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Fractures

What is a fracture?

A fracture is a partial or complete break in the bone. When a fracture occurs, it is classified as either open or closed:

  • Open fracture (also called compound fracture). The bone exits and is visible through the skin, or a deep wound that exposes the bone through the skin.
  • Closed fracture (also called simple fracture). The bone is broken, but the skin is intact.

Fractures have a variety of names. Below is a listing of the common types that may occur:

  • Greenstick. This is an incomplete fracture. A portion of the bone is broken, causing the other side to bend.
Illustration of greenstick fracture
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  • Transverse. The break is in a straight line across the bone.
Illustration of transverse fracture
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  • Spiral. The break spirals around the bone; common in a twisting injury.
Illustration of spiral fracture
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  • Oblique. The break is diagonal across the bone.
Illustration of oblique fracture
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  • Compression. The bone is crushed, causing the broken bone to be wider or flatter in appearance.
Illustration of  a compression fracture
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  • Comminuted. The break is in three or more pieces and fragments are present at the fracture site.
  • Segmental. The same bone is fractured in two places, so there is a "floating" segment of bone.

What causes a fracture?

Fractures occur when there is more force applied to the bone than the bone can absorb. Bones are weakest when they are twisted. Breaks in bones can occur from falls, trauma, or as a result of a direct blow or kick to the body.

What are the symptoms of a fracture?

The following are the most common symptoms of a fracture. However, each individual may experience symptoms differently. Symptoms may include:

  • Pain in the injured area
  • Swelling in the injured area
  • Obvious deformity in the injured area
  • Difficulty using or moving the injured area in a normal manner
  • Warmth, bruising, or redness in the injured area

The symptoms of a broken bone may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is a fracture diagnosed?

In addition to a complete medical history (including asking how the injury occurred) and physical examination, diagnostic procedures for a fracture may include the following:

  • X-ray. A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
  • Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce both horizontal and vertical cross-sectional images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

Treatment for a fracture

Specific treatment for a fracture will be determined by your doctor based on:

  • Location and type of fracture
  • Your age, overall health, and medical history
  • Extent of the condition
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

The goal of treatment is to control the pain, promote healing, prevent complications, and restore normal use of the fractured area.

An open fracture (one in which the bone exits and is visible through the skin, or a deep wound that exposes the bone through the skin) is considered an emergency. Seek immediate medical attention for this type of fracture.

Treatment may include:

  • Splint or cast. This immobilizes the injured area to promote bone alignment and healing to protect the injured area from motion or use.
  • Medication. This is taken to control pain.
  • Traction. Traction is the application of a force to stretch certain parts of the body in a specific direction. Traction consists or pulleys, strings, weights, and a metal frame attached over or on the bed. The purpose of traction is to stretch the muscles and tendons around the broken bone to allow the bone ends to align and heal.
  • Surgery. Surgery may be required to put certain types of broken bones back into place. Occasionally, internal fixation (metal rods or pins located inside the bone) or external fixation devices (metal rods or pins located outside of the body) are used to hold the bone fragments in place to allow alignment and healing.

Smoking and the musculoskeletal system

Smoking takes a significant toll on your musculoskeletal system. Tobacco and nicotine increase the risk of bone fractures and interfere with the healing process, according to a growing body of research. Nicotine can slow fracture healing, estrogen effectiveness, and can counter the antioxidant properties of vitamins C and E. According to the American Academy of Orthopaedic Surgeons, research on the topic of smoking and its effect on the musculoskeletal system was reviewed. Some of the orthopaedic problems caused by smoking include:

  • More severe disc degeneration
  • Increased risk for a hip fracture with age
  • An association with low back pain 
  • Weakened spinal ligaments
  • Reduced production of bone cells
  • Faster bone loss in postmenopausal women
  • Fractures take longer to heal
  • Rotator cuff surgery is less successful
  • Longer healing time for surgical incisions
  • More post-surgery complications
  • Delayed spinal fusion

However, quitting smoking seems to improve the healing process in most cases, except for long-term, heavy smokers who have permanent artery damage, according to the researchers. Those with permanent artery damage due to smoking may not heal easily when a peripheral part of the body is involved, since blood supply may be poor there.

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