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Fractures

A fracture is a broken or cracked bone. It can be a hairline crack in a bone, a partial fracture (usually in children) or a complete break. If you have a complete break your bone can fracture into two or more pieces.

You have 206 bones in your body that make up your skeleton. Your skeleton supports and protects the soft tissues in your body and allows you to move. Bone is a living tissue with a soft centre of bone marrow that produces blood cells. Your bones have a hard outer surface (the cortex) that contains minerals such as calcium.

Healthy bones are strong and can bear a lot of weight and force. They do bend a little and sometimes you may apply force to a bone but it won’t break.

Fractures usually happen when too much force is applied to your bone, usually during a fall or an accident. There are a number of different types of fracture, but they all result in a partially or completely broken bone. If you have a severe accident or injury, your bone may fracture into many pieces. The majority of fractures occur in children or elderly people. This is because young and middle-aged adults generally have very strong bones.

Types of fracture

There are two main types of fracture.

  • A closed fracture is when your bone breaks or cracks, but your skin isn’t damaged.
  • An open fracture (also called compound fracture) is when a broken bone breaks through your skin. Open fractures are more serious because you’re more likely to develop an infection in the bone and wound.

There are also different types of fracture depending on how you break your bone. Bones can break across or along the bone. A comminuted fracture is where your bone breaks into three or more pieces. A greenstick fracture is where your bone breaks on one side but is bent on the other. These fractures only happen in children because they have softer bones.

If you have a transverse fracture, it means your bone has a horizontal fracture line. If your fracture is described as being an oblique fracture, then it has an angled pattern.

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How a wrist fracture is treated
A broken or cracked bone can be set and held in place until it's healed

Details

  • Symptoms Symptoms of fractures

    The main symptom of a fracture is pain. This can be quite severe and may make you feel sick and light-headed. The pain gets worse when you try and move the affected area. You may not be able to use the affected area. For example, you may not be able to walk on a broken ankle or use your hand if you have a broken wrist.

    Other symptoms of a fracture include:

    • swelling
    • bruising
    • a grating feeling or noise – you may hear your bone break during an accident
    • the area looking deformed or twisted

    If you think you have a fracture, you should go to your nearest accident and emergency (A&E) department. If you can’t move, call an ambulance.

  • Diagnosis Diagnosis of fractures

    If you think you have fractured a bone, go to an A&E department. A doctor at A&E will ask about your symptoms and examine you for signs of a fracture, such as swelling or tenderness. They may also ask about your medical history, as well as any accidents or falls.

    You may have an X-ray. Occasionally, if a fracture doesn't show up clearly on an X-ray, you might have a scan, such as an MRI or CT scan. These can produce a more detailed image of your bone and can help to diagnose stress fractures. You may also need a CT or MRI scan if you have a complicated fracture or an injury that needs an operation to treat it.

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  • Treatment Treatment of fractures

    The aim of treatment is to put your bones back into place and then prevent them from moving until they heal.

    First aid

    If you think you’ve broken a bone, or you’re helping someone who has, try and support the affected area to stop it from moving around. This will help to prevent further damage and ease the pain. You can use cushions, clothes or your hand to support the area.

    If you have an open fracture, don’t try to close the wound or put the bone back into place. Cover the wound with a clean dressing or cloth until you can get treatment.

    Non-surgical treatment

    Before your doctor can treat your fracture, he or she will need to move your bones back into their normal place. This is called reducing the fracture. Because this can be a painful procedure, you may have a general anaesthetic. This means you’ll be asleep during the procedure and won’t feel any pain.

    Closed fractures can be treated using a cast or a brace, or by using traction. Each is described below.

    • A cast is a hard and rigid protective covering, which holds your bone in place and helps it to heal. Casts can be made of plaster of Paris or fibreglass.
    • A brace is similar to a cast but it allows you to move in a limited way.
    • Traction involves bringing your bones into line with each other using a gentle but steady pulling action. Weights are used to gently pull your bones together. They’re attached to your skin using tape, or to your bone using metal pins. Traction can be used as an initial treatment, for example, before surgery. It’s most commonly used for leg fractures.

    Some fractures, such as broken ribs, can’t be treated using a cast or traction because of where they are on your body. For these types of fracture, you will probably be advised to take painkillers and limit the amount of activity you do until the fracture heals.

    Surgery

    Depending on the type of fracture you have and how severe it is, you may need to have an operation. This is so your bones can be fixed into place.

    During the operation, your surgeon will move your broken bones into the correct place. They will then fix your bones by using either:

    • metal rods that sit inside your bone
    • screws and metal plates that attach onto the surface of your bone

    Your surgeon will then close your skin. You may have a cast or brace put on to protect your bones as they heal.

    In other operations, the metal plates and screws are attached to metal bars outside your skin. This forms a frame, known as an external fixator, that holds your bones in the proper position so that they can heal.

    Physical therapies

    As your fracture heals, you may be referred to a physiotherapist (a health professional who specialises in maintaining and improving movement and mobility). They can help you to build up strength in your bones and muscles, and ease any stiffness. You may be given an exercise programme to follow, which will help you to get back to your full range of movement.

  • Bone fracture treatment on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including bone fracture treatment.

  • Causes Causes of fractures

    There are a number of different causes of fractures. The main ones are listed below.

    • The most common cause of a fracture is severe force on your bone. This can happen during a fall or in an accident.
    • Bone conditions, such as osteoporosis, can cause fractures. This is because your bones become fragile and brittle, which means they’re more likely to break.
    • Your bones can fracture because of repeated stress on them. Stress fractures can develop in your lower legs, for example, after repeated exercise, such as running. Soldiers sometimes get stress fractures in their feet from marching.
  • Complications Complications of fractures

    Most fractures heal without further problems. However, fractures can sometimes cause complications. The main ones are listed below.

    • When a bone fractures, it may damage surrounding structures, such as your nerves or a blood vessel. You may need an operation to repair any damage.
    • A fracture can lead to compartment syndrome. This happens when your muscles swell. Your muscles sit inside a compartment of tissue, so they don’t have much room to expand. When your muscles swell, the pressure increases and blood can’t flow into your muscle properly. This causes severe pain. An operation called a fasciotomy may be needed to release the pressure on your muscle.
    • If you have an open fracture, or you’ve had surgery to treat a fracture, then the wound or the bone may become infected. If your fracture becomes infected, it may take longer to heal.
  • Recovery Recovering from a fracture

    After your treatment, it’s important to check for any problems with your cast or brace, or any wounds.

    It’s normal to have swelling from your injury, particularly during the first 48 to 72 hours after your fracture. If you have a cast or splint on your arm or leg, swelling can cause it to feel uncomfortable.

    You can help any swelling go down by keeping your arm or leg elevated for the first 24 to 72 hours. Gently moving your uninjured fingers or toes can help to reduce stiffness. Go back to your fracture clinic or A&E department straightaway if: 

    • you continue to have pain or it gets worse
    • your swelling doesn't go down
    • your wound or cast develops a bad smell or you notice any discharge (pus) 
    • your cast has been damaged
    • your skin has become red and tender around a wound, and is burning or stinging
    • you have numbness in your arm or leg beyond the fracture
    • you’re unable to move your fingers or toes

    The time it takes for your bone to heal depends on your age, which bone you’ve broken and the type of fracture you have. In adults, it can take several weeks, or even months, for a fracture to heal fully. If a fracture is very slow to heal, this is called a ‘delayed union’.

    Even after your cast, brace or metal rods have been removed, you may not be able to go back to your usual activity for a few weeks. Your muscles and joints may feel stiff. If you’ve had a cast or splint, you’ll have probably lost some muscle strength in the affected area. Gentle exercise, as instructed by your doctor or physiotherapist, will help you to regain your normal flexibility and muscle strength.

  • FAQs FAQs

    Could I have a sprain rather than a fracture to my bone?

    Answer

    Yes, a sprain can sometimes have the same symptoms as a broken bone. If you're not sure what your injury is, speak to your GP or go to your nearest A&E department.

    Explanation

    A sprain is an injury to ligaments – the strong fibres that hold your joints together. If you tear a ligament, you can sometimes get the same symptoms as a broken bone, particularly if the sprain is severe. These include:

    • swelling and bruising
    • pain
    • movement of the joint that isn't normal and that may get worse over time, until you can't move the joint at all
    • a popping feeling or sound at the time of the accident, if the ligament has broken

    You may not be able to tell whether you’ve broken a bone or sprained a joint, so it's important to get medical advice. If you have any of these symptoms, speak to your GP or go to your nearest A&E department. Your doctor may need to take an X-ray to be sure.

    Is there anything I can do to prevent a broken bone in later life?

    Answer

    Yes. You can lower your risk of fractures in later life by taking steps to build strong and healthy bones while you’re younger. There are also things you can do to reduce your risk of falling as you get older.

    Explanation

    There are a number of things you can do to help keep your bones healthy. The main ones are listed below. 

    • Eat a healthy, balanced diet. Calcium is important to help keep your bones strong and healthy. However, other vitamins and minerals are also important for healthy bones. To get all of the vitamins and minerals you need, you should eat a healthy, balanced diet. This means eating plenty of fruit and vegetables, and wholegrain starchy foods such as rice and pasta. You should also eat some protein, such as eggs, fish and meat and some dairy foods such as milk. Eat only small amounts of foods that contain a lot of sugar or fat.
    • Get enough vitamin D. This essential vitamin helps your body to use calcium. You get most of the vitamin D you need from sunlight, so make sure you spend time outside, particularly during the summer. If you spend a lot of time indoors or covered up, you may not get enough vitamin D and you should consider taking a supplement.
    • Keep active. Being physically active and doing weight-bearing activities, such as walking, helps to maintain healthy bones.
    • Don’t smoke. Smoking can affect how your bones repair themselves.
    • Stay within the recommended limits for alcohol. If you drink too much alcohol, it can damage your bones and increase your risk of a fracture.

    As you get older, you may be more likely to fall, which increases your chances of a fracture. If you think you might be prone to accidents or falling over, ask your GP about treatments or services that can help you.

    You can also do lots of things at home to reduce your chances of having a fall. The following may help.

    • Keep your home free of clutter and check for anything that may trip you up, such as cables or loose carpet.
    • Make sure your pets don't get under your feet.
    • Store everyday items at an easy height for you to reach.
    • Keep your home well lit, particularly stairways.
    • Wear well-fitting shoes.
    • Put a rubber mat in the bath and install a grab rail.
    • Take extra care in the winter when you’re outside as paths may be slippery.

    Is there anything I need to know about looking after my cast?

    Answer

    Yes. It's important that you keep your cast in good condition and prevent it from being damaged. This is so it can give your bones the support they need to heal.

    Explanation

    The purpose of your cast is to keep your bones still and in the right place so that they can heal properly. A cast can also help to ease your pain and reduce any swelling. If your cast becomes damaged, it's less likely to give your fracture the support it needs.

    There are two main types of cast used to treat fractures: plaster of Paris casts and fibreglass casts. Fibreglass is a type of lightweight plastic, which can be moulded to fit different shapes. Both types of cast use padding as a protective layer next to your skin. Both plaster of Paris and fibreglass come in rolls that are dipped in water and put on over the padding to cover the injured area.

    Once the cast is on, it takes time to dry. Plaster of Paris can take two to three days to dry out and fibreglass takes about an hour to dry and become fully hard. It’s important not to damage the cast during this time.

    Once your cast has dried out fully, keep it in good condition. The main things you can do are listed below.

    • Keep your cast dry. Use a double layer of plastic to cover your cast when you’re in the shower or bath.
    • Check your cast regularly and look for any damage or soft areas.
    • Check the skin around your cast regularly. Look for any signs of redness or irritation and check for signs of infection under the cast, such as a bad smell or discharge (pus).
    • Don’t push anything down inside the cast to scratch itching skin. This can damage your skin and maybe lead to infection. If you have persistent itching, see your doctor.

    If your cast becomes damaged or uncomfortable, you should go back to the accident and emergency (A&E) department or your fracture clinic.

  • Resources Resources

    Further information

    Sources

    • Fractures. The Merck Manual. www.merckmanuals.com, published August 2013
    • Fractures. International Society for Fracture Repair. www.fractures.com, accessed 2 May 2014
    • Wrist fractures. PatientPlus. www.patient.co.uk/patientplus.asp, published October 2013
    • Metatarsal stress fracture. Medscape. emedicine.medscape.com, published April 2013
    • Complications from fractures. PatientPlus. www.patient.co.uk/patientplus.asp, published May 2014
    • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd edition. Oxford: Oxford University Press, 2010: 510–11,1106–07
    • Fractures (broken bones). American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published October 2012
    • Care of casts and splints. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published April 2011 
    • Healthy living. Age UK. www.ageuk.org.uk, published June 2013
    • Fractures. St John Ambulance. www.sja.org.uk, accessed 2 May 2014 
    • First aid for a broken bone. Red Cross. www.redcross.org.uk, accessed 2 May 2014 
    • Healthy bones. National Osteoporosis Society. www.nos.org.uk, accessed 2 May 2014
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