A bone fracture is a medical condition in which a bone is cracked or broken. It is a break in the continuity of the bone. While many fractures are the result of high force impact or stress, bone fracture can also occur as a result of certain medical conditions that weaken the bones, such as osteoporosis.
The word “Fracture” implies to broken bone. A bone may get fractured completely or partially and it is caused commonly from trauma due to fall, motor vehicle accident or sports. Thinning of the bone due to osteoporosis in the elderly can cause the bone to break easily. Overuse injuries are common cause of stress fractures in athletes.
Types of fractures include:
Our body reacts to a fracture by protecting the injured area with a blood clot and callus or fibrous tissue. Bone cells begin forming on the either side of the fracture line. These cells grow towards each other and thus close the fracture
The objective of early fracture management is to control bleeding, prevent ischemic injury (bone death) and to remove sources of infection such as foreign bodies and dead tissues. The next step in fracture management is the reduction of the fracture and its maintenance. It is important to ensure that the involved part of the body returns to its function after fracture heals. To achieve this, maintenance of fracture reduction with immobilization technique is done by either non-operative or surgical method.
Non-operative (closed) therapy comprises of casting and traction (skin and skeletal traction).
Skin traction involves attachment of traction tapes to the skin of the limb segment below the fracture. In skeletal traction, a pin is inserted through the bone distal to the fracture. Weights will be applied to this pin, and the patient is placed in an apparatus that facilitates traction. This method is most commonly used for fractures of the thighbone.
External fixation is performed in the following conditions:
Fractures may take several weeks to months to heal completely. You should limit your activities even after the removal of cast or brace so that the bone become solid enough to bear the stress. Rehabilitation program involves exercises and gradual increase in activity levels until the process of healing is complete.
Growth plates, also called the epiphyseal plate or physis, are the areas of growing cartilaginous tissue found at the ends of the long bones in children. These growth plates determine the length and shape of the mature bone. The growth plates are more susceptible to damage from trauma because they are not as hard as bones.
Growth plate injuries commonly occur in growing children and teenagers. In children, severe injury to the joint may result in a growth plate fracture rather than a ligament injury. Any injury that can cause a sprain in an adult can cause a growth plate fracture in a child.
Growth plate fractures are more common in boys than girls because the plates develop into mature bone faster in girls. Growth plate fractures commonly occur at the wrist, long bones of the forearm (radius) and fingers (phalanges), legs (tibia and fibula), foot, ankle or hip during sports activities such as football, basketball and gymnastics.
Types of growth plate fractures
Growth plate fractures can be classified into five categories based on the type of damage caused.
Growth plate injuries are caused by accidental falls or blows to the limbs during sports activities such as gymnastics, baseball, or running. They may also result from overuse of tendons and certain bone disorders such as infection that can affect the normal growth and development of the bone. The other possible causes which can lead to growth plate injuries are:
Signs and symptoms
Signs and symptoms of a growth plate injury include:
In children, fractures heal faster. If a growth plate fracture is left untreated it may heal improperly causing the bone to become shorter and abnormally shaped.
Your doctor will evaluate the condition by asking you about the injury and performing a physical examination of the child.
X-rays may be taken to determine the type of fracture. Since the growth plates have not hardened and may not be visible, X-rays of the injured as well as the normal limb are often taken to look for differences in order to help determine the place of injury.
Other diagnostic tests your doctor may recommend include computed tomography (CT) scan or magnetic resonance imaging (MRI). These tests are helpful in detecting the type and extent of injury as it allows the doctor to see the growth plate and soft tissues.
The treatment for growth plate injuries depends upon the type of fracture involved. In all cases, the treatment should begin as early as possible and include the following:
Most growth plate fractures heal without any long term problems. Rarely, the bone may stop growing and become shorter than the other limb.
A fracture is a break in the bone that occurs when extreme force is applied. Treatment of fractures involves the joining of the broken bones either by immobilizing the area and allowing the bone to heal on its own, or surgically aligning the broken bones and stabilizing it with metal pins, rods or plates. Sometimes, the broken bone fails to re-join and heal even after treatment. This is called non-union. Non-union occurs when the broken bones do not get sufficient nutrition, blood supply or adequate stability (not immobilized enough) to heal. Non-union can be identified by pain after the initial fracture pain is relieved, swelling, tenderness, deformity and difficulty bearing weight.
When you present with these symptoms, your doctor may order imaging tests like X-rays, CT scans and MRI to confirm a diagnosis of non-union. The treatment of non-union fractures can be achieved by non-surgical or surgical procedures.
Non-surgical treatment: This method involves the use of a bone stimulator, a small device that produces ultrasonic or pulsed electromagnetic waves, which stimulates the healing process. You will be instructed to place the stimulator over the region of non-union for 20 minutes to a few hours every day.
The surgical method of treatment for non-union is aimed at:
A stress fracture is described as a small crack in the bone which occurs from an overuse injury of a bone. It commonly develops in the weight bearing bones of the lower leg and foot. When the muscles of the foot are overworked or stressed, they are unable to absorb the stress and when this happens the muscles transfer the stress to the bone which results in stress fracture.
Stress fractures are caused by a rapid increase in the intensity of exercise. They can also be caused by impact on a hard surface, improper footwear, and increased physical activity. Athletes participating in certain sports such as basketball, tennis or gymnastics are at a greater risk of developing stress fractures. During these sports the repetitive stress of the foot strike on a hard surface causing trauma and muscle fatigue. An athlete with inadequate rest between workouts can also develop stress fracture.
Females are at a greater risk of developing stress fracture than males, and may be related to a condition referred to as “female athlete triad”. It is a combination of eating disorders, amenorrhea (irregular menstrual cycle), and osteoporosis (thinning of the bones). The risk of developing stress fracture increases in females if the bone weight decreases.
The most common symptom is pain in the foot which usually gets worse during exercises and decreases upon resting. Swelling, bruising, and tenderness may also occur at a specific point.
Your doctor will diagnosis the condition after discussing symptoms and risk factors and examines the foot and ankle. Some of the diagnostic tests such as X-ray, MRI scan or bone scan may be required to confirm the fracture.
Stress fractures can be treated by non-surgical approach which includes rest and limiting the physical activities that involves foot and ankle. If children return too quickly to the activity that has caused stress fracture, it may lead to chronic problems such as harder-to-heal stress fractures.
Protective footwear may be recommended which helps to reduce stress on the foot. Your doctor may apply cast to the foot to immobilize the leg which also helps to remove the stress. Crutches may be used to prevent the weight of the foot until the stress fracture is healed completely.
Surgery may be required if the fracture is not healed completely by non-surgical treatment. Your doctor makes an incision on the foot and uses internal fixators such as wires, pins, or plates to attach the broken bones of the foot together until healing happens after which these fixators can be removed or may be permanently left inside the body.
Some of the following measures may help to prevent stress fractures:
The forearm is made up of 2 bones namely the radius and ulna. The primary function of your forearm is rotation i.e., the ability to turn your palms up and down. The fracture of the forearm affects the ability to rotate your arm, as well as bend and straighten the wrist and elbow. The breaking of the radius or ulna in the middle of the bone requires a strong force and it is most commonly seen in adults. In most of the cases, both bones are broken during a forearm fracture.
The forearm bones can break in several ways. The bones can crack slightly or can break into many pieces. Forearm fractures are generally due to automobile accidents; direct blow on the forearm or fall on an outstretched arm during sports, climbing stairs, etc.
The symptoms of a forearm fracture include intense pain in the arm, bruises and swelling. Your fractured forearm may appear bent and shorter compared to your other arm. You may experience numbness or weakness in the fingers and wrist. You may be unable to rotate your arm. Rarely, a broken bone sticks out through the skin or the wound penetrates down to the broken bone.
Your doctor may conduct a physical examination and record your medical history initially. Your doctor may feel your arm thoroughly to determine tenderness. You may be asked to get an X-ray done to determine displaced or broken bones.
Usually people with forearm fractures are immediately rushed to the emergency room for treatment. Treatment of forearm fracture aims at putting back the broken bones into position and preventing them from moving out of place until they are completely healed.
In case only one bone is broken and is not out of place, your doctor might treat it with a cast or brace and provide a sling to keep your arm in position. Your doctor will closely monitor the healing of the fracture. If the fracture shifts in position, you may be advised to undergo surgery to fix the bones back together.
When both forearm bones are broken, surgery is usually required. During surgery, the cuts from the injury will be cleaned and the bone fragments are repositioned into their normal alignment. They are held together with screws and metal plates attached to the outer surface of the bone. The incision is sutured firmly and a sling is provided to facilitate healing.
The clavicle or the collarbone is the bone that connects your sternum or breastbone to your shoulder. Clavicle fracture, also called broken collarbone is a very common sports injury seen in people who are involved in contact sports such as football and martial arts as well as impact sports such as motor racing.
A broken collarbone normally occurs after a fall onto the shoulder or a motor vehicle accident. The most common sports associated with clavicle fractures include football, hockey, and skiing.
A broken collarbone most often causes pain, swelling and bruising over the collarbone. Pain increases with shoulder movement. Your shoulder may be slumped downward and forward. You may also have a bump around the area of the break. You may hear a grinding sound when you try to raise your arm.
To diagnose a broken collarbone, your doctor will take a brief history, about the injury, and perform a physical examination of your shoulder. An X-ray of the clavicle is taken to identify the location of the fracture. Your doctor may also recommend a computerized tomography (CT) scan in some cases.
Conservative Treatment Options
Most broken collarbones heal without a surgery. An arm sling may support the arm and hold the bones in their normal position. You may also be given pain medications to relieve the pain. After your pain reduces your doctor may recommend gentle shoulder and elbow exercises to minimize stiffness and weakness in your shoulder. Follow up with your doctor until your fracture heals.
Surgery may be required in case of displaced fractures. Surgery is performed to re-align the fractured ends and stabilize them during healing. Surgery often involves use of pins or plates and screws to maintain proper position of the bone during healing.
Plates and Screws fixation
During this surgical procedure, your surgeon will reposition the broken bone ends into normal position and then uses special screws or metal plates to hold the bone fragments in place. These plates and screws are usually left in the bone. If they cause any irritation, they can be removed after fracture healing is complete.
Placement of pins may also be considered to hold the fracture in position and the incision required is also smaller. They often cause irritation in the skin at the site of insertion and have to be removed once the fracture heals.
Elbow Fractures in Children
The elbow is a joint that consists of three bones – the humerus (upper arm bone), radius (forearm bone) and ulna (forearm bone). An elbow fracture most commonly occurs when your child falls on an outstretched arm. It can lead to severe pain in the elbow and numbness in the hand. Fractures are more common in children due to their physical activities as well as their bone properties. Children’s bones have an area of developing cartilage tissue called a growth plate which is present at the end of long bones that will eventually develop into solid bone as the child grows.
Your child’s doctor first evaluates your child’s arm for signs of damage to blood vessels and nerves. An X-ray examination is then ordered to confirm and determine the severity of the fracture. Treatment of elbow fractures depends on the degree of displacement and type of fracture:
Forearm Fractures in Children
The radius (bone on the thumb side) and ulna (bone on the little-finger side) are the two bones of the forearm. Forearm fractures can occur near the wrist, near the elbow or in the middle of the forearm. Apart from this, the bones in children are prone to a unique injury known as a growth plate fracture. The growth plate, which is made of cartilage (flexible tissue) is present at the ends of the bones in children and helps in the determination of length and shape of the mature bone.
The healing of fractures in children is quicker than that in adults. Thus, if a fracture is suspected in a child, it is necessary to seek immediate medical attention for proper alignment of the bones.
Types of fractures
Forearm bones may break in many ways. Fractures may be “open” where the bone protrudes through the skin or “closed” where the broken bone does not pierce the skin. The common types of fractures in children include:
Forearm fractures in children are caused due to a fall on an outstretched arm or direct hit on the forearm, which may result in breakage of one or both bones (radius and ulna).
Signs and Symptoms
A fractured forearm causes severe pain and numbness. Other signs and symptoms include:
Forearm fractures in children can be diagnosed by analyzing X-ray images of the wrist, elbow or the forearm.
The treatment of forearm fractures in children is based on the location, type of fracture, degree of bone displacement and its severity.
Your child’s doctor will advise you to apply an ice pack over a thin towel on the affected area for 15-20 minutes 3-4 times a day, to relieve pain and swelling. For severe angled fractures, in which the bones have not broken through the skin, your doctor will align the bones properly without the need for surgery (closed reduction). A splint or cast may be required for 3 to 4 weeks for a stable buckle fracture. Immobilization for 6 to 10 weeks is recommended for more serious fractures.
Surgery may be necessary for severe fractures such as fractures of the growth plate or the joint. Other conditions, such as broken skin, bone displacement, unstable fractures, misaligned bones, and bones healing in an improper position may also require surgical repair. Your surgeon will first align the bones through an incision and use fixation devices like pins or a metal implants to hold the bones in place while the wound heals. A cast or a splint may be placed to hold the bones in place.
In the long run, the forearm of your child may have a slightly different or crooked look than before the fracture, which is normal. It may take around 1-2 years for the bones of the forearm to straighten while the bones undergo the process of remodeling (reshaping). For growth plate fractures, your child’s doctor will carefully monitor the hand for many years to ensure that growth occurs normally.
Fracture of the Shoulder Blade (Scapula)
The scapula (shoulder blade) is a flat, triangular bone providing attachment to the muscles of the back, neck, chest and arm. The scapula has a body, neck and spine portion.
Scapular fractures are uncommon but do occur and require a large amount of force to fracture. They are usually the result of intense trauma, such as a high speed motor vehicle accident or a fall from height onto one’s back. They can also occur from a fall on an outstretched arm if the humeral head impacts on the glenoid cavity.
Symptoms of a scapular fracture include the following:
Scapular fractures should be evaluated by an orthopaedic surgeon for proper diagnosis and treatment.
Your surgeon will perform the following:
Diagnostic Studies may include:
Most scapular fractures are not significantly displaced due to the strong supporting soft tissue structures surrounding it. Therefore, a majority of scapular fractures are treated conservatively and with early motion to reduce the risk of stiffness and will usually heal without affecting shoulder movement.
Conservative treatment options include:
Fractures of the scapula involving the neck or glenoid or with severe displacement have been associated with poor outcomes when treated non-operatively. Will usually require surgical intervention to realign the bones properly and restore a functional, pain free range of motion to the shoulder joint.
Scapular fracture repair surgery has historically been performed through a large, open incision. Newer, minimally invasive techniques have evolved and surgery to repair scapular fractures can now be performed through arthroscopy.
Olecranon (Elbow) Fractures
Three bones, humerus, radius and ulna make up the elbow joint. The bones are held together by ligaments thus providing stability to the joint. Muscles and tendons around the bones coordinate the movements and help in performing various activities. Elbow fractures may occur from trauma resulting from a variety of reasons, some of them being a fall on an outstretched arm, a direct blow to the elbow, or an abnormal twist to the joint beyond its functional limit.
Olecranon fractures: These are fractures occurring at bony prominence of the ulna. The fractures, if stable, are treated using an immobilizing splint followed by a regimen of motion exercises. However severe fractures require surgical repair.
Symptoms of an olecranon fracture include pain, swelling, bruising, stiffness in and around the elbow, a popping or cracking sound, and deformity of the elbow bones.
To diagnose olecranon fractures X-rays of the joint are taken. In some cases, a CT scan may be needed to get to know the details of the joint surface.
The aim of the treatment is to maximize early motion to reduce the risk of stiffness. Nonsurgical treatment options include use of a splint or a sling to immobilize the elbow during the healing process. Surgery is indicated in displaced and open fractures to realign the bones and stabilize the joint as well as to avoid deep infections.
Strengthening exercises, scar massage, therapy with ultrasound, heat, and ice are recommended to improve the range of motion. Splints are also used to facilitate stretching of the joint.
Radial Head Fractures
The elbow is a junction between the forearm and the upper arm. The elbow joint is made up of 3 bones namely the humerus bone in the upper arm which joins with the radius and ulna bones in the forearm. The elbow joint is essential for the movement of your arms and to perform daily activities. The head of the radius bone is cup-shaped and corresponds to the spherical surface of the humerus. The injury in the head of the radius causes impairment in the function of the elbow. Radial head fractures are very common and occur in almost 20% of acute elbow injuries. Elbow dislocations are generally associated with radial head fractures. Radial head fractures are more common in women than in men and occur more frequently in the age group of 30 and 40 years.
The most common cause of a radius head fracture is breaking a fall with an outstretched arm. Radial head fractures can also occur due to a direct impact on the elbow, a twisting injury, sprain, dislocation or strain.
The symptoms of a radial head fracture include severe pain, swelling in the elbow, difficulty in moving the arm, visible deformity indicating dislocation, bruising and stiffness.
Your doctor might recommend an X-ray to confirm the fracture and assess displacement of the bone. Sometimes, your doctor might suggest a CT scan to obtain further details of the fracture, especially the joint surfaces.
The treatment of a fracture depends on the type of fracture.
Shoulder injuries most commonly occur in athletes participating in sports such as swimming, tennis, pitching, and weightlifting. The injuries are caused due to the over usage or repetitive motion of the arms.
Shoulder injuries cause pain, stiffness, restricted movements, difficulty in performing routine activities, and popping sensation.
Some of the common shoulder injuries include sprains and strains, dislocations, tendinitis, bursitis, rotator cuff injury, fractures, and arthritis.
Early treatment is necessary to prevent serious shoulder injuries. The immediate mode of treatment recommended for shoulder injuries is rest, ice, compression and elevation (RICE). Your doctor may also prescribe anti-inflammatory medications to help reduce the swelling and pain.
Your doctor may recommend a series of exercises to strengthen shoulder muscles and to regain shoulder movement.