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What Are Fractures?

A fracture is the medical term for a broken bone.

Fractures are common; the average person has two during a lifetime. They occur when the physical force exerted on the bone is stronger than the bone itself.

Your risk of fracture depends, in part, on your age. Broken bones are very common in childhood, although children's fractures are generally less complicated than fractures in adults. As you age, your bones become more brittle and you are more likely to suffer fractures from falls that would not occur when you were young.

There are many types of fractures, but the main categories are displaced, non-displaced, open, and closed. Displaced and non-displaced fractures refer to the way the bone breaks.

In a displaced fracture, the bone snaps into two or more parts and moves so that the two ends are not lined up straight. If the bone is in many pieces, it is called a comminuted fracture. In a non-displaced fracture, the bone cracks either part or all of the way through, but does move and maintains its proper alignment.

A closed fracture is when the bone breaks but there is no puncture or open wound in the skin. An open fracture is one in which the bone breaks through the skin; it may then recede back into the wound and not be visible through the skin. This is an important difference from a closed fracture because with an open fracture there is a risk of a deep bone infection.

Some fracture types are:  A Greenstick fracture is an incomplete fracture in which the boneblood vessels or nerves and infection of the bone ( osteomyelitis ) or surrounding tissue. Recuperation time varies depending on the age and health of the patient and the type of fracture. A minor fracture in a child may heal within a few weeks; a serious fracture in an older person may take months to heal. WebMD Medical Reference " id="pdf-obj-1-2" src="pdf-obj-1-2.jpg">

Some fracture types are:

A Greenstick fracture is an incomplete fracture in which the bone is

bent. This type occurs most often in children. A transverse fracture is when the broken piece of bone is at a right

angle to the bone's axis. An oblique fracture is when the break has a curved or sloped pattern.

A comminuted fracture is when the bone breaks into several pieces.

A buckled fracture, also known as an impacted fracture, is one whose

ends are driven into each other. This is commonly seen in arm fractures in children. A pathologic fracture is caused by a disease that weakens the bones.

A stress fracture is a hairline crack.

The severity of a fracture depends upon its location and the damage done to the bone and tissue near it. Serious fractures can have dangerous complications if not treated promptly; possible complications include damage to blood vessels or nerves and infection of the bone (osteomyelitis) or surrounding tissue. Recuperation time varies depending on the age and health of the patient and the type of fracture. A minor fracture in a child may heal within a few weeks; a serious fracture in an older person may take months to heal.

WebMD Medical Reference

<a href=View Article Sources Reviewed by Melinda Ratini, DO, MS on March 16, 2015 © 2015 WebMD, LLC. All rights reserved. " id="pdf-obj-2-4" src="pdf-obj-2-4.jpg">

Reviewed by Melinda Ratini, DO, MS on March 16, 2015 © 2015 WebMD, LLC. All rights reserved.

Summary

A fracture is a break, usually in a bone. If the broken bone punctures the skin, it is called an open or compound fracture. Fractures commonly happen because of car accidents, falls or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Overuse can cause stress fractures, which are very small cracks in the bone.

Symptoms of a fracture are

Out-of-place or misshapen limb or joint

Swelling, bruising or bleeding

Intense pain

Numbness and tingling

Limited mobility or inability to move a limb

You need to get medical care right away for any fracture. You may need to wear a cast or splint. Sometimes you need surgery to put in plates, pins or screws to keep the bone in place.

Diagnosis/Symptoms

A bone scan is a nuclear imaging test that helps diagnose and track several types of bone disease. Your doctor may order a bone scan if you have unexplained skeletal pain, bone infection or a bone injury that can't be seen on a standard X-ray.

A bone scan is also an important tool for detecting cancer that has spread (metastasized) to the bone from the tumor's original location, such as the breast or prostate.

If you have unexplained bone pain, a bone scan might help determine the cause. The test is very sensitive to variation in bone metabolism. The ability to scan the entire skeleton makes a bone scan very helpful in diagnosing a wide range of bone disorders, including:

Fractures

Arthritis

Paget's disease of bone

Cancer originating in bone

Cancer that has metastasized to bone from a diferent site

Infection of the joints, joint replacements or bones (osteomyelitis)

Fibrous dysplasia

Impaired blood supply to bones or death of bone tissue (avascular necrosis)

A bone scan poses no greater risk than do conventional X- ray procedures. The tracers used in a bone scan produce very little radiation exposure — less than half that of a CT scan.

You don't need to restrict your diet or avoid particular activities in preparation for a bone scan. Immediately before

the test, though, you may be asked to remove jewelry or other metal objects.

Bone scans aren't usually performed on pregnant women or nursing mothers because of concerns about radiation exposure to the baby. Tell your doctor if you're pregnant — or think you might be pregnant — or if you're nursing.

A bone scan is a nuclear imaging procedure. In nuclear imaging, tiny amounts of radioactive materials (tracers) are injected into a vein and taken up in varying amounts at diferent sites in the body. Areas of the body where cells and tissues are repairing themselves most actively take up the largest amounts of tracer. Nuclear images highlight these areas, suggesting the presence of abnormalities associated with disease or injury. A bone scan includes both an injection and the actual scan.

The injection

Tracers will be injected into a vein in your arm. The amount of time between the injection and scan varies, depending on the reason your doctor has ordered the scan.

Some images may be taken immediately after the injection. You will need to wait for two to four hours, however, before the main images are taken, to allow the tracer to circulate and be absorbed by your bones. Your doctor may

recommend that you drink several glasses of water while you wait.

The scan

You'll be asked to lie still on a table while an armlike device supporting a tracer-sensitive camera passes back and forth over your body. The procedure is painless.

A scan of your entire skeleton usually takes less than 30 minutes. Scanning a limited area of your body takes less time.

Your doctor might order a three-phase bone scan, which includes a series of images taken at diferent times. A number of images are taken as the tracer is injected, then shortly after the injection, and again two to four hours later.

To better see some bones in your body, your doctor might order additional imaging called single-photon emission computerized tomography (SPECT). This imaging can help analyze conditions that are especially deep in your bone or in places that are difficult to see.

For a SPECT scan, the camera rotates around your body, taking images as it rotates. The additional SPECT images take about 35 minutes.

After the test

A bone scan generally has no side efects, and no follow-up care is needed. The radioactivity in the tracers is mostly removed from your body after one day and completely eliminated by two days.

A doctor who specializes in reading images (radiologist) will look for evidence of abnormal bone metabolism on the scans. These areas appear as darker "hot spots" and lighter "cold spots" where the tracers have or haven't accumulated.

Although a bone scan is very sensitive to abnormalities in bone metabolism, it's less helpful in determining the exact cause of the abnormality. If you have a bone scan that shows hot spots, more testing may be needed to determine the cause.

What is Bone X-ray (Radiography)?

An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose ofionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.

A bone x-ray makes images of any bone in the body, including the hand, wrist, arm, elbow, shoulder, spine, pelvis, hip, thigh, knee, leg (shin), ankle or foot.

What are some common uses of the procedure?

What are some common uses of the procedure? <a href=View larger with caption A bone x-ray is used to: diagnose fractured bones or joint dislocation. demonstrate proper alignment and stabilization of bony fragments following treatment of a fracture.  guide orthopedic surgery, such as spine repair/fusion, joint replacement and fracture reductions.  look for injury, infection, arthritis , abnormal bone growths and bony changes seen in metabolic conditions. assist in the detection and diagnosis of bone cancer .     locate foreign objects in soft tissues around or in bones. top of page How should I prepare? Most bone x-rays require no special preparation. You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, removable dental appliances, eye glasses and any metal objects or clothing that might interfere with the x- ray images. Women should always inform their physician and x- ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x- " id="pdf-obj-8-6" src="pdf-obj-8-6.jpg">

A bone x-ray is used to:

diagnose fractured bones or joint dislocation. demonstrate proper alignment and stabilization of bony fragments following treatment of a fracture. guide orthopedic surgery, such as spine repair/fusion, joint replacement and fracture reductions. look for injury, infection, arthritis, abnormal bone growths and bony changes seen in metabolic conditions. assist in the detection and diagnosis of bone cancer.

locate foreign objects in soft tissues around or in bones.

How should I prepare?

Most bone x-rays require no special preparation.

You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, removable dental appliances, eye glasses and any metal objects or clothing that might interfere with the x- ray images.

Women should always inform their physician and x- ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-

ray is necessary, precautions will be taken to minimize

radiation exposure to the baby. See the Safety page for more information about pregnancy and x-rays.

What does the equipment look like?

ray is necessary, precautions will be taken to minimize radiation exposure to the baby. See theSafety page for more information about pregnancy and x-rays. top of page What does the equipment look like? View larger with caption The equipment typically used for bone x-rays consists of an x- ray tube suspended over a table on which the patient lies. A drawer under the table holds the x-ray film or image recording plate . Sometimes the x-ray is taken with the patient standing upright, as in cases of knee x-rays. A portable x-ray machine is a compact apparatus that can be taken to the patient in a hospital bed or the emergency room. The x-ray tube is connected to a flexible arm that is extended over the patient while an x-ray film holder or image recording plate is placed beneath the patient. top of page How does the procedure work? X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x- ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special detector. " id="pdf-obj-9-57" src="pdf-obj-9-57.jpg">

The equipment typically used for bone x-rays consists of an x- ray tube suspended over a table on which the patient lies. A drawer under the table holds the x-ray film or image recording plate. Sometimes the x-ray is taken with the patient standing upright, as in cases of knee x-rays.

A portable x-ray machine is a compact apparatus that can be taken to the patient in a hospital bed or the emergency room. The x-ray tube is connected to a flexible arm that is extended over the patient while an x-ray film holder or image recording plate is placed beneath the patient.

How does the procedure work?

X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x- ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special detector.

Different parts of the body absorb the x-rays in varying degrees. Dense bone absorbs much of the radiation while soft tissue, such as muscle, fat and organs, allow more of the x- rays to pass through them. As a result, bones appear white on the x-ray, soft tissue shows up in shades of gray and air appears black.

Until recently, x-ray images were maintained as hard film copy (much like a photographic negative). Today, most images are digital files that are stored electronically. These stored images are easily accessible and are frequently compared to current x-ray images for diagnosis and disease management.

How is the procedure performed?

Different parts of the body absorb the x-rays in varying degrees. Dense bone absorbs much oftop of page How is the procedure performed? View larger with caption The technologist, an individual specially trained to perform radiology examinations, positions the patient on the x-ray table and places the x-ray film holder or digital recording plate under the table in the area of the body being imaged. When necessary, sandbags, pillows or other positioning devices will be used to help you maintain the proper position. A lead apron may be placed over your pelvic area or breasts when feasible to protect from radiation. You must hold very still and may be asked to keep from breathing for a few seconds while the x-ray picture is taken to reduce the possibility of a blurred image. " id="pdf-obj-10-54" src="pdf-obj-10-54.jpg">

The technologist, an individual specially trained to perform radiology examinations, positions the patient on the x-ray table and places the x-ray film holder or digital recording plate under the table in the area of the body being imaged. When necessary, sandbags, pillows or other positioning devices will be used to help you maintain the proper position. A lead apron may be placed over your pelvic area or breasts when feasible to protect from radiation.

You must hold very still and may be asked to keep from breathing for a few seconds while the x-ray picture is taken to reduce the possibility of a blurred image.

The technologist will walk behind a wall or into the next room to activate the x-ray machine.

You may be repositioned for another view and the process is repeated. Two or three images (from different angles) will typically be taken.

An x-ray may also be taken of the unaffected limb, or of a child's growth plate (where new bone is forming), for comparison purposes.

When the examination is complete, you will be asked to wait until the radiologist determines that all the necessary images have been obtained.

A bone x-ray examination is usually completed within five to 10 minutes.

What will I experience during and after the procedure?

A bone x-ray examination itself is a painless procedure.

You may experience discomfort from the cool temperature in the examination room. You may also find holding still in a particular position and lying on the hard examination table uncomfortable, especially if you are injured. The technologist will assist you in finding the most comfortable position possible that still ensures x-ray image quality.

Who interprets the results and how do I get them?

A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will discuss the results with you.

Follow-up examinations may be necessary, and your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a suspicious or questionable finding needs clarification with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time. Follow-up examinations are sometimes the best way to see if treatment is working or if an abnormality is stable over time.

What are the benefits vs. risks?

Benefits

Bone x-rays are the fastest and easiest way for a physician to view and assess bone injuries, including fractures, and joint abnormalities, such as arthritis. X-ray equipment is relatively inexpensive and widely available in emergency rooms, physician offices, ambulatory care centers, nursing homes and other locations, making it convenient for both patients and physicians. Because x-ray imaging is fast and easy, it is particularly useful in emergency diagnosis and treatment. No radiation remains in a patient's body after an x-ray examination.

X-rays usually have no side effects in the typical diagnostic range for this exam.

Risks

There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk. The effective radiation dose for this procedure varies. See the Safety page for more information about radiation dose. Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. See the Safety page for more information about pregnancy and x-rays.

A Word About Minimizing Radiation Exposure

Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection organizations continually review and update the technique standards used by radiology professionals.

Modern x-ray systems have very controlled x-ray beams and dose control methods to minimize stray (scatter) radiation. This ensures that those parts of a patient's body not being imaged receive minimal radiation exposure.

What are the limitations of Bone X-ray (Radiography)?

While x-ray images are among the clearest, most detailed views of bone, they provide little information about muscles, tendons or joints.

An MRI may be more useful in identifying bone and joint injuries (e.g., meniscal and ligament tears in the knee, rotator cuff and labrum tears in the shoulder) and in imaging of the spine (because both the bones and the spinal cord can be evaluated). MRI can also detect subtle or occult fractures or bone bruises (also called bone contusions or microfractures) not visible on x-ray images.

CT is being used widely to assess trauma patients in emergency departments. A CT scan can image complicated fractures, subtle fractures or dislocations. In elderly or patients with osteoporosis, a hip fracture may be clearly seen on a CT scan, while it may be barely seen, if at all, on a hip x- ray.

For suspected spine injury or other complicated injuries, 3-D reconstructed CT images can be made without additional radiation exposure to help the diagnosis and treatment of the individual patient's condition.

An MRI may be more useful in identifying bone and joint injuries (e.g., meniscal and ligamentcongenital problems. Treatments and Therapies First aid " id="pdf-obj-14-8" src="pdf-obj-14-8.jpg">

Ultrasound imaging, which uses sound waves instead of ionizing radiation to create diagnostic images, has also been useful for injuries around joints, and in evaluating the hips of children with congenital problems.

Treatments and Therapies

Fractures (broken bones): First aid

A fracture is a broken bone. It requires medical attention. If the broken bone is the result of major trauma or injury, call 911 or your local emergency number.

Also call for emergency help if:

The person is unresponsive, isn't breathing or isn't moving. Begin CPR if there's no breathing or heartbeat.

There is heavy bleeding.

Even gentle pressure or movement causes pain.

The limb or joint appears deformed.

The bone has pierced the skin.

The extremity of the injured arm or leg, such as a toe or finger, is numb or bluish at the tip.

You suspect a bone is broken in the neck, head or back.

Don't move the person except if necessary to avoid further injury. Take these actions immediately while waiting for medical help:

Stop any bleeding. Apply pressure to the wound with a sterile bandage, a clean cloth or a clean piece of clothing.

Immobilize the injured area. Don't try to realign the bone or push a bone that's sticking out back in. If you've been trained in how to splint and professional help isn't readily available, apply a splint to the area above and below the fracture sites. Padding the splints can help reduce discomfort.

Apply ice packs to limit swelling and help relieve pain. Don't apply ice directly to the skin. Wrap the ice in a towel, piece of cloth or some other material.

Treat for shock. If the person feels faint or is breathing in short, rapid breaths, lay the person down with the head slightly lower than the trunk and, if possible, elevate the legs.

Bone fracture repair - series

Indications

Overview Fractures of the bones are classified in a number of ways. A simple fracture involves

Overview

Fractures of the bones are classified in a number of ways. A simple fracture involves a single fracture line through a bone. A comminuted fracture is one in which the bone has been fractured into two or more fragments. An open fracture is one in which the fractured bone penetrates the skin.

Procedure

Overview The three main treatment options for bone fractures are:  Casting  Open reduction, and

Overview

The three main treatment options for bone fractures are:

Casting

Open reduction, and internal fixation- this involves a surgery to repair the fracture-frequently, metal rods, screws or plates are used to repair the bone, and remain in place, under the skin, after the surgery. This procedure is recommended for complicated fractures not able to be realigned (reduced) by casting, or in cases in which the long-term use of a cast is undesirable.

Open reduction, and external fixation- this involves a surgery to repair the fracture, and placement of a external fixation device on the limb with the fracture. This device is an external frame which supports the bone and hold it in the correct position while it is healing. This technique is generally applied to complex fractures that cannot be repaired using open reduction, and internal fixation.

Procedure

Overview While the patient is pain-free (general or local anesthesia), an incision is made over the

Overview

While the patient is pain-free (general or local anesthesia), an incision is made over the fractured bone. The bone is placed in proper position and screws, pins, or plates are attached to or in the bone temporarily or permanently. Any disrupted blood vessels are tied off or burned (cauterized). If examination of the fracture shows that a quantity of bone has been lost as a result of the fracture, especially if there is a gap between the broken bone ends, the surgeon may decide that a bone graft is essential to avoid delayed healing.

If bone grafting is not necessary, the fracture can be repaired by the following methods:

  • a) one or more screws inserted across the break to hold it.

  • b) a steel plate held by screws drilled into the bone.

c) a long fluted metal pin with holes in it, is driven down the shaft of the bone from one end, with screws then passed through the bone and through a hole in the pin.

In some cases, after this stabilization, the microsurgical repair of blood vessels and nerves is necessary. The skin incision is then closed in the usual fashion.

Aftercare

c) a long fluted metal pin with holes in it, is driven down the shaft of

Overview

The advantage of internal fixation is that it often allows early mobility and faster healing. Unless the internal fixation causes problems, it is not necessary or desirable to remove it. The long-term prognosis is excellent. The length of the hospital stay depends on factors such as the condition of the bone, the presence of infection, the state of the blood and nerve supply, and presence of other injuries. Children's bones heal rapidly, usually in 6 weeks time.

Creating a sling - series

Procedure, part 1

Creating a sling - series Procedure, part 1 Overview To create a sling and swathe, begin

Overview

To create a sling and swathe, begin with a triangular cloth or bandage draped under one arm and over the opposite shoulder.

Procedure, part 2

Overview Tie the two ends of the cloth behind the neck, as shown at left. Pin

Overview

Tie the two ends of the cloth behind the neck, as shown at left. Pin the remaining elbow corner up onto the body of the sling. Use another bandage, a belt, or a strap/webbing to secure the arm to the chest, as shown at right.

Broken bone: Types of fractures, symptoms and prevention

Broken bones can happen after accidents, falls or being struck by something.

Broken bones are also called fractures, and can be very painful.

The risk of broken bones often depends partly on a person's age.

Broken bones can be common in childhood and older age.

Children's bones are still forming, plus they may fall off bikes or climbing frames for example.

In older age, people can become more frail and more likely to trip and fall. Plusosteoporosis can make bones more brittle and more likely to fracture after a fall.

Types of bone fracture

There are many types of fractures, but the main categories are complete, incomplete, compound and simple. Complete and incomplete fractures refer to the way the bone breaks. In a complete fracture, the bone snaps into two or more parts; in an incomplete fracture, the bone cracks but does not break all the way through.

In a compound fracture, also called an open fracture, the bone breaks through theskin. It may then recede back into the wound, so it is no longer visible through theskin. In a simple fracture, also called a closed fracture, the bone breaks but there is no open wound in the skin.

In a compound fracture, also called an open fracture, the bone breaks through th <a href=e skin . It may then recede back into the wound, so it is no longer visible through th e skin . In a simple fracture, also called a closed fracture, the bone breaks but there is no open wound in the skin. Simple fractures include:  Greenstick fracture: an incomplete fracture in which the bone is bent. This type of fracture occurs most often in children .  Transverse fracture: a fracture at a right angle to the bone's axis.  Oblique fracture: a fracture in which the break is at an angle to the bone’s axis.  Comminuted fracture: a fracture in which the bone fragments into several pieces.  An impacted fracture is one whose ends are driven into each other. This commonly occurs with arm fractures in children and is sometimes known as a buckle fracture. " id="pdf-obj-24-10" src="pdf-obj-24-10.jpg">

Simple fractures include:

Greenstick fracture: an incomplete fracture in which the bone is bent. This type of fracture occurs most often in children.

Transverse fracture: a fracture at a right angle to the bone's

axis.

Oblique fracture: a fracture in which the break is at an angle to the bone’s axis.

Comminuted fracture: a fracture in which the bone fragments into several pieces.

An impacted fracture is one whose ends are driven into each other. This commonly occurs with arm fractures in children and is sometimes known as a buckle fracture.

Among other types of fracture are: a pathological fracture, caused by a disease that weakens the bones; and a stress fracture, which is a hairline crack.

The severity of a fracture depends on its location and the damage done to the bone and nearby tissue. Serious fractures can have dangerous complications if they are not treated promptly, such as damage to blood vessels or nerves and infection of the bone (osteomyelitis) or surrounding tissue.

The recuperation time after a fracture varies depending on the age and health of the patient and the type of fracture. A minor fracture in a child may heal within a few weeks; a serious fracture in an older person may take months to heal.

What are the symptoms of a bone fracture?

Signs and symptoms of a fracture include:

Swelling or bruising over a bone.

Deformity of an arm or leg.

Pain in the injured area that gets worse when the area is moved or pressure is applied.

Loss of function in the injured area.

In compound fractures, bone protruding from the skin.

Fractures are usually caused by a fall, blow or other traumatic event. Pathological fractures are those caused by disease that weakens the bones; they can occur with little or no trauma. Osteoporosis, a disorder in which the bones thin and lose strength as they age, causes around 250,000 fractures each year in the UK, especially in the hip, wrist and spine.

Bone cancer is another disease that may lead to pathological fractures.

Seek medical attention if you think you may have fractured a bone. This is a medical emergency.

How can I prevent fractures?

To help prevent fractures, follow general safety precautions, including:

Always wear a seat belt in a car.

Always wear the proper safety equipment (helmets and other protective pads) for recreational activities, such as cycling or contact sports.

Keep walkways and stairs free of objects you could trip over.

If you have osteoporosis, take regular exercise to improve your strength and balance. This may help to reduce the risk of falls. Also, discuss with your doctor whether medication would be appropriate.

Fractures (Broken Bones)

A fracture is a broken bone. A bone may be completely fractured or partially fractured in any number of ways (crosswise, lengthwise, in multiple pieces).

Types of Fractures

Bones are rigid, but they do bend or "give" somewhat when an outside force is applied. However, if the force is too great, the bones will break, just as a plastic ruler breaks when it is bent too far.

The severity of a fracture usually depends on the force that caused the break. If the bone's breaking point has been exceeded only slightly, then the bone may crack rather than break all the way through. If the force is extreme, such as in an automobile crash or a gunshot, the bone may shatter.

If the bone breaks in such a way that bone fragments stick out through the skin, or a wound penetrates down to the broken bone, the fracture is called an "open" fracture. This type of fracture is particularly serious because once the skin is broken, infection in both the wound and the bone can occur.

Common types of fractures include:

Stable fracture. The broken ends of the bone line up and are barely out of place.

Open, compound fracture. The skin may be pierced by the bone or by a blow that breaks the skin at the time of the fracture. The bone may or may not be visible in the wound.

Transverse fracture. This type of fracture has a horizontal fracture line.

Oblique fracture. This type of fracture has an angled pattern.

Comminuted fracture. In this type of fracture, the bone shatters into three or more pieces.

Common types of fractures include:  Stable fracture. The broken ends of the bone line upTop of page Cause The most common causes of fractures are:  Trauma. A fall, a motor vehicle accident, or a tackle during a football game can all result in fractures. " id="pdf-obj-27-39" src="pdf-obj-27-39.jpg">

Types of fractures.

Cause

The most common causes of fractures are:

Trauma. A fall, a motor vehicle accident, or a tackle during a football game can all result in fractures.

Osteoporosis. This disorder weakens bones and makes them more likely to break.

Overuse. Repetitive motion can tire muscles and place more force on bone. This can result in stress fractures. Stress fractures are more common in athletes.

Symptoms

Many fractures are very painful and may prevent you from moving the injured area. Other common symptoms include:

Swelling and tenderness around the injury

Bruising

Deformity — a limb may look "out of place" or a part of the bone may puncture through the skin

Doctor Examination

Your doctor will do a careful examination to assess your overall condition, as well as the extent of the injury. He or she will talk with you about how the injury occurred, your symptoms, and medical history.

The most common way to evaluate a fracture is with x-rays, which provide clear images of bone. Your doctor will likely use an x-ray to verify the diagnosis. X-rays can show whether a bone is intact or broken. They can also show the type of fracture and exactly where it is located within the bone.

Treatment

All forms of treatment of broken bones follow one basic rule: the broken pieces must be put back into position and prevented from moving out of place until they are healed. In many cases, the doctor will restore parts of a broken bone back to the original position. The technical term for this process is "reduction."

Broken bone ends heal by "knitting" back together with new bone being formed around the edge of the broken parts.

Surgery is sometimes required to treat a fracture. The type of treatment required depends on the severity of the break, whether it is "open" or "closed," and the specific bone involved. For example, a broken bone in the spine (vertebra) is treated differently from a broken leg bone or a broken hip.

Doctors use a variety of treatments to treat fractures:

Cast Immobilization

A plaster or fiberglass cast is the most common type of fracture treatment, because most broken bones can heal successfully once they have been repositioned and a cast has been applied to keep the broken ends in proper position while they heal.

Functional Cast or Brace

The cast or brace allows limited or "controlled" movement of nearby joints. This treatment is desirable for some, but not all, fractures.

Traction

Traction is usually used to align a bone or bones by a gentle, steady pulling action.

External Fixation

In this type of operation, metal pins or screws are placed into the broken bone above and below the fracture site. The pins or screws are connected to a metal bar outside the skin. This device is a stabilizing frame that holds the bones in the proper position while they heal.

In cases where the skin and other soft tissues around the fracture are badly damaged, an external fixator may be applied until surgery can be tolerated.

An external fixator applied to a broken thighbone. Open Reduction and Internal Fixation During this operation,

An external fixator applied to a broken thighbone.

Open Reduction and Internal Fixation

During this operation, the bone fragments are first repositioned (reduced) in their normal alignment, and then held together with special screws or by attaching metal plates to the outer surface of the bone. The fragments may also be held together by inserting rods down through the marrow space in the center of the bone.

An external fixator applied to a broken thighbone. Open Reduction and Internal Fixation During this operation,

A specially designed metal rod, called an intramedullary nail, provides strong fixation for this thighbone fracture.

An external fixator applied to a broken thighbone. Open Reduction and Internal Fixation During this operation,

The broken bones of the forearm are held in position by plates and screws while they heal.

Recovery

Fractures take several weeks to several months to heal, depending on the extent of the injury and how well you follow your doctor's advice. Pain usually stops long before the fracture is solid enough to handle the stresses of normal activity.

Even after your cast or brace is removed, you may need to continue limiting your movement until the bone is solid enough for normal activity.

During your recovery you will likely lose muscle strength in the injured area. Specific exercises will help you restore normal muscle strength, joint motion, and flexibility.

Prevention

Proper diet and exercise may help in preventing some fractures. A diet rich in calcium and Vitamin D will promote bone strength. Weightbearing exercise also helps keep bones strong.

What is a fracture? What are broken bones?

Last updated: Friday 26 September 2014

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A fracture, also referred to as a bone fracture,FRX, FX, F x or # is a medical condition where the continuity of the bone is broken. A significant percentage of bone fractures occur because of high force impact or stress; however, a fracture may also be the result of some medical conditions which weaken the bones, for exampleosteoporosis, some cancers or osteogenesis imperfecta. A fracture caused by a medical condition is known as a pathological fracture.

The word break is commonly used by lay (non-professional) people. Among health care professionals, especially bone specialists, such as orthopedic surgeons, break is a much less common term when talking about bones.

A crack (not only a break) in the bone is also known as a fracture. Fractures can occur in any bone in the body. There are several different ways in which a bone can fracture; for example a clean break to the bone that does not damage surrounding tissue or tear through the skin is known as a closed fracture or a simple fracture. On the other hand, one that damages surrounding skin or tissue is known as a compound fracture or an open fracture. Compound or open fractures are generally more serious than simple fractures, with a much higher risk of infection.

Most human bones are surprisingly strong and can generally stand up to fairly strong impacts or forces. However, if that force is too powerful, or there is something wrong with the bone, it can fracture.

The older we get the less force our bones can withstand. Approximately 50% of women and about 20% of men have a fracture after they are 50 years old (Source: National Health Service, UK).

Because children's bones are more elastic, when they do have fractures they tend to be different. Children also have growth plates at the end of their bones - areas of growing bone - which may sometimes be damaged.

Some different types of fracture:

Avulsion fracture - a muscle or ligament pulls on the bone, fracturing it.

Comminuted fracture - the bone is shattered into many pieces.

Compression (crush) fracture - generally occurs in the spongy bone in the spine. For example, the front portion of a vertebra in the spine may collapse due to osteoporosis.

Fracture dislocation - a joint becomes dislocated, and one of the bones of the joint has a fracture.

Greenstick fracture - the bone partly fractures on one side, but does not break completely because the rest of the bone can bend. More common among children, whose bones are softer and more elastic.

Hairline fracture - a partial fracture of the bone. Often this type of fracture is harder to detect.

Impacted fracture - when the bone is fractured, one fragment of bone goes into another.

Longitudinal fracture - the break is along the length of the bone.

Oblique fracture - A fracture that is diagonal to a bone's long axis.

Pathological fracture - when an underlying disease or condition has already weakened the bone, resulting in a fracture (bone fracture caused by an underlying disease/condition that weakened the bone).

Spiral fracture - A fracture where at least one part of the bone has been twisted.

Stress fracture - more common among athletes. A bone breaks because of repeated stresses and strains.

Torus (buckle) fracture - bone deforms but does not crack. More common in children. It is painful but stable.

Transverse fracture - a straight break right across a bone.

What are the signs and symptoms of a bone fracture? A symptom is something the patient

What are the signs and symptoms of a bone fracture?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign. The signs and symptoms of a fracture vary according to which bone is affected, the patient's age and general health, as well as the severity of the injury. However, they may include some of the following:

Pain

Swelling

Bruising

Discolored skin around the affected area

Angulation - the affected area may be bent at an unusual angle

The patient is unable to put weight on the injured area

The patient cannot move the affected area

The affected bone or joint may have a grating sensation

If it is an open fracture there may be bleeding

When a large bone is affected, such as the pelvis or femur ..

The sufferer may look pale and clammy

There may be dizziness (feeling faint) ..

..

as

well as a feeling of sickness and nausea.

If possible, do not move a person with a broken bone until a health care professional is present and can assess the situation and, if required, apply a splint. Obviously, if the patient is in a dangerous place, such as in the middle of a busy road, one sometimes has to act before the emergency services arrive.

What are the causes of bone fractures?

The majority of fractures are caused by a bad fall or automobile accident. Healthy bones are extremely tough and resilient and can withstand surprisingly powerful impacts. When people enter old age two factors make their risk of fractures greater; weaker bones and a greater risk of falling.

Children, who tend to have more physically active lifestyles than adults, are also prone to fractures.

People with underlying illnesses and conditions that may weaken their bones also have a higher risk of fractures. Examples include osteoporosis, infection, or a tumor. As mentioned earlier, this type of fracture is known as a pathological fracture.

Stress fractures, which result from repeated stresses and strains, commonly found among professional sports people, are also common causes of fractures.

How is a fracture diagnosed?

A doctor will carry out a physical examination, identify signs and symptoms and make a diagnosis. The patient will be interviewed - or friends, relatives or witnesses if the patient cannot communicate properly - and asked about circumstances that clearly caused the injury or may have caused it.

Doctors will often order an X-ray. In some cases an MRI (magnetic resonance imaging) or CT (computed tomography) scan may also be ordered.

What are the treatment options for a bone fracture?

Bone healing is a natural process which in most cases will occur automatically. Fracture treatment is usually aimed at making sure there is the best possible function of the injured part after healing. Treatment also focuses on providing the injured bone with the best circumstances for optimum healing (immobilization).

For the natural healing process to begin, the ends of the broken bone need to be lined up - this is known as reducing the fracture.

The patient is usually asleep under a general anesthetic when fracture reduction is done. Fracture reduction may be done by manipulation, closed reduction (pulling the bone fragments), or surgery.

Immobilization - as soon as the bones are aligned they must stay aligned while they heal. This may include:

Plaster casts or plastic functional braces - these hold the bone in position until it has healed.

Metal plates and screws - current procedures use minimally invasive techniques.

Intra-medullary nails - Internal steel rods are placed down the center of long bones. Flexible wires may be used in children.

External fixators - these may be made of metal or carbon fiber; they have steel pins that go into the bone directly through the skin. They are a type of scaffolding outside the body.

Usually the fractured bone area is immobilized for between two to eight weeks. The duration depends on which bone is affected and whether there are any complications, such as a blood supply problem or an infection.

Healing - if a broken bone has been aligned properly and kept immobile the healing process is usually straightforward.

Osteoclasts (bone cells) absorb old and damaged bone while osteoblasts (other bone cells) are used to create new bone. Callus is formed; callus is new bone which is formed around a fracture. It forms on either side of the fracture and grows towards each end until the fracture gap is filled. Eventually the excess bone smoothes off and the bone is like it used to be before.

The patient's age, which bone is affected, the type of fracture, as well as the patient's general health are all factors which influence how rapidly the bone heals. If the patient smokes regularly the healing process will take longer.

Physical therapy (UK: physiotherapy) - after the bone has healed it may be necessary to restore muscle strength as well as mobility to the affected area. If the fracture occurred near or through a joint there is a risk of permanent stiffness - the individual may not be able to bend that joint as well as before.

Surgery - if there was damage to the skin and soft tissue around the affected bone or joint, plastic surgery may be required.

Delayed unions and non-unions

Non-unions are fractures that fail to heal, while delayed unions are those that take longer to heal.

Ultrasound therapy - low-intensity ultrasound is applied daily to the affected area. This has been found to help the fracture to heal. Studies in this area are still ongoing.

Bone graft - if the fracture does not heal a natural or synthetic bone is transplanted to stimulate the broken bone.

Stem cell therapy - studies are currently underway to see whether stem cells can be used to heal fractures that do not heal.

What are the possible complications of a bone fracture?

Heals in the wrong position - this is known as a malunion; either the fracture heals in the wrong position or it shifts (the fracture itself shifts).

Disruption of bone growth - if a childhood bone fracture affects both ends of bones, there is a risk that the normal development of that bone may be affected, raising the risk of a subsequent deformity.

Persistent bone or bone marrow infection - if there is a break in the skin, as may happen with a compound fracture, bacteria can get in and infect the bone or bone marrow, which can become a persistent infection (osteomyelitis). Patients may need to be hospitalized and treated with antibiotics. Sometimes surgical drainage and curettage is required.

Bone death (avascular necrosis) - if the bone loses its essential supply of blood it may die.

Prevention of fractures

Nutrition and sunlight - the human body needs adequate supplies of calcium for healthy bones. Milk, cheese, yoghurt and dark green leafy vegetables are good sources of calcium. Our body needsvitamin D to absorb calcium - exposure to sunlight, as well as

eating eggs and oily fish are good ways of getting vitamin D.

Physical activity - the more weight-bearing exercises you do, the stronger and denser your bones will be. Examples include skipping, walking, running, and dancing - any exercise where the body pulls on the skeleton.

Older age not only results in weaker bones, but often in less physical activity, which further increases the risk of even weaker bones. It is important for people of all ages to stay physically active.

The (female) menopause - estrogen, which regulates a woman's calcium, starts to drop and continues to do so until after the menopause; levels never come back up to pre-menopausal levels. In other words, calcium regulation is much more difficult after the menopause. Consequently, women need to be especially careful about the density and strength of their bones during and after the menopause. The following steps may help reduce post-menopausal osteoporosis risk:

Do several short weight-bearing exercise sessions each week.

Do not smoke.

Consume only moderate quantities of alcohol, or don't drink it.

Make sure you get adequate exposure to daylight.

Make sure your diet has plenty of calcium-rich foods. For those who find this difficult, talk to your doctor about taking calcium supplements.

Part 1 of 9: Overview

What Is a Fracture?

A fracture is a broken bone. It can range from a thin crack to a complete break. A bone can fracture crosswise, lengthwise, in several places, or into many pieces. Typically, a bone becomes fractured when it is impacted by more force or pressure than it can support.

If you suspect a fracture, seek medical help immediately.

Part 2 of 9: Types

Types of Fractures

There are two types of fractures: open and closed.

In an open fracture, the ends of the broken bone tear the skin. When the bone and skin

are exposed, they are at risk of infection. This type of fracture is also called a compound fracture.

In a closed fracture, the broken bone does not break the skin. This type of fracture is also called a simple fracture. But these fractures can be just as dangerous as open fractures. Both types require medical attention.

Certain types of fractures are more common in children because their bones are softer. Their bones are more likely to bend than break. Children are more likely to experience incomplete fractures—fractures in which the bone does not break completely. Types of incomplete fractures include:

greenstick fracture: The bone is broken

on one side, while the other side is bent. buckle or torus fracture: The bone is broken on one, and this causes a bump or raised buckle on the other side.

Complete fractures can occur at any age. They can be classified by the way the bone is affected. A broken bone can be described as a:

nondisplaced fracture: The bone is

broken into pieces that can be aligned in place. displaced fracture: The bone is broken

into pieces that don’t align. hairline fracture: The bone is broken in a

thin crack. single fracture: The bone is broken only

in one place. compression fracture: The bone is

crushed by. comminuted fracture: The bone is

crushed or broken into three or more pieces. segmental fracture: The bone is broken in two places, which leaves at least one bone segment floating and unattached.

Part 3 of 9: Causes

What Causes a Fracture?

A fracture is a possible result of an impact of greater pressure or force than a bone can support. Typically, the force occurs suddenly or is very intense. The force weakens the bone and breaks it. The strength of the force determines the severity of the break. Some common causes of fractures are:

falls

direct strikes to the body

traumatic events such as auto accidents

or gunshots injuries during sports

overuse, particularly in sports

Part 4 of 9: Risk Factors

Who Is at Risk for a Fracture?

Anyone can be affected by a fracture. But people with brittle bones (less bone density)

are more vulnerable. These factors contribute to brittle bones:

osteoporosis

advanced age

endocrine and intestinal disorders

corticosteroids

physical inactivity

smoking

drinking alcohol

Part 5 of 9: Symptoms

What Are the Symptoms of a Fracture?

Most fractures are accompanied by intense pain when the injury occurs. This discomfort can become worse when the injured area is moved or touched. Some people may pass out from the initial pain of a fracture. Others may feel dizzy or chilled from shock. Common symptoms that accompany a fracture also include:

the sound of a snap or grinding when the

injury occurs swelling, redness, and bruising in the

injured area an injured area that appears deformed or has a portion of the bone pushing through the skin

Part 6 of 9: Diagnosis

Diagnosing a Fracture

After a visual examination, your doctor will likely use an X-ray to diagnose a fracture. An X-ray is the most common way to diagnose a fracture (AAOS).

An X-ray can provide a comprehensive image of the bone and reveal any breaks. With an X-ray, your physician can determine a fracture’s type and exact location. In some instances, magnetic resonance imaging (MRI) or computed tomography scan (CT or CAT scan) may be used for further examination.

Part 7 of 9: Treatment

How Is a Fracture Treated?

The goal of treating a fracture is to put broken bone pieces back into their proper position and allow them to heal. It is important to keep the pieces immobile until healing is complete. When a bone heals, new bone forms around the edges of the broken pieces, connecting them.

Treatment also emphasizes preventing complications. Medications may be used to control pain during the healing process.

Treatment for a fracture depends on its location and type.

Most fractures can be treated with a cast. Casts are typically made of plaster or fiberglass. A cast will prevent the bone pieces from moving while they heal.

In some cases, traction may be necessary. Traction stretches the muscles and tendons around the broken bone. It is administered with a system of pulleys and weights. The system produces a gentle, pulling motion. The mechanism is positioned in a metal frame over your bed.

For more complex or compound fractures, surgery may be necessary. A surgical procedure called open reduction and internal fixation may be used. First, the bones are repositioned (or reduced) into their normal alignment. The bones are then connected (or fixed), often with metal plates and/or screws. In some cases, rods are inserted through the center of the bone.

External fixation also can be used to keep broken bones from moving. Pins or screws are placed into the bone above and below the fracture site. These pins or screws are then connected to a metal stabilizing bar outside the skin. The bar holds the bones in place to heal.

Part 8 of 9: Outlook

What Is the Outlook for a Fracture?

It may take several weeks, or sometimes months, for a fracture to heal. In most cases, pain will subside before the healing is complete. The fracture’s location and severity will determine individual recovery rates. The presence of other injuries or medical conditions may affect recovery. If you are recovering from a fracture, it is important to closely follow medical instructions.

After a fracture, you can expect to have restricted movement of the injured area. This will be necessary until healing is complete. When the fracture is healed, you may be able to return to normal movement. But immobilizing a part of the body for a long time can cause a loss of muscle strength. You may require physical therapy

to help regain normal use of the injured area.

Part 9 of 9: Prevention

Preventing a Fracture

You can’t prevent all fractures, but you can work to keep your bones strong so they will be less susceptible to damage. To maintain bone strength, consume a healthy diet and exercise regularly (AAOS). Foods rich in calcium and vitamin D can promote strong bones. Weight-bearing exercises, in particular, can also be effective, according to the AAOS.