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. In a complete break a bone can fracture into two or more pieces.

How a wrist fracture is treated

A Flash plug-in is required to view this animation.

About fractures

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, during a fall for example.

Fractures usually happen when too much force is applied to a 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 in elderly people as 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 the 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 once your skin is damaged you’re more likely to develop an infection in the bone and wound.

There are also different types of fractures depending on how you break your bone. A comminuted fracture is where the bone has broken into three or more pieces. A greenstick fracture is where the bone has broken on one side but bent on the other. Bones can break across or along the bone.

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 department or call for an ambulance if you’re unable to move.

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 have 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.

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 and this makes them 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.

Diagnosis of fractures

If you think you have fractured a bone, go to accident and emergency or see your GP straightaway. Your doctor will ask about your symptoms and examine you for signs of a fracture, such as swelling or tenderness. He or she may also ask about your medical history as well as any accidents or falls.

You may be asked to have an X-ray. Occasionally, if a fracture doesn't show up clearly on the X-ray, your doctor may ask you to 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 an MRI scan if you have a complicated fracture or an injury that needs an operation to treat it.

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 have 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 will 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 or a local anaesthetic. If you have a general anaesthetic, you will be asleep during the procedure. Local anaesthesia completely blocks pain from the affected area and you will stay awake during the procedure.

Closed fractures can be treated using a cast or a brace or by using traction.

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 isn’t often used, but it involves bringing your bones into line with each other using a gentle but steady pulling action. Weights are used to gently pull the bones together and these are attached to your skin using tape, or to your bone using metal pins. Traction can be used as an initial treatment, before surgery for example. It’s usually 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, your doctor may ask you to take painkillers and reduce 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 to fix the bones in place to allow them to heal.

During the operation your surgeon will move your broken bones into the correct place and then fix them using metal rods that sit inside your bone, and screws and metal plates that attach onto the surface of your bone.

In some operations 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 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). He or she can help you to build up strength in your bones and muscles and to ease any stiffness. You may be given an exercise programme to follow, which will help you to get back a full range of movement in the affected area.

After your treatment

After your treatment it’s important to check for any problems with your cast or brace or any wounds. Go back to your fracture clinic or accident and emergency department straightaway if:

• you continue to have pain
• your swelling doesn't go down
• the fracture wound or cast has an offensive smell or you notice any discharge (pus)
• your cast has been damaged
• your skin has become red and tender around a wound
• you have numbness in your arm or leg beyond the fracture

The time it takes for your bone to heal depends on your age, which bone you have broken and the type of fracture you have. In adults, it can take several weeks or several months for a fracture to heal fully.

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. You may need to gradually increase the amount you do until you return to your usual activities.

Produced by Rebecca Canvin, Bupa Health Information Team, August 2012.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.