A fracture is a break of bone or cartilage, often with accompanying damage to the surrounding soft tissues. Fractures occur when the force applied to a bone exceeds its strength. An injury or trauma is the most frequent cause, but conditions that weaken the bone, such as osteoporosis (reduced bone density) can make the bone prone to breaking. Injuries can be low energy such as a fall from standing or sitting, or high energy, such as a car accident, or fall from a height (from a ladder, for instance). Other types of fractures include pathologic fractures, which are fractures through bone affected by a tumor or infection, and stress fractures. Stress fractures occur in normal bone which is subjected to abnormal or unaccustomed stress. When the repetitive stresses outstrip the body’s healing response, a fracture can result. Fractures that occur with a break in the skin, thus allowing communication of the fracture with the outside world, are called open fractures.
The signs of a fracture can include swelling, tenderness, pain with use of the affected area, and, in more severe injuries, deformity or open wounds. X-rays are the first diagnostic test, and often can diagnose the fracture, and direct treatment. If further detail is needed, CT scans, which can give a 3 dimensional picture of the fracture, can be used. Sometimes a fracture is not evident on regular X-rays. In this case, if a fracture is suspected, an MRI, which is a magnetic scan, may be necessary. Bone scans also can be used to diagnose a fracture, particularly for patients with pacemakers, or other metallic implants, who cannot undergo an MRI.
Once the fracture is diagnosed, treatment can be implemented.
Options for treatment include:
- Immobilization using a cast or brace or splint.
- A reduction or manipulation of the fracture back to proper alignment, followed by immobilization.
- Stabilization of the fracture with metal plates, screws, pins, wires or rods, placed through small incisions, or through full open incisions.
- An open reduction, where the bones are realigned after opening up the fracture. Stabilization, like in #3, is often performed at the same time.
- Open fractures, where the bone breaks through the skin, are treated emergently with thorough rinsing of the fracture, and reduction and stabilization.
- Stress fractures are often treated with immobilization, and elimination of the activity that caused the fracture. Occasionally surgery is necessary.