Bones form the skeleton of the body and allow the body to be supported against gravity and to move and function in the world. Bones also protect some body parts, and the bone marrow is the production center for blood products.
Bone is not a stagnant organ. It is the body's reservoir of calcium and is always undergoing change under the influence of hormones. Parathyroid hormone increases blood calcium levels by leeching calcium from bone, while calcitonin has the opposite effect, allowing bone to accept calcium from the blood.
When outside forces are applied to bone it has the potential to fail. Fractures occur when bone cannot withstand those outside forces. Fracture, break, or crack all mean the same thing. One term is not better or worse than another. The integrity of the bone has been lost and the bone structure fails.
There are a variety of types and locations that bone fractures that can occur.
Common types and locations of fractures include:
- greenstick fracture,
- spiral fracture,
- comminuted fracture,
- transverse fracture,
- compound fracture,
- vertebral compression fracture,
- stress fracture,
- compression fracture,
- rib fracture,
- skull fracture.
Symptoms of fractures commonly include pain, swelling, bruising, and a change of shape at the surface of the skin due to the protrusion of a bone in the affected region. More rarely, a fracture can break through your skin, resulting in bone protruding from a wound.
Common symptoms of fractures
You may experience fracture symptoms immediately after an injury, while sometimes it may take more time for symptoms to appear.
Common symptoms of a fracture include:
- Inability to move a joint.
- Numbness and tingling in the affected region.
- Redness and warmth.
Serious symptoms that might indicate a life-threatening condition
In some cases, fractures can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms:
- Bone protruding through the skin.
- Confusion or loss of consciousness for even a brief moment.
- Profuse bleeding.
- Suspected fracture of the neck, back, skull, pelvis, hips or femur.
- Vision changes or loss.
Broken bones hurt for a variety of reasons including:
- The nerve endings that surround bones contain pain fibers and and these fibers become irritated when the bone is broken or bruised.
- Broken bones bleed, and the blood and associated swelling (edema) causes pain.
- Muscles that surround the injured area may go into spasm when they try to hold the broken bone fragments in place, and these spasms cause further pain.
Often a fracture is easy to detect because there is obvious deformity. However, at times it is not easily diagnosed. It is important for the physician to take a history of the injury to decide what potential problems might exist. Moreover, fractures don't always occur in isolation, and there may be associated injuries that need to be addressed.
Fractures can occur because of direct blows, twisting injuries, or falls. The type of forces on the bone may determine what type of injury that occurs. Descriptions of fractures can be confusing.
They are based on:
- where in the bone the break has occurred,
- how the bone fragments are aligned,
- whether any complications exist.
The first step in describing a fracture is whether it is open or closed. If the skin over the break is disrupted, then an open fracture exists. The skin can be cut, torn, or abraded (scraped), but if the skin's integrity is damaged, the potential for an infection to get into the bone exists. Since the fracture site in the bone communicates with the outside world, these injuries need to be cleaned out aggressively and many times require anesthesia in the operating room to do the job effectively.
Next, there needs to be a description of the fracture line. Does the fracture line go across the bone (transverse), at an angle (oblique) or does itspiral? Is the fracture in two pieces or is it comminuted, in multiple pieces?
Finally, the fracture's alignment is described as to whether the fracture fragments are displaced or in their normal anatomic position.
If the bones fragments aren't in the right place, they need to be reduced or placed back into their normal alignment.
Initial treatment for fractures of the arms, legs, hands and feet in the field include splinting the extremity in the position it is found, elevation and ice. Immobilization will be very helpful with initial pain control. For injuries of the neck and back, many times, first responders or paramedics may choose to place the injured person on a long board and in a neck collar to protect the spinal cord from potential injury.
Once the fracture has been diagnosed, the initial treatment for most limb fractures is a splint. Padded pieces of plaster or fiberglass are placed over the injured limb and wrapped with gauze and an elastic wrap to immobilize the break. The joints above and below the injury are immobilized to prevent movement at the fracture site.
This initial splint does not go completely around the limb. After a few days, the splint is removed and replaced by a circumferential cast. Circumferential casting does not occur initially because fractures swell (edema). This swelling would cause a build up of pressure under the cast, yielding increased pain and the potential for damage to the tissues under the cast.
Surgery on fractures are very much dependent on what bone is broken, where it is broken, and whether the orthopedic surgeon believes that the break is at risk (for staying where it is) once the bone fragments have been aligned. If the surgeon is concerned that the bones will heal improperly, an operation will be needed. Sometimes bones that appear to be aligned normally are splinted, and at a recheck appointment, are found to be unstable and require surgery.
Surgery can include closed reduction and casting, where under anesthesia, the bones are manipulated so that alignment is restored and a cast is placed to hold the bones in that alignment. Sometimes, the bones are broken in such a way that they need to have metal hardware inserted to hold them in place.
Open reduction means that, in the operating room, the skin is cut open and pins, plates, or rods are inserted into the bone to hold it in place until healing occurs. Depending on the fracture, some of these pieces of metal are permanent (never removed), and some are temporary until the healing of the bone is complete and surgically removed at a later time.