Fractures

Published by Bupa's Health Information Team, April 2010.

This factsheet is for people who have a fracture, or would like information about them.

A broken or cracked bone is known as a fracture. This can be a crack or buckle in the structure of the bone or a complete break, producing two or more fragments.

How a wrist fracture is treated

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About fractures

Bone is the strong tissue that forms the basis of your skeleton. It is a living tissue, made up of bone-forming cells, which produce the mineral compound (matrix) that makes your bones strong and hard.

Your bones can usually tolerate external forces (for example, knocking a bone as a result of a fall or injury) but if the force is very big or your bones are weak, they may crack or break into fragments.

Types of fracture

Fractures are divided into two types depending on whether or not they break through your skin.

• Closed fractures. This is when your bone doesn't damage your skin.
• Open (compound) fractures. In these fractures, the broken end of your bone breaks through your skin and may stick out.

Your fracture may also be classed depending on the structure of the break and what caused it.

• Simple fracture. This is when your injury causes a single crack across the bone.
• Complex fracture. These are also called spiral fractures due to their shape. They are caused by a twisting movement. Fractures in long bones, such as your thigh bone (femur) are often spiral fractures. The surfaces of the broken bone may not come together and be harder to heal properly.
• Hairline fracture. This is when your bone is only partially fractured. These fractures can be difficult to detect on X-rays.
• Greenstick fracture. This is when your bone buckles and splits on one side, but just bends on the other. These usually occur in children as their bones are softer.
• Comminuted fracture. In this type of fracture, your bone breaks into several fragments. This is more common after a serious accident.
• Impacted fracture. This is when one of your bone fragments is driven into another after they separate.
• Stress fracture. This is when small repeated stresses and strains build up and eventually break one of your bones. These may be difficult to pick up on X-rays.
• Avulsion fracture. This happens when one of your muscles or ligaments pulls on a bone and causes a piece to break off.
• Pathological fracture. This is a fracture that develops when a tumour or a disease such as osteomalacia weakens your bone.
• Fragility fracture. These are common after middle age, when your bone density can decrease due to osteoporosis and a minor trauma, such as falling from standing height, can cause the bone to fracture.

Symptoms of fractures

If you fracture a bone, you will usually feel a lot of pain, especially when you try to move it. You may even find that you can't move the fractured part of your body.

At the site of the fracture you may also notice:

• swelling
• bruising
• the bone sticking out or bending
• a grating feeling or sound

You may also become pale and clammy, and feel sick or light-headed due to the pain. If you think you have a fracture, you should go to your nearest accident and emergency department or call for an ambulance if you are unable to move.

Complications of fractures

Fractures can sometimes cause a number of additional problems. Your fracture may damage surrounding structures, such as your nerves or a blood vessel. You may need special treatment if this happens.

Your fracture may become infected. This is more common if you have an open fracture or if you need surgery to fix it. If your fracture becomes infected, it may take longer to heal and there is a chance that your bone will become infected. This is called osteomyelitis - see Related topics for more information

Causes of fractures

Fractures usually occur if you hit your bone or if you twist or bend awkwardly. This can happen as a result of a fall or a collision. Fractures are more common in young children because they tend to have more falls and accidents, partly because they are less aware of hazards.

You may fracture a bone without an obvious trauma. For example, athletes are more at risk of getting stress fractures, as these can happen with repeated stress over time. You're also more likely to break a bone as you get older or if you have a disease that weakens your bones.

Diagnosis of fractures

At the hospital, your doctor will ask about your symptoms and examine you for signs of a fracture, such as swelling or if your bones are held in an unusual position.

He or she will usually use X-rays to diagnose your fracture. However, if a fracture doesn't show up clearly on the X-ray, your doctor may request an MRI (magnetic resonance imaging) or CT (computerised tomography) scan to look at it more closely. Your doctor may also ask you to have some blood tests to check for conditions that can weaken your bones.

Treatment of fractures

You should always seek medical attention if you think you may have broken a bone. However, there are some things you can do to reduce your pain and prevent further injury until you see a doctor.

First aid

If you break your arm, you can secure the bone with a sling or a splint to help reduce the pain and prevent further injury, until you receive medical help.

You can also take painkillers to ease the pain. Always read the patient information leaflet that comes with the medicine and ask your pharmacist or doctor for advice.

Hospital treatment

Fractured bones are able to heal naturally by themselves. However, the fractured parts of your bone may need to be lined up and fixed in position so that the bone is in the correct position when it heals. Re-alignment of your bones is called reduction of the fracture. It is usually carried out under general anaesthesia, which means you will be asleep during the procedure. Your surgeon will gently pull and manipulate your bones until they are in the correct position. Sometimes, you may need to have surgery to re-align the broken bone.

Once your bone has been moved into the correct position, it will need to be held in place (immobilised) until it heals. You may be given a cast, splint or sling to wear. Sometimes, you may need surgery to fix the bone together with metal plates, screws or rods to help them unite (see Related topics).

Whether or not your surgeon will advise you to have surgery depends on a number of factors individual to you, including whether you have any other injuries, the type of fracture you have, your age and how active you are.

The time it takes for your bone to heal depends on your age, as well as which bone you have broken and the type of fracture you have. Fractures in children and smaller bones, such as the finger bones, usually take less time to heal. In adults, it usually takes between six and 12 weeks until your bone is strong enough for normal use. However, it can take up to two years until it is back to full strength.

If your fracture is taking a long time to heal, your doctor may refer you for a treatment called pulsed ultrasound therapy or electromagnetic therapy. This treatment is still being investigated to find out how effective it is at helping bones to heal, and so it may not be offered in all hospitals.

Physical therapies

Once your fractured bone has been set in place, you will need to build up the strength in the bone. Your doctor may suggest you begin with some gentle exercises or refer you to a physiotherapist. Physiotherapy can help promote healing and increase your movement of the affected area.

After your treatment

You should return to the fracture clinic or accident and emergency department at the hospital as soon as possible if:

• you continue to have pain
• your swelling doesn't go down and your toes or fingers turn bluish
• your fracture has an offensive smell or discharge
• your cast has been damaged (eg it has softened because it got wet)
• your skin has become increasingly red around the wounds

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

For sources and links to further information, see Resources.