As rugged as our bodies are, they are often susceptible to painful and disabling injuries such as strains, sprains, dislocations and fractures. Fractures are simply a break in a bone caused by forces that exceed the strength of the osseous tissue in the bone. Most fractures are caused by excessive external forces and are classified as traumatic fractures. A rarer type of break known as a pathologic fracture may be caused by diseases or disorders, such as osteoporosis, that weaken the bone to the point of fracturing under normal strain. Continue Scrolling To Read More Below...
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Fractures can range in severity from minor inconveniences (requiring very little medical intervention) to severe, life-threatening injuries that take months or years for full recovery. Improper treatment of fractures can even lead to debilitating changes to the body’s strength and mobility.
All bone fractures, regardless of cause, are sorted into two major classes: simple and compound fractures.
- Simple fractures, also called closed fractures, are broken bones that remain within the body and do not penetrate the skin.
- Compound fractures, also called open fractures, are broken bones that penetrate through the skin and expose the bone and deep tissues to the exterior environment.
Compound fractures are considered much more serious than simple fractures because they may be complicated by deep infections if pathogens enter the body through the wound. Antibiotics are often used to prevent possible infections that may be associated with compound fractures.
Within the dichotomy of simple and compound fractures are many specific types of fractures.
- Comminuted fractures are severe fractures that involve the breaking of a bone into several smaller pieces.
- Greenstick fractures are breaks in bones along only one side of the bone caused by a force perpendicular to the bone’s long axis. Greenstick fractures are seen only in children whose developing bones are more flexible than adult bones and therefore tend to bend and only partially break instead of breaking completely.
- Another type of fracture known as avulsion fractures involves a small piece of bone being torn off from the main bone due to an extreme force applied to a ligament or tendon. Avulsion fractures may be caused by overexertion of muscles or sudden traumatic pulling of part of the body during an accident.
Bone fractures may occur at many different angles depending on the direction in which a force is applied to a bone.
- Transverse fractures form perpendicular to the long axis of a bone and are the result of a force applied at a right angle to the bone.
- Oblique fractures are slanted fractures that occur when a force is applied at any angle other than a right angle to the bone.
- Spiral fractures are the result of an extreme twisting force being exerted on a bone.
The period immediately after a bone fracture is critical for the proper repair of the bone and healing of the affected tissues. Bones begin to heal very quickly after a fracture and the bone tissue will knit together with any nearby bone fragments to form a callus of cartilage and eventually new bone tissue. The ultimate goal of bone healing is to reach a proper union of the fractured bone pieces that restores the original bone anatomy and restores full function to the muscles and joints that move the bone.
When a bone is broken, the first step in repair is to take an X-ray to confirm the diagnosis and to provide a clear picture of the type of fracture and the degree of displacement and misalignment. The first aim in treatment is to see that bone ends that abut each other are in alignment so that, when the fracture heals, the bone will retain its previous shape. Bone ends that have been displaced are manually maneuvered back into position. The bone may be manipulated through the skin using a local or general anesthetic, or the bone may be repositioned by means of an operation during which the site is opened.
Once the fracture has been placed in proper position, the bone is immobilized to allow the broken pieces to reunite firmly. In most cases a rigid cast is used to immobilize the bones for several weeks and achieve the proper union. In severe cases, the ends of the fractured bone may be fixed in place by metal pins connected to an external frame; once the fracture has healed, the pins and frame are removed. In other cases an operation is performed to open up the injury site and fasten together the bone pieces with metal screws, nails, plates, rods, or wires. Even after the bones have healed the metal hardware is left within the body permanently to prevent possible infection from a removal surgery.
The older a person is, the longer it takes for a bone to heal; a child may recover within a few weeks and an elderly person may take several months. At all ages, some bones will heal faster than others. An arm may heal in a month, but a leg may take up to six months. Once a bone mends, it is usually stronger along the fracture line than it was before the break.
The elderly, as well as those in poor health, may experience a condition known as delayed union, where the bone takes longer than normal to heal. People in the risk groups for delayed union may also be susceptible to nonunion fractures where the bones fail to fuse together. Nonunion fractures may also occur in otherwise healthy people that have not had their bones medically treated or have suffered an infection or severe trauma to the soft tissues surrounding the fracture site.
Another risk of avoiding medical treatment is the possibility of a malunion, where the bones are not properly aligned and fuse in a way that is not anatomically correct. The results of a malunion vary by severity and the region of the body affected, but may include pain, loss of mobility, and loss of bone and muscle strength.
Prepared by Tim Taylor, Anatomy and Physiology Instructor