Fractures

Bones can fracture in a number of different ways. This can be a simple crack across the shaft of a bone –known as a transverse fracture. In long bones, such as the femur (thigh bone) a more complex, spiral, fracture is more common. This leaves surfaces that are less likely to reunite easily. Usually, an injury results in a single fracture, and is known as a simple fracture. Sometimes, especially in more serious accidents, a bone can fracture in a way that produces several fragments. This is called a comminuted fracture.

After a fracture, the broken fragments of bone usually separate to some degree. Sometimes, the broken fragments can be wedged together. This is called an impacted fracture. Bones can also fracture as a result of exposure to repeated small stresses and strains. This is known as a stress fracture and is most often seen in the lower leg or foot bones, especially in athletes. Sometimes the broken end of a bone protrudes through the skin. This is known as a compound (open) fracture and it can lead to infection.

Also, fractures in children tend to be different to those in adults. The bone is softer, and more able to bend. When fractures occur, the bone is not always broken completely. The bone can buckle and split and result in what is known as a greenstick fracture (like snapping a young, green twig). Another type of fracture common in children is called a growth plate fracture. Bone grows in length from special areas near the ends of longer bones, known as the growth plates (epiphyseas). Fractures can sometimes involve these areas and interfere with future growth of the bone.

From about middle-age onwards, the bones begin to become less dense and more liable to fracture. Osteoporosis refers to a condition of brittle bones where this process is accelerated. It particularly affects women after the menopause.

The most obvious symptom of a fractured bone is pain, especially on movement. There is often swelling and bruising at the site of the fracture. The fractured bone may have an abnormal bent appearance and this may be obvious. It may be impossible to move a fractured part of the body, either as a direct result of the fracture or because of the pain it causes.

Someone who has fractured a bone can appear pale and clammy and experience nausea or light-headedness. This is often due to pain. When large bones, such as the pelvis or thighbone (femur) are fractured, there will be internal bleeding from the bone and this can cause similar symptoms.

For someone who is conscious, breathing and does not have open wounds, the most important aspect of first aid treatment is to minimise movement of the fractured bone. This helps minimise pain and can also prevent further injuries caused by movement of the sharp ends of broken bone. How a fracture is immobilised depends on where the fracture is. It may be necessary to use a sling or form a splint. These techniques can be learnt from first aid courses and manuals. It's important to seek medical advice for anyone with a suspected broken bone.

Most fractures can be clearly diagnosed by X-ray, although some types, such as a fracture of the base of the thumb, or a stress fracture, do not show up reliably. After serious accidents, or where a person has circulation or breathing problems, or other serious injury that affects these essential processes, doctors treat these first. Fractures are then treated as follows:

• Re-aligning the broken bone, if necessary. This may needs to be done with the use of an anaesthetic, painkillers or both of these and is known as reducing the fracture.
• Immobilising the broken bone. Plaster casts, splints or slings may be used. Some fractures require surgery, and the use of metal screws, wires, pins or plates to hold the broken pieces of bone together. This is may be necessary where the broken ends of bone cannot easily be brought back together or kept close enough to allow them to knit together.

The repair of a fracture by the body is a gradual, continuous process. The time it takes for the broken ends of the bone to knit back together (unite) varies depending on the type of fracture and where the fracture is. As a general rule, fractures need to be immobilised for between two and eight weeks. After this it is important to begin gentle movement and exercise as this helps to build up strength in the healing bone over the following months. Physiotherapy may be needed to promote healing and a return to mobility of the affected bone.

Occasionally there can be complications with fractures. Very serious fractures can heal with some limitations – such as pain or stiffness – in the use of the limb or joint involved. Some fractured bones do not knit back together well and can lead to a slow recovery, with surgery needed to help the bones to unite. Infection can also complicate and delay the healing of fractures. This is more common if the fracture was an open or if surgery has been required to fix the bone.