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?

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. Read more about fractures » Top Searched Fracture Terms: stress, avulsion, compound, compression, scaphoid, hip, comminuted, elbow, wrist, ankle, types, open, skull

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.

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