Fracture is a breaking of the bones due to the acting of strong external forces. In diagnosis and treatment, physicians are calling different types of fractures with the following expressions:
– closed fracture: the bone is broken, while the adjacent muscles and other tissues are mostly undamaged
– open fracture: the bone is broken and is accompanied by considerable damage to the surrounding tissues and skin
– “complete” fracture: the bone is broken all over the width and the ends are disassembled
– “incomplete” fracture: only the part of the bone is broken and the fracture does not affect whole width
Fracture is usually a result of strong strains, which occur in certain forms of injury, although not in all cases. A bone that has become debilitating due to age or illness – for example, due to osteoporosis – can also be broken by the action of a slight external force; such a fracture is called a “spontaneous or pathological” fracture. Fractures of this type often occur in the hips of the elderly whose bones weakened due to common action for a number of reasons such as reduced motion, changes in bone structure associated with aging and (sometimes) disease.
There is another type of fracture due to overload or tiredness which can occur in normal, healthy bones exposed to long-term and abnormally high stress.
The area of the fracture is swollen, blood-stained, and sometimes deformed. The pains are usually strong and intensify by pressing or by moving the affected part of the body. Smaller fractures – for example, a wrist – can only cause fewer symptoms, and can easily be replaced by sprains.
Most people break their bone(s) at some point in life. Most common are fractures of the wrists, arms, and feet, which are usually a result of fall. The fractures of other bones – bones of the arms and legs, and spine and hip – are usually the result of the action of stronger forces, for example, forces in traffic accidents.
The likelihood of fracture increases with age. Although they are very active and prone to injury, children have elastic bones that are easier to bend and, therefore, fractures are not so common in children. The bones of the elderly, however, are fragile and weak, and the falls are more likely to be due to the difficulty of balancing and coordinating the movement.
Fracture can be dangerous for two main reasons. The first concerns the very bone. If the fracture is not treated, or if a person waits too long for treatment, broken bones may begin to misalign (i.e. it will not be properly aligned), and so in many such cases surgical procedure is required for re-separation and re-alignment of the fragments. In severe complicated fractures, bones may catch infections that will hinder the curing process. In addition (though such cases are not common), if the broken bone fragment is not supplied with blood, it may die out.
The other dangers associated with fractures are threatened by damage to surrounding tissues. Sharp fragments of the bones can compress or cut the surrounding blood vessels or nerves. Skull or spinal fractures can damage the brain or spinal cord. In some cases, broken bones may also damage other internal organs; for example, a broken rib can pierce the lungs (pneumothorax). If you are severely injured in an accident, any damage to soft tissue is treated surgically, often at the same time as treating fracture.
What to do?
If you break a bone or if it happens to someone in your presence, use the instructions of first aid kit and immediately call a doctor or emergency. Do not give any food or drink to the injured person; by doing so, you can delay the treatment because doctors will have to wait several hours to give general anesthesia to the patient.
Any allegedly sprain that does not show signs of improvement after two or three days may be a fracture. In that case, go to a doctor who is likely to check it with the X-ray to see what kind of injury is it.
The first step in treating the fracture is to align the broken bones (if they are not in the correct position); the doctors call this procedure reduction. It is usually performed under general anesthesia and may also require the opening of the tissue around the fracture. The patient is given antibiotics to prevent infections of bones or adjacent tissue.
The second part of the treatment is immobilization, i.e. keeping the broken fragments in the correct position until they are completely rejoined (healed). This does not mean that all the fractures are put in gypsum or in a modern plastic and similar light bandages. There are many ways in which bone can be secured (fixed) over a few weeks, i.e. until the bone is healed. In fact, some bones and should not even have a bandage as they are naturally aligned. Thus, for example, a broken rib firms numerous muscles of the chest to the adjacent, unbroken ribs. The broken finger may be attached to the adjacent fingers to stabilize during the treatment.
The thigh bone is so deeply embedded in the big muscles that we can not immobilize it with a gypsum or a bandage. Therefore, in such fractures, an extension (stretching) is often applied – weights are ”hanged” on the leg for the reduction of the bony ends that slid to one another.
Some fractures are fixed in the body, i.e. the broken ends are connected with metal screws, nails or plates. Such internal mobilization offers great benefits, since the patient may begin to use injured foot (or hand) after a few days, not after a few weeks or months. Such a procedure greatly contributes to the third major part of the treatment, i.e. joint rehabilitation or muscle that the patient did not use during the immobilization stage.
As soon as you start with rehabilitation, the physiotherapist will show you how to train a part of the body where the fracture occurred and maintain the activity of the adjacent joints. This prevents swelling and triggers blood circulation, which also contributes to healing. In addition, the activity of the joints prevents bone and muscle degeneration, as well as stiffness of the joints – this is really important because arthrosis can affect joints that are immobile for several weeks or longer.
How long does the fracture need to heal?
The answer depends on a number of factors, such as the type of broken bone, the type of fracture and age. A broken baby’s fingers can be completely healed after two weeks, while an adults it may take three or more months for tibia (shinbone) to heal. In some cases, the fracture does not heal despite rapid and effective treatment. If the doctors are not happy with your progress, they will send you to another X-rays and take special measures to speed up the healing. The most commonly used method is the bones transplantation, i.e. transplantation of bits of bones (just a few millimeters long) of another bone (often from the thigh bone) to the place of the fracture. Fresh bone encourages the joining and healing of broken bones.
Athletics and other people who regularly and intensively deal with sport are exposed to significant risk of injury to the muscles, ligaments, bones or joints. Injuries are most common at the beginning of the sports season when athletes start training.
If you get injured during the match, you will probably want to return to the “fight” as soon as possible. Even if you take all the recommended measures to return to the game as soon as possible, this can be dangerous in the long run. If it is cuts or contusion that has not seriously damaged the muscles or ligaments, a trainer or physiotherapist will probably be justifiably relieving the pain with an ice pack or an anesthetic spray and recovering the injury. However, it is possible that your muscle or ligament has been damaged and, in that case, the pain reliever can help you with withstanding additional damage, even if you are not aware of it. Whenever you are unsure of the extent of injury, or if you have fainted (even if it is just for a few seconds), you should not go back to the game.
Sports injuries – what to do?
Many injuries only require sleep, with possible physical therapy to strengthen the muscles and improve the circulation of damaged tissues. However, some injuries, such as recurrent meniscus injuries to soccer players, are best treated with surgery.
Repetitive injuries are facing you with a tough decision: should you continue with sports or not? Unfortunately, as soon as a ligament or bone injury begins to recur, it is most likely to be permanent damage. So, if you do not withdraw from the sport, you can expect arthrosis or some other discomfort with the joints early. However, before the decision is made, the doctors should thoroughly diagnose the extent of the damage. This will require examinations, such as X-rays, endoscopy of the wrist, and possibly exploratory operation.