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 Fractures  |
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What is a Fracture?
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People often think that a fracture is less severe than a broken bone, but fractures are broken bones.
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| Your Bones |
The bones of the body form the human frame, or skeleton, which supports and protects the softer parts of the body. Bones are living tissue giving them the ability to renew themselves when they are broken. Bones have a center called the marrow, which is softer than the outer part of the bone. Bone marrow has cells that develop into red blood cells that carry oxygen to all parts of the body and into white blood cells that help fight disease. Bones also contain the minerals calcium and phosphorus. These minerals are combined in a crystal-like or latticework structure. Because of their unique structure, bones can bear large amounts of weight.
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| Why Bones Break |
Bones are rigid, but they do bend, or "give" somewhat when an outside force is applied to them. When this force stops, bone returns to its original shape. For example, if you fall forward and land on your outstretched hand, there's an impact on the bones and connective tissue of your wrist as you hit the ground. The bones of the hand, wrist and arm can usually absorb this shock by giving slightly and then returning to their original shape and position. If the force is too great, however, bones will break, just as a plastic ruler breaks after being bent too far.
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Types of Fractures
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The severity of a fracture usually depends on the force that caused the fracture. If the bone's breaking point has been exceeded only slightly, then the bone may crack rather than breaking all the way through. If the force is extreme, such as in an automobile collision or a gunshot, the bone may shatter. There are two main types of fractures:
When the bone is broken, but the skin is not lacerated (cut) it is called a "closed" or simple fracture. If the bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone, it is called an "open" or compound fracture. This type of fracture is particularly serious because once the skin is broken, infection in both the wound and the bone can occur.
There also are names for the particlar way bones will sometimes break:
Transverse Fracture - the fracture is at right angles to the length of the bone.
Greenstick Fracture - a fracture on one side of the bone, causing a bend on the other side of the bone.
Comminuted Fracture - a fracture that results in three or more bone fragments.
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Types of Treatments
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All forms of treatment of broken bones follow one basic rule: the broken pieces must be put back into position and prevented from moving out of place until they are healed. Broken bones heal by first forming a protective blood clot and callus (fibrous tissue). Then new "threads" of bone cells start to grow on both sides of the fracture. These threads grow towards each other until the frature is closed and the callus is absorbed. Orthopedists use casts, splints, pins and other devices to hold the bone in the correct position while it is healing. The specific method of treatment depends on:
- The severity of the break
- Whether it is "open" or "closed"
- The specific bone involved, for example a broken bone in the spine (vertebra) is treated differently from a broken leg bone or a broken rib.
- The judgment of the orthopaedist and the patient
Fractures take several weeks to several months to heal, depending on the severity of the injury. The following treatments are used to help fractures bones heal:
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| Cast Immobilization |
A plaster or fiberglass cast is the most common type of fracture treatment, because most broken bones can heal successfully once they have been repositioned and a cast has been applied to keep the broken ends in proper position while they heal.
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| Functional Cast or Brace |
This type of cast or brace allows limited or "controlled" movement of nearby joints. This treatment is desirable for some but not all fractures.
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| Traction |
Traction is usually used to align a bone or bones by a gentle, steady pulling action. The pulling force may be transmitted to the bone through skin tapes or a metal pin through a bone. Traction may be used as a preliminary treatment, before other forms of treatment.
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| Open Reduction and Internal Fixation |
In this type of treatment, an orthopaedist must perform surgery on the bone. During this operation, the bone fragments are first repositioned (reduced) into their normal alignment, and then held together with special screws or by attaching metal plates to the outer surface of the bone. The fragments may also be held together by inserting rods down through the marrow space in the center of the bone. These methods of treatment can reposition the fracture fragments very exactly. Because of the risks of surgery, however, and possible complications, such as infection, they are used only when the orthopaedic surgeon considers such treatment to be the most likely to restore the broken bone to normal function.
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| External Fixation |
| In this type of treatment, pins or screws are placed into the broken bone above and below the fracture site. Then the orthopaedic surgeon repositions the bone fragments. The pins or screws are connected to a metal bar or bars outside the skin. This device is a stabilizing frame that holds the bones in the proper position so they can heal. After an appropriate period of time, the external fixation device is removed. |
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Arthritis
