Bone Fractures

The adult human body is supported by a skeleton of 206 rigid bones, some of which are large and long, like the femur in the thigh and some of which are small, like the bones of the wrist. Our bones provide the architectural framework for all of the soft tissues and organs that are held within our skin, and in conjunction with the muscles, tendons and ligaments, give us the ability to walk, run, and perform limitless motions and activities.

Bone is a living organ, which is vital for life and which continually rebuilds itself in a healthy human being. It is necessary for the production of both red and white blood cells and acts as the body’s storehouse for calcium and other minerals. Bones are mostly made up of collagen, with the minerals calcium, calcium carbonate and calcium phosphate. Collagen provides strength and flexibility that keep the bones from being completely stiff. Bone can also contain marrow, cartilage, nerve fibers, blood vessels and other tissue.

Bones can be fed and kept healthy by exercise and eating a nutritious diet or they can lack both and may suffer correspondingly from disease, such as rickets or osteoporosis. While bones are strong, they do possess a certain amount of “give”, allowing them to bend when outside force is directed on the bone. However, whenever the force applied is too great, the bone will break.

Depending upon the type of force applied to the bone, the bone can fracture in different ways:

  • Stable Fracture – the bone ends are more or less in line
  • Spiral Fracture – the bone fractures along its axis due to a twisting or rotating force (torque)
  • Transverse Fracture – there is a horizontal fracture line
  • Oblique Fracture – a diagonal or angled fracture line
  • Comminuted Fracture – the bone has broken into more than three pieces, may be crushed or shattered
  • Open or Compound Fracture – one or more bone ends has pierced the skin and may or may not protrude through the skin. Alternately, the blow causing the fracture pierces the skin to the broken bone.

Common Causes of Bone Fractures

  • Falls
  • Automobile Accidents
  • Sports Injuries
  • Osteoporosis
  • Repetitive Use
  • Gunshot Wounds or blunt force trauma

Symptoms of Bone Fractures

The most noticeable symptom of a bone fracture is pain, which can range from mild to severe. There may also be significant bruising, swelling, deformity, and inability to move the affected limb or body part. In the case of an open fracture, the bone or bone fragments may even protrude from the wound.

Fracture First Aid

If you or someone you know suspects they have a fracture, what steps can you take to minimize trauma until a physician can administer care? Follow these steps:

  • Immobilize – try to splint the affected body part to keep it from moving, whenever possible.
  • Protect – loosely cover the affected body part, especially if the skin is open or bone is protruding, to protect against infection.
  • Ice – ice the affected body part intermittently to reduce swelling and bruising.
  • Elevate – elevate the affected body part to help reduce swelling.
  • Do not give anything by mouth, like medications or liquids. Surgery may be necessary to reduce the fracture and you don’t want to wait for the stomach contents to clear.
  • Seek medical care as soon as possible.

Fracture Diagnosis

When a fracture is suspected, your OSC Orthopaedic Specialist will ask a lot of questions about how the injury occurred and your medical history, perform a thorough physical examination of the affected body part and will order x-rays to confirm the diagnosis. An x-ray is one of the best diagnostic tests to determine bone fractures because it gives clear images of the bone, how and where it is fractured. In some cases, an MRI or CT scan will need to be ordered to clearly define the fracture.

Fracture Treatment

The treatment for all fractures is the same: put the bones back into their original position and stabilize them in place until they fully heal, which is called “union”. This bone-setting procedure is called “reduction”. It can be done in a closed fashion, without opening the skin surgically, or an open fashion, by opening the skin surgically to visualize the bone. Closed or open reductions can involve the use of pins or screws, only open reductions involve the use of plates and rods.

Treatment of the fracture also depends upon where in the body the fracture is located. A fractured rib is not casted or splinted because doing so would impair breathing. A fractured toe will usually heal very well if simply taped to its neighbor. A fractured vertebrae cannot be splinted, but may need an internal “cast” to be created through a procedure called kyphoplasty, where a balloon is injected into the bone, the balloon is inflated, restoring height and repositioning the bone. Cement is injected into the space created by the balloon, which then hardens, creating the internal cast. Some fractures, like those of the hip, almost always require surgery to reduce.

Non-Surgical Reduction

For simple fractures, your OSC physician will determine if you need a removable brace, a functional cast or brace (which allows limited movement) or a rigid plaster or fiberglass cast, how long you will need to wear the cast and if you will need to wear the brace or cast without interruption.

During the reduction or “bone-setting” procedure, your OSC physician will usually give you an injection of numbing medication into the affected body part to reduce the amount of pain you feel when the bone is moved back into its proper position. After you are numb, the physician will move your bones back into proper position and hold them in place with padding materials, a fiberglass or plaster cast or a splint. You will be given instructions as to how long you will need to wear the cast or splint and when to return for follow-up visits to ascertain if the bone is healing in place properly. You may be asked to return in a few days for recasting after the swelling has subsided or you may be told to return in several weeks. You may need x-rays or to be re-casted at your follow-up appointment.

Surgical Fixation of a Fracture

Even if there isn’t an open fracture or an extremely complex issue, some fractures are just too painful for the Orthopaedic physician to attempt closed reduction and splinting without the patient having anesthesia in an operating room setting.

There are many reasons that surgery may be required to repair a fractured bone, such as:

  • Severity
  • Open or Compound Fracture
  • Location of fractured bone in the body
  • Crush or Shatter Fracture
  • Internal or External Fixation Needed
  • Damage to surrounding tissue, nerves, blood vessels
  • Patient co-morbidities
  • Infection control

As with all fractures, while in surgery, your OSC Orthopaedic surgeon will reposition the bones into their proper position. He will make an incision over the affected bone or he may use the wound site of an open fracture or he may extend the wound by making a larger incision. When caring for an open fracture, infection is always a huge concern, so your surgeon will make sure that the wound, bone and any bone fragments are thoroughly cleaned before reduction takes place. He may need to attach pins, screws, plates or rods internally to help keep the bones in position. Usually, these are left in place permanently, after the bones have healed. Any damage to surrounding tissue will be repaired and the wound/incision will be closed. If damage is extensive, a plastic or vascular surgeon may be called in to assist with surgery.

Sometimes, external pins or screws are affixed to allow for traction to be used during recovery. Traction is where mild, even tension is applied to the bones to help them repair and heal properly. External pins and screws are removed after the bones have healed.

Recovery

– Patient recovery times will vary upon many factors, including the patient’s general condition, whether the patient required surgery and where the bone was broken and how severe the fracture. All bone fractures go through three stages in the healing process, which are:

  • Reactive – a blood clot forms at the fracture site, bridging the gap between the two ends of broken bones.
  • Repair – The periosteum or outer lining of the bone emits specialized repair cells which start to build a latticework of new bone and cartilage, called callus, which will span the break. These new layers continue to lay down one over the other.
  • Remodeling – the new bone that is formed will be reshaped into its original dimensions over the next few years.

Most fractures will heal within 6-8 weeks, but some may take as long as 3 months or even longer in some cases. Some bones do not heal well. We call this non-union, and may require a bone-growth stimulator to encourage new bone to grow. A bone growth stimulator is a device which sends small amounts of electrical current into the bone to encourage new bone formation. These are typically used in spine surgeries where there is non-union; however, they may be used in other areas as well.

What are some of the reasons that fractured bones do not heal well?

  • Patient history of smoking
  • Osteoporosis or osteopenia
  • Infection of the bone
  • Post traumatic arthritis
  • Metabolic disease – such as diabetes

Your Orthopaedic physician can help to determine why your bone may not be healing as it should and prescribe treatments that can help healing to occur. It is important to follow all of your physician’s instructions carefully so that your bone heals properly.