Fracture
Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR
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Did I Break the Bone or Just Fracture It?
Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD
 Yadier Molina broke his wrist in May 2007 while catching for the St. Louis
Cardinals, and some may be surprised that he may not have been casted for a few
days. And while I don't understand the rules for baseball's injury reserve list
(why was he put on the 15 day disabled list, when the team knows he will be out
for four to six weeks?), I do however, know what's going on with
fracture care.
First a few quick definitions.
- Broken, cracked, or fractured all mean the same thing, that the
integrity of the bone is no longer intact. One term is not worse than
another. How many times have people thanked me that their ankle wasn't
broken, just fractured! I have to remind myself to do the definition list at
the bedside as well.
- Fractures can be displaced or non-displaced, and this attempts to
explain whether the bones are aligned properly. Some amount of displacement
is allowed depending on which bone is broken and where in the bone the break
occurs. The body can remodel bones as they heal, so displaced does not
automatically equal having to "set" the bones.
Top Searched Fracture Terms:
stress, avulsion, compound, compression,
scaphoid, hip,
comminuted, elbow, wrist, ankle, types, open, skull
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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.
Next: What are common types of fractures? »
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