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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. Plus
osteoporosis 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 the skin. It may
then recede back into the wound, so it is no longer visible through the skin. In a simple fracture, also
called a closed fracture, the bone breaks but there is no open wound in the skin.

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?


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.

" FRACTURES AND SPLINTING" By Willis Lamm


Reprinted with permission of TrailBlazer Magazine for non-commercial use.

What happens during a fracture:

When a fracture occurs, a portion of a bone may chip or crack away or the bone may be
completely broken. In any event, the bone fragments will damage nearby tissues and blood vessels,
causing swelling and blood clots in the area of the fracture. Nearby tissue cells which lose their blood
supply will die.
Undamaged tissue cells nearby the fracture site will respond to the injury by rapidly dividing in
an attempt to form a collar of tissue surrounding the fracture site. New bone is generated from this mass
of tissue in order to eventually heal the damaged bone.
If the fracture site is mishandled early after the injury, more soft tissues could be damaged
which could significantly prolong healing. If the bone ends are disturbed, the disruption to the normal
healing process could result in a permanent disability.
More critically, arteries and nerves run parallel to bones in the arms and legs. A mishandled
severe fracture could result in a bone end severing an artery or major nerve creating a potentially fatal
bleed or paralysis. Even small fractures, such as in a finger, can lead to a frustrating disability if not
treated correctly. Accordingly, all fractures (or suspected fractures), no matter how minor, should be
taken seriously.
As there is not enough column space to discuss all of the possible fractures, here are some
common situations and basic care concepts. Remember that each situation is different, so utilize
common sense when caring for any fracture until professional help can be obtained.
There are two classifications of fractures, closed fractures and open fractures. Closed fractures
include any fracture where the bone does not penetrate the skin (the skin stays closed). In such
instances, proper treatment includes immobilizing the fracture and seeking medical help. Open fractures
occur when a bone or bone fragment breaks through the skin or the skin and bone are broken in a
traumatic, crushing injury. Proper treatment for open fractures must also include concern for possible
infection.
Recognizing Fractures:
An open fracture will typically be self evident due to the exposed bone. The following clues suggest
you are dealing with a probable closed fracture:
1. The patient felt a bone break or heard a "snap".
2. The patient feels a grating sensation when he/she moves a limb. (This condition is known as
crepitus.)
3. One limb appears to be a different length, shape or size than the other, or is improperly
angulated.
4. Reddening of the skin around a fracture may appear shortly after the fall.
5. The patient may not be able to move a limb or part of a limb (e.g., the arm, but not the fingers),
or to do so produces intense pain.
6. Loss of a pulse at the end of the extremity.
7. Loss of sensation at the end of the extremity.
8. Numbness or tingling sensations.
9. Involuntary muscle spasms.
10. Other unusual pain, such as intense pain in the rib cage when a patient takes a deep breath or
coughs.
If you discover any of these symptoms and cannot attribute them to any other obvious cause, assume
them to be symptomatic of a fracture.
Hip Fractures:
Hip fractures can be very serious since they actually involve the upper portion of the femur, the
large bone of the upper leg. Hip fractures are more common in older persons, and any elderly riders
who sustain a fall and complain of hip pain should be suspect for this injury.

Symptoms of hip fractures include sensitivity when pressure is exerted on the prominence of
the hip, swelling with or without discoloration of the surrounding tissues, the patient is unable to move
his/her leg when on his/her back, the suspect limb appears shorter or is rotated (usually outward).
Patients with suspected hip fractures should only be moved on a stretcher. The injured limb can
be secured to the uninjured limb to provide splinting. If medical help is a long way off and someone can
spell you if you tire, you may find that manual traction provides significant relief for your patient.
Fractured Hands and Ankles:
These extremities should be splinted in "positions of mechanical function", that is in as natural
of a position as possible. The natural position of a hand is as if one were gently grasping a softball. A
roll of clothing or other padded material can become the "ball" which can be placed in the palm before
the hand is wrapped. Hands, ankles and wrists should be secured in whatever manner is necessary to
protect them from being bumped or moving about while the patient is being rescued.
Fractured Ribs:
The primary concern of a suspected rib fracture is to prevent a loose piece of rib from
puncturing a lung. The best course of action here is to keep the patient from moving around, pad and
gently wrap the chest, and apply a sling and swathe to secure the arm on the injured side so it lays
comfortably across the chest. Padding and wrapping the chest on the trail may be awkward, and it is not
worth unnecessarily moving the patient around to accomplish this task. In such instances simply make
the patient comfortable and discourage unnecessary movement.
Skull and Facial Fractures:
Fractures to the face and skull are serious emergencies, obviously involving the brain in the
case of skull fractures, but also compromising the airway and breathing ability in the case of facial
fractures. If you find evidence of skull or facial fractures you should presume the possibility of cervical
spine injury also.
Decreased consciousness, deep lacerations or severe bruising, deformity, fluid from the ears,
unequal pupils, "raccoon's eyes", and a sunken eye are all symptoms of possible skull or facial injury. If
you find any of these signs you should presume the possibility of cervical spine injury also.
Care for skull and facial fractures includes maintaining an open airway, immobilizing the neck
and spine, and treating wounds. Do not apply pressure, however, to any suspected fracture site! Note the
patient's change in level of consciousness prior to the arrival of medical help as these observations may
assist in the diagnosis of the extent of the injury.
How do bones break?
Bones usually have no problem supporting your body as you go about your daily activities,
including exercise and play. They are strong and flexible enough to absorb the light impacts your body
experiences during these activities. Once in a while, a bone is put under more stress than it can handle.
When that happens, it breaks. A broken bone is called a fracture by doctors. There are three main types
of fractures: stress fractures, impact fractures, and pathological fractures.
Stress over time
Stress fractures happen when too much pressure is placed on the same spot on a bone over long
periods of time. Over time, the pressure from small impacts weakens the bone until it begins to crack
along the surface. These cracks can be very small at first but get bigger and bigger if they are not given
a chance to heal.

A common stress fracture happens in the legs and feet of runners and athletes. Athletes make
their bodies work very hard in order to become stronger and faster. They sometimes perform the same
exercise many times in a row to become better at it and build larger muscles. Fractures are especially
likely to happen when the muscles are tired. When the body is worn out, stress which would normally
be absorbed by the muscle goes straight to the bone instead. The long thin bones on the top of the foot
as well as the heel bone which absorbs the impact of every step when running are especially likely to
fracture this way.
Sudden impacts
Sudden impact fractures happen when a bone takes a sudden, hard hit that puts more stress on it
than it can handle at once. Unlike stress fractures that build up over time, impact fractures happen in a
single moment, like snapping a dry piece of wood in half. Things that might cause impact fractures
include a fall, a strong direct hit from an accident while playing a sport, or a car crash.
Sick bones
Certain diseases can make bones thinner and more fragile. When that happens, it's possible for
bones to break from regular everyday activities that would not normally cause a fracture in a healthy
person. People who know that they have weak bones need to be extra careful and try to avoid doing
things that cause sudden impacts to their bones.
Osteoporosis is one of the diseases that can cause weak bones. It occurs mostly in women and
elderly people. This disease makes it more difficult for calcium and other minerals important to bone
strength to stay in the bones. Luckily, simple lifestyle choices like good diet and exercise can help
prevent osteoporosis, and help treat it once it's already begun. There are also many medications that can
help.
Are all broken bones the same?
When a movie character breaks a bone, they usually end up with part of the bone poking out of
their skin. This can happen, but doesn't happen every time a bone breaks. Fractures can be closed
(simple) or open (compound). This tells you whether or not the bone has broken through the skin. A
simple fracture, also known as a closed fracture, means that no part of the bone has broken through the
skin. A compound fracture, also known as an open fracture, means that the bone has broken through the
skin. There is a much higher risk of infection with compound fractures since the bone gets exposed to
air, dirt, and bacteria from the environment. Because of this, compound fractures must be treated and
watched much more carefully than simple fractures.
Fractures are also categorized based on the shape of the break. Bone fracture types:
1.
2.
3.
4.
5.
6.

Transverse fractures go more or less straight across the bone.


Oblique fractures are diagonal breaks across the bone.
Spiral fractures happen when one or both halves of the bone are twisted.
Comminuated fractures break the bone into more than two pieces.
Avulsion fractures mean pieces of the bone have been pulled apart.
Impacted fractures are the opposite of avulsion fractures. These happen when a piece of bone is
pushed down into another piece of bone.
7. Fissure fractures are cracks in the bone.
Greenstick fractures happen when the bone bends and breaks partially, but not completely. Have
you ever tried breaking a fresh twig of wood? Instead of snapping in half like a dry piece of wood, it
tends to break on the outside but only bend in the middle. This is what a greenstick fracture looks like.
This kind of fracture is more common in children and teenagers than adults. As a person ages, their

bones become harder and more brittle. Kid's bones, on the other hand, are much more flexible. This
makes them more likely to bend in the middle instead of breaking all the way through.
Commonly broken bones: Clavicle bones
What would you guess are the most commonly broken bones in the human body? If you
guessed something in the arms or hands, you are correct! Bones in this area are more likely to be broken
than bones in other parts of the body because we tend to use our arms and hands the most when trying
to break a fall. As it turns out, the clavicle, also known as the collar bone, located between your
shoulder and the front of the neck, is the bone which is most likely to get broken in the human body.
The clavicles can be easily fractured by impacts to the shoulder, from the force of falling on
outstretched arms, and by a direct hit.
Detecting a broken bone
Broken bones sometimes feel and look the same as muscle pain or other kinds of injuries. This
makes it very important for doctors to assess and injury before treating someone for a broken bone.
There's usually swelling, bruising and pain when you touch or put weight on the injured spot. Stress
fractures are especially tricky to detect due to the fact that they build up over time. Unlike impact
fractures, there isn't always a specific moment when the break occurred which the patient can
remember. So how do you know if your bone is really fractured?
The most common way to find out whether or not a bone is really broken is by taking an x-ray
image of it. This also tells the doctor how bad the fracture is and exactly where it's located. Detailed
bone scans are also sometimes used instead of x-ray images to detect very small cracks. These can be
used to see itsy bitsy fractures that aren't always visible with an x-ray.
How to fix a broken bone
A cast is used to immobilize broken bones.
The human body is very good at repairing itself after an injury, and it comes equipped with all
the tools it needs to fix fractures. Doctors work together with the body by creating the best possible
conditions for healing. After that, it's just a matter of standing back and giving the body time to do its
job. Sometimes the body does such a good job at healing a bone that after it heals it's impossible to tell
the bone was ever broken!
To create the perfect environment for a bone to heal, it's important to keep the broken bone in
one place and prevent it from moving (also known as 'immobilizing' it). This provides support by taking
pressure off the break so it will heal more quickly. It also keeps the pieces aligned to prevent the bone
from healing crookedly.
X-ray of a bone with many plates and screws after surgery.
The most common way to immobilize and protect a broken bone is by putting a cast or splint
around it. A cast is a hard shell usually made of plaster or fiberglass. A splint is a hard support similar
to a cast which can be worn temporarily and is easily removed. Little bones such as toes that are too
small for casts are usually held in place next to the other toes using special tape. If the broken bone is in
the leg or foot, crutches are often used to keep weight off the injured leg. If part of the arm is broken, a
sling can be used in addition to a cast to help hold it in place.
Surgery
Surgery is sometimes needed to help realign the bones when there are too many broken pieces
or a very complicated fracture which won't stay still any other way. In these cases, metal screws, pins,

rods, and plates are used to hold the bone together. Sometimes these are temporary and can be removed
once the bone heals, but other times they're left in place permanently to help make the bone stronger.
How to make your bones stronger
Exercise
Physical activity is an important part of building strong bones. Many studies have shown bones
that aren't used much become thinner and weaker over time, while bones that are used regularly during
exercise become stronger and thicker from the stress of your muscles pulling on your bones. The
stronger the bone, the less likely it is to break in an accident. Lifting weights and other high intensity
activities are especially good for building strong bones.
Eat Healthy
Bones need the right kind of nutrients and minerals from the food you eat to grow and become
strong, which is why it's important to eat healthy, balanced meals every day. The two most important
nutrients for bones are calcium and vitamin D.
Calcium is used by most cells in your body to signal different processes. It's also what makes
your bones strong and hard. Most of the calcium in your body, almost 99%, is stored in your bones.
Your bones act like a warehouse, storing extra nutrients so they can supply calcium and other minerals
to your body when it needs them. Calcium comes from dairy foods such as milk, cheese, and ice cream.
Dark-green vegetables such as spinach, broccoli, and collard greens are a good source of calcium as
well.
Vitamin D helps to control how calcium and other minerals are used in the body and how much
of these are getting stored in the bones. Vitamin D comes from liver, whole eggs, and certain fish. You
can also get Vitamin D directly from sunlight on your skin! Many foods found in the grocery store, such
as butter, cereal and orange juice, also now come fortified with vitamin D. Fortified means that extra
nutrients have been added.
Don't smoke
In addition to causing major damage to your heart, lungs, throat, and teeth, smoking cigarettes
is bad for your bones. Tobacco smoke makes osteoblasts (the cells which create new bones) work more
slowly, which means the bones of someone who smokes get thinner and more fragile over time. Weak
bones are more likely to break from an impact and take longer to heal when broken. Luckily, bones
slowly become strong again as soon as a person quits smoking. This is just one of the many good
reasons that you should never smoke!
PAIN CAUSED BY BONE FRACTURE
Pain is the bodys natural response when a bone breaks. Both the fracture and any injuries to the
body tissue near the fracture site can produce pain. Soft tissue refer to the muscles, ligaments, nerves,
tendons and blood vessels, joint cartilage, etc. that surround the bone. When the soft tissue around the
fracture is injured the result can be pain, swelling, bruising and redness.
1. Acute pain usually occurs immediately after the fracture when the bone has broken.
2. Sub-acute pain usually occurs the first few weeks after the fracture while the bone and soft tissue heal.
3. Chronic pain is pain that continues long after the fracture and soft tissues have finished healing.
Any fracture can cause all or some of these types of pain to occur. For example, immediately
after a bone breaks you might experience acute pain, followed by sub-acute pain while your bone heals,
but you may not have any chronic pain. Other individuals may only experience acute pain. It is also
possible to have a fracture without any pain; many people have had a spine fracture and do not know
they have had one.
Immediately or soon after a fracture occurs, most people will experience what is called acute
pain. Medication to reduce this type of pain is often prescribed during this stage. Acute pain will
decrease with time.

In order for a broken bone to heal, it may need a cast, a brace, a splint, surgery or any
combination of the above. Whatever method is used to treat your broken bone, the key is to reduce or
immobilize the fracture for several weeks so that the bone can set or heal.

Reduce means to bring the broken ends of the bone as close together as possible to speed up the
healing process. Sometimes, this requires surgery.

Immobilize means to prevent the broken ends of the bone from moving apart again so the fracture
can set or heal. A cast, a brace, a splint or surgery may be used to immobilize the area around
the fracture.

A broken bone in the back is managed by a combination of rest and the correct method of
controlled movement.

It is important that you follow the instructions you are given by your doctor in terms of rest and
movement. You may be asked to avoid certain movements so that you do not make the injury
worse. A broken bone and the surrounding soft tissue damage need a minimum of six to eight weeks
to heal. However, depending on your general health and the condition of your bone and soft tissue,
healing can take much longer. For example, osteoporotic bones take longer to heal than normal bones.
During this time, it is usually necessary to reduce and modify your activities.
The acute pain that you may have felt immediately after the injury will decrease with time, but
in the weeks after your fracture, some pain may continue and this is called sub-acute pain. This is
mainly because the lack of movement that was necessary to help your bone heal has caused the soft
tissue around the injury to stiffen and the muscles to weaken. In addition, scarring and ongoing
inflammation may have developed in the soft tissue while the fracture was healing, which can also
make movement difficult and cause pain.
Physical therapy is often recommended at this stage of recovery. A physical therapist can help:
1.
2.
3.
4.

prevent or reduce the stiffness that can occur during fracture healing,
provide exercises to strengthen weakened muscles and improve range of motion,
break down scar tissue and reduce inflammation, and
help to overcome fear of movement.

The points listed above help to reduce pain and improve the function of the injured body part.
The physical therapist may use ultrasound, electrical stimulation, massage or other modalities to help
you recover from a fracture. Physical therapy may require you to do exercises. Medication may also be
used at this stage to help control pain or inflammation.
During this stage of recovery you may be advised by your doctor to begin using the injured
body part as much as possible for your usual activities even though you may still have some pain.
Gradually over the next few months, movements usually become easier and more comfortable and may
eventually return to normal. Slowly, the pain may completely go away.
It is normal to be fearful of some movements or activities. The memory of the pain can be
powerful and the fear of breaking another bone can often lead to anxiety and reduced general activity.
Despite your fear, it is important to start some gentle movement at this time; it will not be harmful. If
you are uncertain, see a Bone Fit trained healthcare professional in your area* or, if one is not
available, a healthcare provider such as a physical therapist or occupational therapist, or talk to your
doctor.
Your doctor or healthcare provider can advise you about what is reasonable for you to expect
for your recovery. It is important to remember that at this stage you may have pain but that does not
necessarily mean you are causing further harm. Your healthcare team will help you reduce your risk of
a second fracture.

Many people who fracture will eventually heal and recover to the point where they no longer
experience any pain. However, some people may continue to experience pain long after the fracture and
soft tissues have healed. Full healing from a fracture can take anywhere from several weeks to several
months and occasionally even several years.
Pain that persists after full healing is expected to have taken place is called chronic pain.
Chronic pain may be due to nerve damage, the development of scar tissue, an aggravation of underlying
arthritis or any number of other causes.
Chronic pain is usually managed on an individual basis. The choice of treatment will depend on
your initial injury and the specific cause of the pain. Some examples of how to manage chronic pain
include physical therapy, exercises and medications. These examples may not cure your pain but they
may help to control or reduce the pain. Controlling pain can help you manage your day-to-day activities
and enjoy a better quality of life.
If your pain continues, talk to your healthcare provider about other ways that are available to
manage your pain to help with your daily living and overall quality of life. It is important that you
consult with your healthcare provider to ensure that all possible reasons for the ongoing pain have
been examined. Again, it is important to remember that at this stage you may have pain but that does
not necessarily mean you are causing further harm; returning to a reasonably physically active lifestyle
will help reduce your risk of a second fracture.