How Untreated Bone Fractures Occur – Part I

Jeffrey R. Carlson, MD, CPE

It may be hard to imagine that someone would have a bone fracture and not seek appropriate medical treatment or that it could be missed by a practitioner during an exam.  However, this happens more often than you might think.  In three articles, I’ll detail the reasons why broken bones may go untreated and what can happen as a result.  When those patients finally end up in my office, I’ll also talk about what I can do to help them feel and function better – sometimes, after years of pain and dysfunction.

1. The patient is unaware of their fractured bone – some folks have a very high pain tolerance and can be entirely oblivious to the fact that they have a small broken bone in their hand or foot.  This can also happen in the frail elderly who are suffering from cognizance deficit issues.
2. The patient is aware of discomfort and chooses not to seek treatment – this is often due to economic reasons as folks cannot afford the cost of treatment or it simply may be that the patient (usually male) is going to “tough it out”, rub some dirt on it and see if it gets better on its own.  This often happens when folks break a little toe, which is typically treated at home with a broken popsicle stick and some tape.
3. The patient is prevented from seeking treatment by someone else, a parent, spouse, child, boyfriend, guardian, etc. – unfortunately, this can happen in an abusive or neglectful situation because the abuser does not want the abuse or neglect to be seen by a medical provider and reported to the police.
4. The patient is afraid/embarrassed to seek treatment – this may also be a result of the scenario mentioned in #3, where the patient may have been threatened with more harm if they report the abuse and seek treatment or they choose to cover for the abuser (Battered Wife/Child Syndrome) by not seeking care.  It can also be a case of injury caused by addiction, substance abuse, or lifestyle choices that the patient does not wish to acknowledge to a medical provider, who might ask too many probing questions.
5. The patient sought medical treatment, but was misdiagnosed/or the fracture was missed – unfortunately this can happen, especially with poor diagnostic imaging equipment or none, a rushed physical examination, or a recently graduated medical provider without sufficient orthopaedic training.
6. The patient sought medical treatment, but no x-rays were taken/or available – in rural or remote areas, diagnostic imaging may be unavailable, and some hairline or greenstick fractures are hard to diagnose by an unseasoned practitioner without orthopaedic experience.

In the next article, I will address how I diagnose these untreated fractures, and how I treat them, sometimes conservatively, but often with surgery, in order to get the best outcome for the patient.