “Anyone would have broken a bone after taking a fall like that,” but a break after a fall in people over 50 may be a critical sign of osteoporosis. Talk with your doctor about whether you should have a bone density test to determine if your fracture could be due to osteoporosis.
There are many medications available to treat osteoporosis, and they have been shown to substantially reduce the risk of bone fractures in people with osteoporosis. If your doctor in Hyderabad prescribes an osteoporosis medication, it’s important to keep taking it even if you don’t see improvements on your next bone density scan. Osteoporosis drugs can be reducing your risk of bone fracture in ways that don’t show up on a bone density scan. And as always, you should continue to eat a diet rich in calcium and vitamin D.
What first-aid can I give the person who suffers from a fracture in my presence?
Do no harm: Never move the patients or the affected part, unless you need to do so to prevent a further emergency.
Administer CPR: If the patient is unconscious, is not breathing and has no signs of a pulse, administer cardiopulmonary resuscitation or CPR. It is a systematic method of reviving a patient using alternate mouth to mouth breathing and chest compressions. But be cautious if you suspect the patient to have a fracture in the back of the neck. Then you should not try to tilt the head of the person back to maintain the airway; instead try to thrust the jaw forward with the help of your fingers.
Be alert about the person’s breathing: If the patient is in shock, i.e. he/she faints or has shallow and rapid breathing and his/her skin turn pale. Make the patient lie on his/her back and raise the legs by a few inches. Avoid this if you think he/she has a fracture in the leg.
Try to stop bleeding: This could be done by applying pressure at the bleeding point with a clean piece of cloth or gauze.
Try to stabilize the fractured part(s): This can be done by applying a splint to the fractured part(s). The splint can be in the form of a piece of metal, wood or plastic that has been padded (the padding will reduce discomfort). The main function of the splint is to prevent the movement of the fractured part.
Do not attempt anything drastic: This means that you should not try to push back a bone that has come out through the skin. Apart from causing immense pain, it could cause more damage than good.
Help with the pain: Apply ice packs to the fractured area to reduce swelling and tenderness.
When you finally reach a doctor’s office, the physician will do a careful physical exam of the injury and order diagnostic tests of the injured area to assess the type and extent of the fracture. The investigations may be in the form of routine X-rays or CT scans, MRI, angiogram, etc.
Who gets osteoporosis?
Important risk factors for osteoporosis include:
- Age: After maximum bone density and strength is reached (generally around age 30), bone mass begins to naturally drop with age.
- Gender: Women over the age of 50 have the greatest risk of developing osteoporosis. In fact, women are four times more likely than men to develop osteoporosis. Women’s lighter, thinner bones and longer life spans are some of the reasons why they are at high risk for osteoporosis.
- Race: Research has shown that Caucasian and Asian women are more likely to develop osteoporosis. Additionally, hip fractures are twice as likely to occur in Caucasian women as in black women. However, women of color are more likely to die after a hip fracture.
- Bone structure and body weight: Petite and thin women have a greater risk of developing osteoporosis because they have less bone to lose than women with more body weight and larger frames. Similarly, small-boned, thin men are at greater risk than men with larger frames and more bodyweight.
- Family history: Heredity is one of the most important risk factors for osteoporosis. If your parents or grandparents have had any signs of osteoporosis, such as a fractured hip after a minor fall, you may be at greater risk of developing the disease.
Medicover Hospitals is one of the best fracture hospitals in Hyderabad