Fracture

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Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR

• Introduction to fracture
• What causes a fracture?
• What are common types of fractures?
• Stress fracture
• Compression fracture
• Rib fracture
• Skull fracture
• Fracture in children
• How is a fracture diagnosed?
• What is the treatment for a fracture?
• Related a stress fracture article:
  Stress Fracture - on eMedicineHealth
• Patient Discussions: Fracture - Describe Your Experience

Featured fracture (broken bone) patient discussions on type of fracture experienced "I 'm 73 and active, doing martial arts. I tripped and fell hard with my arm at an awkward angle and tried to catch myself. I had a lot of pain and couldn't bend, lift or straighten my left arm. Also, it was painful to try to turn my palm over, and my arm felt stiff. I have a fracture of the radial head, and I hope I haven’t done damage to tendons or ligaments. I have my arm in a splint for 13 days and then I'm supposed to start moving it. " "I am 70 years old, and one evening, I fell down a flight of outdoor stairs, landing on concrete. I fractured my femur and also fractured my hip in three places. I had surgery the following morning where they placed a 13-inch rod down the femur, a pin above my knee, and two pins in my hip. It has been one year, and I still experience some pain in the hip, although I feel I am doing fairly well." "I slipped on a 1 meter board at a diving pool. The board flipped back and hit my left, lower leg and resulted in six fractures (compound and spiral). This was about three years ago. Today, I have undergone surgery four times. My knee is busted (the cap is dislocated, and the cartilage is ripped off.) Things are looking up though. I’m still in pain, but I can walk, and if I rest enough, I can even do some housework and mow the lawn, etc. I’m 32 years old." Read All Comments on Fracture » Top Searched Fracture Terms: stress, avulsion, compound, compression, scaphoid, hip, comminuted, elbow, wrist, ankle, types, open, skull Patient Discussions are not a substitute for professional medical advice, or treatment. See the disclaimer at the bottom of the comments page.

Introduction to fracture

Bones form the skeleton of the body and allow the body to be supported against gravity and to move and function in the world. Bones also protect some body parts, and the bone marrow is the production center for blood products.

Bone is not a stagnant organ. It is the body's reservoir of calcium and is always undergoing change under the influence of hormones. Parathyroid hormone increases blood calcium levels by leeching calcium from bone, while calcitonin has the opposite effect, allowing bone to accept calcium from the blood.

What causes a fracture?

When outside forces are applied to bone it has the potential to fail. Fractures occur when bone cannot withstand those outside forces. Fracture, break, or crack all mean the same thing. One term is not better or worse than another. The integrity of the bone has been lost and the bone structure fails.

Broken bones hurt for a variety of reasons including:

• The nerve endings that surround bones contain pain fibers and and these fibers become irritated when the bone is broken or bruised.
  
  
• Broken bones bleed, and the blood and associated swelling (edema) causes pain.
  
  
• Muscles that surround the injured area may go into spasm when they try to hold the broken bone fragments in place, and these spasms cause further pain.

Often a fracture is easy to detect because there is obvious deformity. However, at times it is not easily diagnosed. It is important for the physician to take a history of the injury to decide what potential problems might exist. Moreover, fractures don't always occur in isolation, and there may be associated injuries that need to be addressed.

Fractures can occur because of direct blows, twisting injuries, or falls. The type of forces on the bone may determine what type of injury that occurs. Descriptions of fractures can be confusing. They are based on:

• where in the bone the break has occurred,
  
  
• how the bone fragments are aligned, and
  
  
• whether any complications exist.

The first step in describing a fracture is whether it is open or closed. If the skin over the break is disrupted, then an open fracture exists. The skin can be cut, torn, or abraded (scraped), but if the skin's integrity is damaged, the potential for an infection to get into the bone exists. Since the fracture site in the bone communicates with the outside world, these injuries need to be cleaned out aggressively and many times require anesthesia in the operating room to do the job effectively.

Next, there needs to be a description of the fracture line. Does the fracture line go across the bone (transverse), at an angle (oblique) or does it spiral? Is the fracture in two pieces or is it comminuted, in multiple pieces?

Finally, the fracture's alignment is described as to whether the fracture fragments are displaced or in their normal anatomic position. If the bones fragments aren't in the right place, they need to be reduced or placed back into their normal alignment.

Fracture - Describe Your Experience

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