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Bone Fracture

Alternate Names

  • broken bone
  • Fracture of the leg

Definition

A bone fracture is a break in a bone. The surrounding tissues are usually injured as well. Bone fractures are classified as:
  • simple or closed fracture, in which the broken bone does not come through the skin
  • compound or open fracture, in which the bone pierces the skin

Risks

What are the causes and risks of the injury?

A bone fracture occurs when the force against a bone is greater than the strength of the bone. Most fractures result from an injury, such as that caused by an automobile crash or a fall.
Factors that increase a person's risk of bone fracture include:
  • normal aging, which causes the bones to become more brittle
  • osteoporosis or osteopenia, or excess bone thinning that results from loss of calcium in the bone with increasing age
  • menopause. During menopause, the ovaries stop making estrogen, which normally protects against bone loss.
  • removal of the ovaries
  • diet low in calcium or vitamin D
  • sedentary lifestyle
  • eating disorders such as anorexia and bulimia
  • family history of osteoporosis
  • medications such as corticosteroids, certain medications for seizures, and some medications used for high blood pressure
  • excess alcohol intake
  • smoking
  • hyperthyroidism, a condition in which the thyroid gland makes too much thyroid hormone
  • hypogonadism, a condition in which the ovaries in women or testes in men do not function normally
  • hyperparathyroidism, a condition in which the parathyroid gland makes too much parathyroid hormone. This hormone can affect calcium levels in the bloodstream and weaken bone further.
  • rheumatoid arthritis, a condition in which the body attacks its own joint tissue
  • cancers affecting the bone
  • physical abuse, including child abuse, elder abuse, and spousal abuse. Bone fractures are often seen in abused children and adults

Prevention

What can be done to prevent the injury?

Some fractures can be avoided by following sports safety guidelines for children, adolescents, and adults. Bone loss, which increases a person's risk of fractures, can be slowed by doing 30 minutes of moderate weight-bearing exercise a day. Weight-bearing exercise includes low-impact aerobics, walking, running, lifting weights, tennis, and step aerobics.
A person doing moderate exercise can talk normally without shortness of breath and is comfortable with the pace of the activity. The 30 minutes a day can be done all in one session, or it can be broken up into smaller segments of time. Low-impact aerobics and water aerobics are examples of exercises that minimize joint stress in elderly individuals or people with arthritis. Recent research has shown that people who do high-impact activities such as jogging have less bone loss as they age.
Individuals can lower their risk of bone fractures from osteoporosis by:
  • eating a well-balanced diet, following the food guide pyramid. A diet with adequate calcium and vitamin D—or taking calcium and vitamin D supplements—may help slow bone loss. There is some evidence that too much bone thinning is hastened by a diet high in fat.
  • eating 25 grams of soy protein daily
  • avoiding smoking
  • limiting alcohol intake
  • for women who have reached menopause, using hormone therapy
  • getting effective treatment for conditions such as hypogonadism, rheumatoid arthritis, and hyperthyroidism

Diagnosed

How is the injury recognized?

A bone fracture is recognized by a history of the injury and the results of the physical examination. An X-ray of the area is done to confirm the diagnosis. Special imaging tests such as a tomogram, CT scan or MRI may be needed to view the damaged area more clearly.

Treatments

What are the treatments for the injury?

Emergency treatment consists of splinting the limb above and below the suspected fracture. This keeps the area from moving. Ice should be applied. The injured area should be elevated to reduce swelling and pain.
Repairing the bone can prevent a deformity of the bone as it heals. The bone repair may be classified as a closed repair (also known as a closed reduction), which is done without cutting into the skin, or an open repair, which involves surgery. A closed repair is used if the bone is cracked completely, but the pieces are not quite in the right place. The healthcare professional pulls on the bone to get the bone pieces back in their proper position.
For some fractures, splints or casts that restrict motion are used. Fractures of the collarbone, shoulder blades, ribs, toes, and fingers generally heal well with such treatment.
An open repair (open reduction) is done for more serious fractures, including:
  • fractures in which the 2 ends of the broken bone cannot be lined up correctly
  • fractures that extend into a joint
  • broken bones that are visible or stick out through the skin
An open repair is done in the operating room. A variety of tools are used to repair the fracture and hold it in place. These include surgical nails, screws, wires, rods, and metal plates. The surgeon may need to clean out the area around the fracture. This will reduce the risk of infection from the open wound.
Sometimes a fracture must be completely immobilized in order to heal. This can be done with a splint, brace, cast, traction, or open repair.
  • A splint is a firm object that is affixed to the areas surrounding the bone. A fractured finger is an example of a fracture that can be splinted.
  • A cast is a firm material made of either fiberglass or plaster. The cast is wrapped around the area of the broken bone. A layer of softer material is placed against the skin to protect it from injury and irritation. A fractured wrist is an example of a fracture that could be casted.
  • Traction holds a limb in alignment using pulleys and weights. It is not used very often anymore. However, it is sometimes used as a temporary measure until surgery can be done on a hip fracture.
  • Open repair uses a variety of tools to hold the bone pieces in place. These include surgical nails, screws, wires, rods, and metal plates

Side Effects

What are the side effects of the treatments?

A closed repair may have complications. The bone may not heal properly or it may not function properly. An open repair carries the same risks as any surgery. These include infection, bleeding, damage to blood vessels or nerves, and a reaction to the anesthetic.

After Treatment

What happens after treatment for the injury?

Fractured bones generally need at least 4 weeks to heal solidly. Some types of fractures take 8-12 weeks to heal. In the elderly or someone with diabetes, healing may take longer. A cast may be worn to prevent movement of the bone while it heals. Muscles in a leg or arm can become weak and tight while the bone heals. Therefore, many people who have a bone fracture need physical therapy.
The therapy begins while the bone is immobilized and continues after the splint, cast, or traction has been removed. A person who has had an open repair needs to watch for signs of infection, swelling, or numbness. Any new or worsening symptoms should be reported to the healthcare professional.
The bone is usually strong and fully functional once it has completely healed. The healthcare professional should be consulted about an appropriate weight-bearing exercise program to minimize the risk of future bone fractures. To avoid further bone fractures in elderly individuals, the home should be made safe to prevent injuries.
Ways to increase safety include:
  • keeping areas safe, well-lit, and uncluttered to prevent falls
  • avoiding the use of throw rugs on floors
  • taking care with icy, wet, or slippery surfaces
  • using nonskid mats in the shower and bathtub
  • wearing comfortable shoes with nonslippery soles
  • using a cane if needed
  • trying not to lift heavy objects
  • using proper back support and lifting methods
  • wearing undergarments that have a protective pad around the hips to prevent hip fractures
Intriguing new research done in older individuals with arthritis found that brisk walking or weight training improved balance in those individuals. Improved balance could very well help such individuals avoid hip fractures and wrist fractures resulting from falls.

Sources

The Merck Manual of Medical Information, 1997

Professional Guide to Diseases: 6th edition, 1998

Sheehy, Susan, Emergency Nursing Principles and Practice, 3rd Edition, 1997

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