Fractures and Broken Bones

Introduction
Bone strength is directly related to the size and health of the bone. How brittle it is depends on the age and health of the bone. A bone may become fractured (broken) because of too much force being applied too quickly to the bone. How much is too much depends on the strength of the bone and how brittle it is.

Children's bones are much more flexible and less brittle than adults. That's why kids may have severe falls or accidents that do not result in fractures. Older people and others with osteoporosis, on the other hand, may fracture a bone with little force being applied. In these individuals, simply walking may cause a fracture.

There are three ways that force can be applied to a bone:

• 1. Directly to a spot on the bone
  
• 2. Bending the two ends of the bone toward each other
  
• 3. Twisting the bone
  

The first two usually cause a single break straight across the bone. Bones that are broken by twisting are often spiral with many fracture lines (comminuted). If the bone sticks out through the skin, it is called a compound fracture. If the bone does not stick out through the skin, it is called a simple fracture.

Indications that a bone has been broken may include:

• 1. Swelling and discoloration of the skin over the bone
  
• 2. Pain at the site of the fracture that increases when the area is touched or when the bone is moved
  
• 3. The limb (arm, leg, finger, etc.) is deformed
  
• 4. A decreased ability to use the affected part
  
• 5. The bone may extend through the skin
  

Except for number 5, these may all be present with a sprain. One way to determine if a fracture has occurred is through an X-ray examination. However, some small breaks (such as hairline fractures) may not been seen on X-ray immediately after the accident. After a few days, during which time calcium is being deposited at the fracture site, the fracture may be more easily detected.

Treatment
The general approach to treatment of a bone fracture may include: protection of the limb, reduction (returning the bone fragments to the normal positions), immobilization of the parts, and rehabilitation. If pieces of the broken bone are not in proper alignment, they may need to be readjusted through a process called reduction. This can often be done without medications.

Sometimes, however, a person may choose to be sedated to reduce pain and prevent the muscles in the area from working against the process. Occasionally, the bones cannot be reduced unless surgery is performed.

There are three main approaches to immobilizing the bone to minimize movement during the healing process. The first is the use of a splint. The second is through the application of an external cast. And the third is by using pins and/or plates directly attached to the each side of the break.

Splints are sometimes recommended when the forces on the bone are small and if the body part is not used (for example finger fractures). When the body's own structures provide adequate immobilization, (for example, rib fractures), the physician might not recommend any type of splint or cast.

Casts may be made out of hard or soft material. Soft casts have the advantages of being less irritating. They are also able to expand and contract with the underlying swelling, and many are removable. The main disadvantage of soft casts is that they do not provide the rigid support that hard casts do. Discuss the benefits, risks and costs of each type with your doctor before deciding which treatment recommendation is best.

Immobilization with a pin or plate is called fixation. This controls the movement of the fractured bone the most. It is called internal fixation when pins or plates are inserted during surgery, and the skin is sewn over it. Pins can also be inserted through the skin. This is called external fixation. The additional benefits of fixation may be overcome by the risks due to the surgery itself and the presence of a pin or plate during recover.

Again, in order to make an informed decision about your health and well-being (or those of your child) ask your physician to fully explain the benefits, risks and costs of each recommendation.

Rehabilitation is as important as any other part of treatment. Because effective rehabilitation is determined by the individual's own actions, understanding what needs to be done and why, is important.

The main goal of rehabilitation is to move the injured limb, without overdoing it. Your physician will probably recommend beginning rehabilitation as soon as adequate immobilization has been accomplished. Good rehabilitation increases and speeds up the healing process by increasing blood flow to the injured area. It may prevent atrophy (wasting) of muscles and can help maintain muscle tone. It may also decrease the amount of joint stiffness that normally occurs with a break.

The time needed for complete healing varies. Some broken bones heal within a couple of weeks. Others may take months. Healing depends on many factors including the specific bone that was broken and the age of the individual.

Sometimes, even with treatment, bones fail to heal. If your physician suspects that the fractured bone is not healing -- or is not healing properly -- he or she may recommend additional X- rays and alternative treatments.

The best way to handle fractures is to prevent them in the first place. Keeping safety in mind at work and play will go a long way toward this goal. For the elderly, especially women, prevention of osteoporosis is also important.