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 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

View Article Sources

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

Tests and Procedures

Bone scan
By Mayo Clinic Staf

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 Xray 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.
top of page

What are some common uses of the

procedure?
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.
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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 xray images.
Women should always inform their physician and xray 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.
top of page

What does the equipment look like?

View larger with caption

The equipment typically used for bone x-rays consists of an xray 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.
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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 xray 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 xrays 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.
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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.

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.
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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.
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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.
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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.
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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 xray.
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.
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

First aid

Fractures (broken bones):

First aid
Fractures (broken bones): First
aid
By Mayo Clinic Staf

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 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 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 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

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

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 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.

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 bones 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.

Types of fractures.
Top 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.

 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.
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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
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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.
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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, 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.

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

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

A fracture, also referred to as a bone fracture,FRX, FX, F 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.
x

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 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 fracturesfractures 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 dont 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 fractures 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 fractures 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 cant 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.