A fracture is a break in the bone’s continuity, which occurs when a bone counters a force stronger than it can bear as in trauma because of a fall/fight/vehicular accident. Fractures may be caused when the bones get weak because of conditions such as osteoporosis, brittle bone disease, osteomalacia, and bone tumours.
Most people assume there is only one type of fracture – the type that requires a white cast that possibly lasts for a few months; however, there is considerably more to a fracture than that. Nevertheless, the fact is that there are multiple different types and based on the type, the line of treatment and recovery time varies.
Displaced or non-displaced: When the fractured fragments are separate, they are still correctly aligned and have not moved from their normal position; they are known as non-displaced fractures. If they have moved, it is known as a displaced fracture.
Open or closed fracture: When the fractured bone breaks the skin and comes out through a wound, it is called an ‘open’ fracture. When no such wound is present, the fracture is called a ‘closed’ fracture.
Greenstick fracture: Generally, this type of fracture is seen in children, where the bone is bent and partially broken similar to a fresh green wood/stick (hence the name) (this occurs because a child’s bones are suppler than an adult’s bones).
Comminuted fracture: This is where the fractured bone is fragmented into multiple small pieces or when the bone breaks into more than two to three parts
Stress fracture: Known as a ‘hairline crack’, such fractures occur because of low-grade trauma over a long time period to a part of a bone. Most commonly associated with the lower limb and most commonly seen in runners/joggers and army personnel
Pathological fracture: Sometimes, bones may become weak and thin because of a disease such as osteoporosis/bone tumours. In such cases, a person may suffer from a fracture without any trauma or injury. Such a fracture is called a pathological fracture.
Symptoms
The symptoms vary depending on the type of fracture. These include –
Displaced or non-displaced: A person with a displaced fracture will notice a disfigurement (a small protrusion) of the area that is fractured. For a non-displaced fracture, one will only notice a swelling in the region.
Open or closed fracture: The open fracture is the easiest to identify because of the wound seen on the person’s skin. For the closed fracture, one will be able to see the broken bone pushing through the skin.
Greenstick fracture: Usually associated with immense pain and inability to use the fractured part, a greenstick fracture requires considerable care and attention. The person will not notice the usual deformity seen with other fractures.
Comminuted fracture: A person with this fracture type will notice bruising, pain and swelling. The person might hear a snap or a crack when the bone breaks. There might be certain disfigurement of the area.
Stress fracture: Here the patient will experience symptoms such as dull aching pain that gradually develops: one that increases with weight-bearing activity and goes away with rest, pain and tenderness around the area of the fracture.
Pathological fracture: In this type of fracture, the person will experience sudden symptoms associated with that particular type of fracture while he/she might be experiencing pain along the region of the break for a while (usually associated with the weakening of the bones)
In addition to all these specific symptoms as per the type of the common symptoms that are reported these are pain, tenderness, inability to put stress on the fractured area and painful active or passive movements of the same.
Causes And Risk Factors
Causes
The major or most common cause of fractures is trauma. Now, this can be a high-energy trauma such as vehicular accidents or fall from a height or trauma by blunt force causing fractures in normal healthy bones, whereas even a trivial amount of trauma such as a sudden twisting, bending or a jerk at the associated area can cause a fracture for osteoporotic bones.
Risk Factors
Women possibly have fractures because they usually have less dense bones compared to men. Because of the loss of estrogen with age, women lose more bone density. A list of other risk factors that can increase an individual’s risk for a fracture is as follows:
Car accidents, falls, and sports injuries.
Osteoporosis (a medical condition in which the bones weaken with age).
Regular smoking.
Heavy alcohol consumption from an early age.
High doses of steroids are prescribed to treat arthritis, chronic obstructive pulmonary disease, and inflammatory disease.
Different conditions such as rheumatoid arthritis, Celiac disease, Crohn’s disease, and ulcerative colitis.
Diabetes.
Prevention
Take the following measure to decrease the risk of getting a fracture:
Wear appropriate protection such as a helmet, elbow and knee pads, and wrist guards while biking, skiing, or playing any sport.
Prevent falls by avoiding standing on a chair or any unstable objects.
Creating a safer environment for the elderly people at home and outside by making use of walking stick or walkers to avoid falls
Create a safe environment at home for the kids and regularly supervise their activities.
Exercises such as walking, keeps bones healthy and improves muscle balance and keeping your body weight in check by daily exercise
An individual should ensure consuming 1200-1500 m of Ca in a day. Include Ca- and vitamin C-rich foods such as almonds, chickpeas, tofu, milk, yoghurt, eggs, broccoli, spinach, oats, and brown rice.
Also, all postmenopausal women most likely after the age of 45-50 years of age should start Vitamin D and Ca supplements prophylactically and compulsorily to avoid osteoporosis.
A bi-annual or annual medical check-up to rule out any underlying pathology if any.
Diagnosis
Diagnostic tests such as X-rays or CT scans and MRI of the injured area are performed to assess the type and extent of the fracture.
Treatment
Depending on the type of fracture, the treatment options are determined. However, after proper alignment or ‘reduction’, a fracture is immobilized with the help of a plaster of Paris cast, splint or traction. Certain fractures may require a minor surgery (open reduction) and metallic plates, rods, screws or pins are used to stabilize bone fragments in position. The common treatment options for fractures are as follows:
Displaced or non-displaced: For a displaced fracture, the fragments have to be brought back into alignment, usually surgically. This procedure is called ‘reduction’, which can be ‘closed’ (without surgery) or ‘open’ (with surgery). Depending on the severity of the fracture a person might require surgery. In such cases, although the affected area usually returns to normal functioning, the period for complete recovery is anywhere from three to six months.
Open or closed fracture: For an open fracture, the wound requires to be carefully cleaned and accordingly dressed so as to avoid an infection of the bone. Antibiotics are indefinitely prescribed to prevent an infection. In this fracture type, the patient almost always requires surgery to realign the bones and repair the damage to the skin and underlying soft tissues. The doctor may require to place a plate or metal screws to hold bones in place till they heal. The recovery time for such a fracture is usually about six months, followed by physiotherapy to regain use of the fractured part.
Greenstick fracture: This fracture type is usually cast in an immovable cast so as to allow the bones to heal. For children, the doctor may use a cast for the entire area to minimize movements made by the child, especially in the case of a fractured arm or leg. Usually seen in children, the doctor usually prescribes the child to remain in the cast for at least three months with close monitoring. If the fracture has not healed, he/she may extend the amount of time the cast is maintained.
Comminuted fracture: This fracture type often requires surgery to realign all the bone fragments and the insertion of a metal plate or wires to hold them in place till they heal. Depending on the severity of the fracture, a patient may require to remain in the case and have regular post-operative checkups to ensure that the area is healing well. He/she may be required to remain in a cast for a few months and will require a significant amount of physiotherapy after treatment.
Stress fracture: Most stress fractures only require a cast to heal; however, there are others that require surgical intervention to help bones join and heal. Depending on the case, the patient will require anywhere between a few weeks to a few months to heal and can return to normal activity.
Pathological fracture: In such cases, the patient is treated for the fracture and given appropriate medical care for the underlying reason.
People who suffer from a fracture because of pathological reasons usually have a long road to recovery. Even after the fracture has healed, it takes a long while to rehabilitate that area and make the bones strong enough to support their weight and the stress of everyday activities. One should realise that a fracture does require first aid when it occurs.
Lifestyle/management
Eating a balanced diet rich in vitamins and minerals can improve bone health and potentiate healing. Include vitamin C-rich foods such as eggs, liver, and seafood; and Ca-rich foods such as dairy, green leafy vegetables, almonds, seafood, legumes, fortified juice, soy milk and tofu.
Daily exercise and ensuring the body weight remains in check along with cessation of smoking and alcohol consumption
Prognosis And Complications
PROGNOSIS AND COMPLICATIONS
Prognosis
Depending on the severity and the location of the fracture, healing time will vary in patients and patient compliance after the treatment (this being the most important aspect) along with the age of the patient and any underlying medical condition. For example, fracture healing is going to be affected in diabetic patients and chronic smokers, it is going to be slow and sometimes incomplete for any underlying systemic infection or a direct bone infection.
Optimum nutrition during the recovery period is of utmost importance for fracture healing. It takes six to eight weeks to recover from a bone fracture. Recovery time is dependent on the patient’s age.
Complications
Bone fractures can lead to blood clots, sores, osteomyelitis (infection of the bone), joint stiffness, bleeding and swelling in the muscles around the fracture and joints as well as major fractures if neglected or promptly lapse in acting on it can be life-threatening.
Alternative Treatments
Herbs can help reduce swelling, pain, and soreness during a fracture ultimately helping in speedy recovery. Roots and stems are useful for treating fractures. They are administered internally or applied to the fracture’s surface; however, it is better to seek the help of a medical professional before beginning any treatment.
References
Broken bone. MedlinePlus. Available at: https://medlineplus.gov/ency/article/000001.htm. (https://medlineplus.gov/ency/article/000001.htm)
Bone fractures. Cleveland clinic. Available at: https://my.clevelandclinic.org/health/diseases/15241-bone-fractures. (https://my.clevelandclinic.org/health/diseases/15241-bone-fractures)
Fracture risk factors. American Bone Health. Available at: https://americanbonehealth.org/fracture/fracture-risk-factors/. (https://americanbonehealth.org/fracture/fracture-risk-factors/)
Karpouzos A, et al. J Osteoporos. 2017;4218472.
Health screenings for women ages 40 to 64. MedlinePlus. Available at: https://medlineplus.gov/ency/article/007467.htm. (https://medlineplus.gov/ency/article/007467.htm)
Fracture Healing Overview. StatPearls. Available at: https://www.ncbi.nlm.nih.gov/books/NBK551678/. (https://www.ncbi.nlm.nih.gov/books/NBK551678/)
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