Fractures

In adults, the body contains over 200 bones of various sizes and shapes. Long bones are found in the arms and legs, while the spine is composed of a series of small bones known as vertebrae. The hands and feet consist of numerous tiny bones, and the ribs and skull feature curved shapes. All these bones connect to form the skeleton, which provides structural support, produces blood cells, facilitates movement through joints with muscles, and protects vital organs.

Bones are living tissues that continuously grow and change. Most bones are made up of layered materials. The outer layer, called the periosteum, acts as the life support system for bones, supplying nutrients to bone cells and producing new bone cells during growth or after an injury. Beneath the periosteum lies the compact bone, known as the cortex, which is solid and encases the spongy cancellous bone. The cancellous bone, resembling a sponge with many pores, provides strength against weight and structural changes. Many bones also contain red marrow, responsible for producing and maturing blood cells.

Fractures are most commonly caused by falls and motor vehicle accidents. Certain sports that involve high impact, speed, or balance increase the risk of fractures. Stress fractures can develop from repetitive impact or overuse, as seen in running, jogging, or high-contact sports. Additionally, physical violence, such as being struck by a fist or weapon, can result in fractures.

Apart from accidents, some fractures are linked to medical conditions. Osteoporosis causes the body to absorb more calcium than it replaces, leading to reduced bone density and increased fragility. Type I osteoporosis primarily affects women aged 51 to 75, often resulting in spinal and wrist fractures, while Type II affects individuals aged 70 to 85, typically causing hip, pelvis, and limb fractures.

Bone tumors can also weaken bones and lead to fractures. Most tumors originate in other body parts and metastasize to the bone, while primary bone tumors are rare.

When a fracture occurs, a snapping or cracking sound may be audible. Symptoms include sharp or intense pain, numbness, or tingling sensations, accompanied by swelling, bruising, or bleeding at the fracture site. The affected area may appear deformed or misaligned, and you may find it difficult to move or bear weight on the injured limb.

A physical examination by a doctor can confirm a fracture diagnosis. They will inquire about the injury and symptoms, often ordering imaging tests for verification. X-rays are commonly used to identify the fracture's type and location; however, stress fractures may not always be visible on X-rays, requiring CT or MRI scans for detailed imaging. These procedures are painless.

Bone scans are also helpful in identifying abnormalities due to osteoporosis or cancer. A small, harmless radioactive substance is injected prior to the scan to highlight areas where the bone is repairing or deteriorating.

In addition to identifying the fracture, doctors classify its type to determine the appropriate treatment. Fractures are categorized based on their characteristics, including the alignment of broken pieces and the fracture line's direction.

Treatment for a fracture depends on its type and the involved bones. The main goal is to align the broken bones for healing. When a fracture occurs, the body forms a protective blood clot and callus around the injury site, leading to eventual bone regeneration.

Doctors use X-rays to guide the alignment of bones. Some fractures may be managed with a cast to immobilize and protect the area, typically worn for one to two months, depending on the fracture's severity.

If a fracture fails to heal within the expected timeframe, it may be classified as a delayed union, often due to excess movement or poor blood supply. A nonunion indicates a fracture that will not heal without additional intervention. Conversely, a malunion is when the bone heals improperly.

Delayed unions, nonunions, and malunions may necessitate further treatment. Bone stimulators can be employed to enhance healing, using electrical or ultrasound methods.

Surgical intervention is required for malunions and many nonunions to correct alignment. Surgery may involve bone grafting to promote healing.

Following treatment, physical or occupational therapy is usually recommended to restore movement and strength. Therapists will help regain flexibility and may utilize techniques like heat or ultrasound to enhance recovery.

Surgery may be advised for fractures that do not heal correctly or if the fracture's nature makes it difficult to maintain proper alignment with conservative treatments. The surgical approach will depend on the fracture's location and type. Options include Open Reduction and Internal Fixation, where surgical hardware stabilizes the fracture beneath the skin, and Open Reduction and External Fixation, which stabilizes the fracture from outside the skin.

Pain may diminish before the fracture fully heals. Your doctor will recommend limiting activities during the healing process, which typically lasts around six weeks but may extend for some fractures. Most patients achieve successful outcomes and can return to their normal activities post-recovery.