The skeleton of the body is made up of bones.
Bones also function as attachment points for the muscles and makes typical activities like jumping, running, grasping, lifting, kneeling, and sitting possible because they are connected by joints.
What causes fractures?
When an outside force is exerted upon the bone (i.e. from falls or blows), there is a possibility that it cannot withstand the force and breaks.
The loss of integrity will result in a fracture. However, in some cases, the amount of force needed to cause a fracture may not be that great. For instance, a minor injury may create enough force to cause a hip fracture or vertebral compression fracture of the back in people weakened by osteoporosis.
What are the common types?
Fractures are typically described by how the bones are aligned, their location, whether or not the skin is intact at the injury site, and whether there are complications in terms of blood or nerve function. The definitions and terms used to describe fractures make it possible for healthcare professionals to accurately describe where the fracture is located. For a reference point, the heart is used. That means the anatomic descriptions are based in their location with the heart as a reference.
Some of the typical anatomic terms used to describe fractures include:
- Proximal – closer to the body’s centre
- Distal – further from the centre
- Anterior – toward the body’s front
- Posterior – toward the back
- Medial – toward the body’s middle
- Lateral – to the body’s outer edge
Fractures are also either non-displaced or displaced. In other words, they are either adequately aligned in-contact or not. However, some physicians believe that all fractures have displacements and therefore prefer using the term “minimally” or “completely” displaced.
Fracture descriptions can also use the direction it takes within the bones as reference. For instance:
- Oblique – occurs at an angle
- Transverse – perpendicular across the bone
- Spiral – extends or spirals down the bone’s length
- Comminuted – has more than two parts or multiple fragments
There are also special terms used to describe fractures. For example:
- Torus – In children, when only a single part of the bone buckles, it is referred to as torus or incomplete fracture. The fracture line does not extend across the whole bone.
- Greenstick – Bones in young children are not yet solid so when force is applied, the bones will tend to bow but not break completely, like a young bamboo stalk.
Fractures are also classified into “open” (when the sharp bone end penetrates the skin) or closed (when the skin remains intact). Open fractures may require the expertise of an orthopaedic surgeon to wash out the fracture site. This is done to prevent bone infection (osteomyelitis). The procedure may take place in the operating room and will take into consideration other key factors such as fracture type, patient’s overall condition, and the amount of contamination to the wound and skin.
What are the signs and symptoms?
Broken bones hurt. The periosteum (lining of the bone) is rich with nerve endings that can result in pain when torn and inflamed. The muscles that surround the fracture can go into spasm which can intensify the pain further. And since bones have a rich blood supply, it can bleed when injured. The bleeding can result in swelling and the blood that will seep into the surrounding tissues may also cause pain. This can also manifest as a purple or dark red bruise in the area of the injury. If the tendons and the muscles are not damaged or injured, the patient may still be able to move the injured area.
However, it does not mean that no bones are broken. If a nearby artery is damaged, the limb may be pale and cool distal to the injury. In the event of nerve damage, numbness may be felt distally.
How is a fracture diagnosed?
While most fractures require medical care, the urgency of that care will often depend on the type of fracture and other key factors.
To diagnose a broken bone, the doctor will do the following:
- Ask regarding the patient’s injury. The injury site will also be examined to ensure there are no other injuries sustained aside from the fracture.
- The skin surrounding the area will be examined for any signs of scrape, lacerations, or skin tears. The nerves and blood flow distally are checked.
- Depending on the specific injury, an X-ray is usually ordered.
- In other cases, an MRI or CT scan might be required in order to further assess the damage.
What are the first aid measures for fractures?
In the event of fractures, it is recommended that unnecessary movement is avoided to prevent further injury.
The following should be observed while waiting for medical help:
- Stop bleeding, if any. Apply pressure to the wound using a clean cloth, a sterile bandage, or any clean piece of clothing.
- Immobilize the area injured. Never attempt to realign or push back in a bone that’s sticking out. If someone has been trained to do a splint, applying one in the area above and below the site fractured would be advisable while waiting for professional help. Padding the splints is also recommended to help minimize discomfort.
- Apply ice packs to alleviate pain and reduce swelling, especially in a closed fracture. Do not apply ice directly to the skin. Instead, wrap the ice in a piece of cloth, towel, or any other material before applying it on the skin.
- If the patient is breathing in short rapid breaths or is about to pass out, lay the patient down and ensure the head is slightly lower than the trunk. In addition, elevating the legs can also help.