Fracture

Introduction to fracture

Bones form the skeleton of the body and allow the body to be supported against gravity and to move and function in the world. Bones also protect some body parts, and the bone marrow is the production center for blood products.

Bone is not a stagnant organ. It is the body's reservoir of calcium and is always undergoing change under the influence of hormones. Parathyroid hormone increases blood calcium levels by leeching calcium from bone, while

calcitonin has the opposite effect, allowing bone to accept calcium from the blood.

What causes a fracture?

When outside forces are applied to bone it has the potential to fail. Fractures occur when bone cannot withstand those outside forces. Fracture, break, or crack all mean the same thing. One term is not better or worse than another.

The integrity of the bone has been lost and the bone structure fails.

Broken bones hurt for a variety of reasons including:

The nerve endings that surround bones contain pain fibers and and these fibers become irritated when the bone is broken or bruised.

Broken bones bleed, and the blood and associated swelling (edema) causes pain.

Muscles that surround the injured area may go into spasm when they try to hold the broken bone fragments in place, and these spasms cause further pain.

Often a fracture is easy to detect because there is obvious deformity. However, at times it is not easily diagnosed. It is important for the physician to take a history of the injury to decide what potential problems might exist. Moreover,

fractures don't always occur in isolation, and there may be associated injuries that need to be addressed.

Fractures can occur because of direct blows, twisting injuries, or falls. The type of forces on the bone may determine what type of injury that occurs. Descriptions of fractures can be confusing. They are based on:

where in the bone the break has occurred,

how the bone fragments are aligned, and

whether any complications exist.

The first step in describing a fracture is whether it is open or closed. If the skin over the break is disrupted, then an open fracture exists. The skin can be cut, torn, or abraded (scraped), but if the skin's integrity is damaged, the

potential for an infection to get into the bone exists. Since the fracture site in the bone communicates with the outside world, these injuries need to be cleaned out aggressively and many times require anesthesia in the operating room to

do the job effectively.

Next, there needs to be a description of the fracture line. Does the fracture line go across the bone (transverse), at an angle (oblique) or does it spiral? Is the fracture in two pieces or is it comminuted, in multiple pieces?

Finally, the fracture's alignment is described as to whether the fracture fragments are displaced or in their normal anatomic position. If the bones fragments aren't in the right place, they need to be reduced or placed back into their

normal alignment.

What are common types of fractures?Stress fracture

A stress fracture is an overuse injury. Because of repeated micro-trauma, the bone can fail to absorb the shock that is being put upon it and become weakened.

Most often it is seen in the lower leg, the shin bone (tibia), or foot. Athletes are at risk the most, because they have repeated footfalls on hard surfaces. Tennis

players, basketball players, jumpers, and gymnasts are typically at risk. A March fracture is the name given to a

stress fracture of the metatarsal or long bones of the foot. (It is named because it often occurs in soldiers

who are required to march long distances.)

Diagnosis is made by history and physical exam, though on occasion a bone scan may be done to

confirm the diagnosis.

Treatment is conservative, rest, ice, and anti-inflammatory medication like ibuprofen. These fractures

can take six to eight weeks to heal (as long as the fracture can be seen on x-ray). Trying to return too quickly can cause re-injury, and may also allow the stress fracture to extend through the entire bone.

Shin splints may have very similar symptoms as a stress fracture of the tibia but they are due to

inflammation of the lining of the bone, called the periosteum. Shin splints are caused by overuse,

especially in runners, walkers, dancers, including those who do aerobics. Muscles that run through the

periosteum and the bone itself may also become inflamed.

Treatment is similar to a stress fracture and physical therapy can be helpful.

Compression fractureAs people age, there is a potential for the bones to

develop osteoporosis, a condition where bones lose their calcium content. This makes bone more

susceptible to breaking. One such type of injury is a compression fracture to the spine, most often the thoracic or lumbar spine. Since we are an upright

animal, if the bones of the back are weaker than the force of gravity these bones can crumple. Pain is the

major complaint, especially with movement.

Compression injuries of the back may or may not be associated with nerve or spinal cord injury. An x-ray of

the back can reveal the bone injury, however, sometimes a CT scan or MRI will be used to insure that

no damage is done to the spinal cord.

Treatment includes pain medication and often a back brace. Some compression fractures can also be treated with vertebroplasty. Vertebroplasty involves inserting a glue-like material into the center of the collapsed spinal

vertebra in order to stabilize and strengthen the crushed bone. The glue (methylmethacrylate) is

inserted with a needle and syringe through anesthetized skin into the midportion of the vertebra under the guidance of specialized x-ray equipment.

Once inserted, the glue soon hardens, forming a cast-like structure with the locally broken bone.

Rib fractureThe ribs are especially vulnerable to injury and are

prone to breaking due to a direct blow. Rib x-rays are rarely taken as it doesn't matter if the rib is broken or just bruised. A chest x-ray is usually taken to make certain there is no collapse or bruising of the lung.

When we breathe, it is like a bellows. We inhale air into our lungs and the ribs move out and the diaphragm

moves down. When a person has a rib injury, the pain associated with it makes breathing difficult, and the

person has a tendency to not take deep breaths. If the lung underlying the injury does not expand, it is at risk

for infection. The person is then susceptible to pneumonia (lung infection),which is characterized by

fever, cough, and shortness of breath.

As opposed to other parts of the body that can rest when they are injured, it is very important to take deep breaths to prevent pneumonia when rib fractures are present. The treatment for bruised and broken ribs is the same: ice to the chest wall, ibuprofen as an anti-

inflammatory, deep breaths and pain medication. Even if all goes well, there will be significant pain for four to

six weeks.

With lower rib fractures, there may be concern about organs in the abdomen that the ribs protect. The liver is

located under the ribs on the right side of the chest, and the spleen under the ribs on the left side of the chest. Many times your doctor may be more worried

about abdominal injury than about the broken rib itself. Ultrasound or CT scan may help diagnosis intra-

abdominal injuries.

Skull fracture

With the wide availability of CT scans, skull x-rays are rarely taken to diagnose head injury. If a head injury exists, the physician will feel or palpate the scalp and skull to determine if there may be a skull fracture. He

will also look into the ears to see if there is blood behind the ear drumm and he will also complete a

neurologic examination.

The skull is a flat, compact bone and it takes significant force to break it. If a skull fracture exists, there is an

increased likelihood of bleeding in the brain, especially in children. There are guidelines that are available to

decide whether a CT scan is indicated (needed).

Minor head injury is defined as witnessed loss of consciousness, definite amnesia, or witnessed

disorientation in patients with a GCS (Glasgow Coma Score) score of 13-15. With minor head injury, the

following risk groups are considered when evaluating need for CT brain scan:

High risk for potential neurosurgical operation

Abnormal neurologic exam within two hours after injury

Suspected open or depressed skull fracture

Any sign of basal skull fracture (blood behind the ear drum, blackened eyes, clear fluid running from

the ears, or bruising behind the ear)

Vomiting - two episodes

65 years of age or older

Medium risk (for brain injury on CT)

Amnesia before impact - more than 30 minutes

Dangerous mechanism (pedestrian struck by motor vehicle, occupant ejected from motor vehicle, fall

from height greater than 3 feet or five stairs)

Fracture in childrenChildren can break bones and yet have normal x-rays. Fractures appear as clear lines through the bone on an

x-ray through the bone. If calcium hasn't yet accumulated in the repairing bone, the break may not be apparent. This lack of calcification happens in two

ways.

1.Bones mature at different times in a child's development and while the bony structure is there,

it may have more cartilage than calcium.

2.The second situation is associated with growth plates. Each bone has an area where cell activity is maximal and where the bone grows. These areas appear as lucent lines on x-ray. It may be one of

the weaker points in the bone as well, and a fracture through the growth plate may not be seen.

The doctor needs to match the history and physical exam with what is seen on x-ray to make to a

diagnosis. Sometimes, the child is placed in a cast for a period of time to protect the broken limb. As fractures

heal, the body lays down extra calcium as building material and then remodels it to normal shape. After 7-10 days, there may be evidence on x-ray of the healing

calcium to confirm the fracture.

Growth plate fractures are classified by Salter-Harris category. When a break occurs through the growth

plate, it can involve different parts of the bone on each side of the plate. It is important that these fractures are aligned properly so that the bone grows properly as the

child ages. For more, please read the Growth Plate Fractures in Children article.

Children are more flexible than adults until the calcium completely solidifies their bone. If you think of an arm or leg bone as tubular, sometimes only one side of the bone breaks, just like an immature branch on a tree. This is referred to as a greenstick fracture, and may need to be "set" so that it heals properly. Sometimes

the bones can bend but not break because they are so pliable. This is called a plastic deformity and again will

need to be set or aligned to allow proper healing.

How is a fracture diagnosed?When you arrive for medical care, the doctor will take a

history of the injury. Where, when, and why did the injury occur? Did the person trip and fall, or did they pass out before the fall? Are there other injuries that take precedence over the fracture? For example, a

person who falls and hurts their wrist because they had a stroke or heart attack will have their fracture care delayed to allow care for the life threatening illness. The injured area will be examined and a search will

happen for potential associated injuries. These include damage to skin, arteries and nerves.

Pain control is a priority and many times, pain medication will be prescribed before the diagnosis is

made. If the doctor believes that an operation is likely, pain medication will be given through an intravenous (IV) line or by an injection into the muscle. This allows the stomach to remain empty for potential anesthesia.

A decision will be made whether x-rays are required, and which type of x-ray should be taken to make the

diagnosis and better assess the injury. There are guidelines in place to help doctors decide if an x-ray is necessary. Some include the Ottawa ankle and knee x-

ray rules.

The body is three dimensional, and plain film x-rays are only two dimensional. Therefore, two or three x-rays of

the injured areas may be taken in different positions and planes to give a true picture of the injury.

Sometimes the fracture will not be seen in one position, but is easily seen in another.

There are areas of the body where one bone fracture is associated with another fracture at a more distant part. For example, the bones of the forearm make a circle and it is difficult to break just one bone in that circle.

Think of trying to break a pretzel in just one place, it is difficult to do. Therefore broken bones at the wrist may be associated with an elbow injury. Similarly, an ankle

injury can be accompanied by a knee fracture. The doctor may x-ray areas of the body that don't initially

appear to be injured.

Occasionally, the broken bone isn't easily seen, but there may be other signs that a fracture exists. In elbow injuries, fluid seen in the joint on x-ray is an indicator of a subtle fracture. And in wrist injuries, fractures of the scaphoid or navicular bone may not show up on x-ray for one to two weeks, and diagnosis is made solely on

physical examination with swelling and tenderness over the snuffbox at the base of the thumb.

In children, bones may have numerous growth plates that can cause confusion when reading an x-ray.

Sometimes, the doctor will choose to x-ray the opposite arm or leg to determine what normal is for the child

before deciding whether a fracture exists.

What is the treatment of a fracture?Initial treatment for fractures of the arms, legs, hands

and feet in the field include splinting the extremity in the position it is found, elevation and ice. Immobilization

will be very helpful with initial pain control. For injuries of the neck and back, many times, first responders or

paramedics may choose to place the injured person on a long board and in a neck collar to protect the spinal

cord from potential injury.

Once the fracture has been diagnosed, the initial treatment for most limb fractures is a splint. Padded pieces of plaster or fiberglass are placed over the

injured limb and wrapped with gauze and an elastic wrap to immobilize the break. The joints above and

below the injury are immobilized to prevent movement at the fracture site. This initial splint does not go

completely around the limb. After a few days, the splint is removed and replaced by a circumferential cast.

Circumferential casting does not occur initially because fractures swell (edema). This swelling would cause a

build up of pressure under the cast, yielding increased pain and the potential for damage to the tissues under

the cast.

Surgery

Surgery on fractures are very much dependent on what bone is broken, where it is broken, and whether the

orthopedic surgeon believes that the break is at risk (for staying where it is) once the bone fragments have been aligned. If the surgeon is concerned that the bones will

heal improperly, an operation will be needed. Sometimes bones that appear to be aligned normally are splinted, and at a recheck appointment, are found

to be unstable and require surgery.

Surgery can include closed reduction and casting, where under anesthesia, the bones are manipulated so that alignment is restored and a cast is placed to hold

the bones in that alignment. Sometimes, the bones are broken in such a way that they need to have metal

hardware inserted to hold them in place. Open reduction means that, in the operating room, the skin is cut open and pins, plates, or rods are inserted into the bone to hold it in place until healing occurs. Depending

on the fracture, some of these pieces of metal are permanent (never removed), and some are temporary until the healing of the bone is complete and surgically

removed at a later time.Classification

Orthopedic

In orthopedic medicine, fractures are classified in various ways. Historically they are named after the doctor who first described the fracture conditions. However, there are more systematic classifications in place currently.

All fractures can be broadly described as:

Closed (simple) fractures are those in which the skin is intact Open (compound) fractures involve wounds that communicate with the fracture, or where

fracture hematoma is exposed, and may thus expose bone to contamination. Open injuries carry a higher risk of infection.

Other considerations in fracture care are displacement (fracture gap) and angulation. If angulation or displacement is large, reduction (manipulation) of the bone may be required and, in adults, frequently requires surgical care. These injuries may take longer to heal than injuries without displacement or angulation.

Compression fractures usually occurs in the vertebrae, for example when the front portion of a vertebra in the spine collapses due to osteoporosis (a medical condition which causes bones to become brittle and susceptible to fracture, with or without trauma).

Other types of fracture are:

Complete fracture : A fracture in which bone fragments separate completely. Incomplete fracture: A fracture in which the bone fragments are still partially joined. In such

cases, there is a crack in the osseous tissue that does not completely traverse the width of the bone.[1]

Linear fracture: A fracture that is parallel to the bone's long axis. Transverse fracture: A fracture that is at a right angle to the bone's long axis. Oblique fracture: A fracture that is diagonal to a bone's long axis. Spiral fracture : A fracture where at least one part of the bone has been twisted. Comminuted fracture: A fracture in which the bone has broken into a number of pieces. Impacted fracture: A fracture caused when bone fragments are driven into each other.

Anatomical

An anatomical classification may begin with specifying the involved body part, such as the head or arm, followed with more specific localization. Fractures that have additional definition criteria than merely localization can often be classified as subtypes of fractures that merely are, such as a Holstein-Lewis fracture being a subtype of a humerus fracture. However, most typical examples in an orthopedic classification given in previous section cannot appropriately be classified into any specific part of an anatomical classification, as they may apply to multiple anatomical fracture sites.

Skull fracture o Basilar skull fracture o Blowout fracture - a fracture of the walls or floor of the orbito Mandibular fracture o Nasal fracture o Le Fort fracture of skull - facial fractures involving the maxillary bone and surrounding

structures in a usually bilateral and either horizontal, pyramidal or transverse way.

Spinal fracture o Cervical fracture

Fracture of C1, including Jefferson fracture Fracture of C2, including Hangman's fracture Flexion teardrop fracture - a fracture of the anteroinferior aspect of a cervical

vertebral Clay-shoveler fracture - fracture through the spinous process of a vertebra

occurring at any of the lower cervical or upper thoracic vertebrae Burst fracture - in which a vertebra breaks from a high-energy axial load Compression fracture - a collapse of a vertebra, often in the form of wedge

fractures due to larger compression anteriorly.

Chance fracture - compression injury to the anterior portion of a vertebral body with concomitant distraction injury to posterior elements

Holdsworth fracture - an unstable fracture dislocation of the thoraco lumbar junction of the spine

Rib fracture Sternal fracture

Shoulder fracture o Clavicle fracture o Scapular fracture

Arm fracture o Humerus fracture (fracture of upper arm)

Supracondylar fracture Holstein-Lewis fracture - a fracture of the distal third of the humerus resulting in

entrapment of the radial nerve.o Forearm fracture

Ulnar fracture Monteggia fracture - a fracture of the proximal third of the ulna with

the dislocation of the head of the radius Hume fracture - a fracture of the olecranon with an associated anterior

dislocation of the radial head Radius fracture

Essex-Lopresti fracture - a fracture of the radial head with concomitant dislocation of the distal radio-ulnar joint with disruption of the interosseous membrane.[2]

Distal radius fracture Galeazzi fracture - a fracture of the radius with dislocation of

the distal radioulnar joint Colles' fracture - a distal fracture of the radius with dorsal

(posterior) displacement of the wrist and hand Smith's fracture - a distal fracture of the radius with volar

(ventral) displacement of the wrist and hand Barton's fracture - an intra-articular fracture of the distal radius

with dislocation of the radiocarpal joint.

Hand fracture o Scaphoid fracture o Rolando fracture - a comminuted intra-articular fracture through the base of the first

metacarpal boneo Bennett's fracture - a fracture of the base of the first metacarpal bone which extends

into the carpometacarpal (CMC) joint.[3]

o Boxer's fracture - a fracture at the neck of a metacarpal

Pelvic fracture o Fracture of the hip bone

o Duverney fracture - an isolated pelvic fracture involving only the iliac wing.

Femoral fracture o Hip fracture (anatomically a fracture of the femur bone and not the hip bone)

Patella fracture

Crus fracture o Tibia fracture

Bumper fracture - a fracture of the lateral tibial plateau caused by a forced valgus applied to the knee

Segond fracture - an avulsion fracture of the lateral tibial condyle Gosselin fracture - a fractures of the tibial plafond into anterior and posterior

fragments[4]

Toddler's fracture - an undisplaced and spiral fracture of the distal third to distal half of the tibia[5]

o Fibular fracture Maisonneuve fracture - a spiral fracture of the proximal third of the fibula

associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane.

Le Fort fracture of ankle - a vertical fracture of the antero-medial part of the distal fibula with avulsion of the anterior tibiofibular ligament.[6]

Bosworth fracture - a fracture with an associated fixed posterior dislocation of the proximal fibular fragment which becomes trapped behind the posterior tibial tubercle. The injury is caused by severe external rotation of the ankle.[7]

o Combined tibia and fibula fracture Trimalleolar fracture - involving the lateral malleolus, medial malleolus and the

distal posterior aspect of the tibia Bimalleolar fracture - involving the lateral malleolus and the medial malleolus. Pott's fracture

Foot fracture o Lisfranc fracture - in which one or all of the metatarsals are displaced from the tarsus [8] o Jones fracture - a fracture of the fifth metatarsalo March fracture - a fracture of the distal third of one of the metatarsals occurring

because of recurrent stresso Calcaneal fracture

OTA classification

The Orthopaedic Trauma Association, an association for orthopaedic surgeons, adopted and then extended the classification of Müller and the AO foundation [9] ("The Comprehensive Classification of the Long Bones") an elaborate classification system to describe the injury accurately and guide treatment.[10][11] There are five parts to the code:

Bone : The OTA classification of a fracture starts by coding for the bone involved:

(1) Humerus fracture, (2) Radius fracture/Ulnar fracture, (3) Femoral fracture, (4) Tibial fracture/Fibular fracture, (5) Spinal fracture, (6) Pelvic fracture, (24) Carpal fracture, (25) Metacarpal fracture, (26) Phalanx fracture of the hand, (72) Talus fracture, (73) Calcaneus fracture, (74) Navicular fracture, (75) Cuneiform bone fracture, (76) Cuboid bone fracture, (80) LisFranc fracture, (81) Metatarsal fracture, (82) Phalanx fracture of the foot, (45) Patella fracture, (06) Clavicular fracture, (09) Scapular fracture

Location: a code for the part of the bone involved (e.g. shaft of the femur): proximal=1, diaphyseal=2, distal=3 (at the ankle the malleolar region is considered separately due to the pre-existing Weber classification and coded as 4[12]). Except at the proximal femur the distal and proximal regions of the bone are defined by a square that is as wide as the as the distance between the condyles. The diaphysis is considered to be the rest of the bone between these two squares.

Type: It is important to note whether the fracture is simple or multifragmentary and whether it is closed or open: A=simple fracture, B=wedge fracture, C=complex fracture

Group: The geometry of the fracture is also described by terms such as transverse, oblique, spiral, or segmental.

Subgroup: Other features of the fracture are described in terms of displacement, angulation and shortening. A stable fracture is one which is likely to stay in a good (functional) position while it heals; an unstable one is likely to shorten, angulate or rotate before healing and lead to poor function in the long term.

Other classification systems

There are other systems used to classify different types of bone fractures:

"Denis classification" for spinal fractures [13]

"Frykman classification" for forearm fractures (fractures of radius and ulna)

"Gustilo open fracture classification"[14]

"Letournel and Judet Classification" for Acetabular fractures [15]

"Neer classification" for humerus fractures [16] [17]

"Seinsheimer's Classification" for femoral fractures [18]

Signs and symptoms

Although bone tissue itself contains no nociceptors, bone fracture is very painful for several reasons:[19]

Breaking in the continuity of the periosteum, with or without similar discontinuity in endosteum, as both contain multiple nociceptors.

Edema of nearby soft tissues caused by bleeding of torn periosteal blood vessels evokes pressure pain.

Muscle spasms trying to hold bone fragments in place

Damage to adjacent structures such as nerves or vessels, spinal cord and nerve roots (for spine fractures), or cranial contents (for skull fractures) can cause other specific signs and symptoms.

PathophysiologyMain article: Bone healing

The natural process of healing a fracture starts when the injured bone and surrounding tissues bleed, forming a fracture Hematoma. The blood coagulates to form a blood clot situated between the broken fragments. Within a few days blood vessels grow into the jelly-like matrix of the blood clot. The new blood vessels bring phagocytes to the area, which gradually remove the non-viable material. The blood vessels also bring fibroblasts in the walls of the vessels and these multiply and produce collagen fibres. In this way the blood clot is replaced by a matrix of collagen. Collagen's rubbery consistency allows bone fragments to move only a small amount unless severe or persistent force is applied.

At this stage, some of the fibroblasts begin to lay down bone matrix (calcium hydroxyapatite) in the form of insoluble crystals. This mineralization of the collagen matrix stiffens it and transforms it into bone. In fact, bone is a mineralized collagen matrix; if the mineral is dissolved out of bone, it becomes rubbery. Healing bone callus is on average sufficiently mineralized to show up on X-ray within 6 weeks in adults and less in children. This initial "woven" bone does not have the strong mechanical properties of mature bone. By a process of remodeling, the woven bone is replaced by mature "lamellar" bone. The whole process can take up to 18 months, but in adults the strength of the healing bone is usually 80% of normal by 3 months after the injury.

Several factors can help or hinder the bone healing process. For example, any form of nicotine hinders the process of bone healing, and adequate nutrition (including calcium intake) will help the bone healing process. Weight-bearing stress on bone, after the bone has healed sufficiently to bear the weight, also builds bone strength. Although there are theoretical concerns about NSAIDs slowing the rate of healing, there is not enough evidence to warrant withholding the use of this type analgesic in simple fractures.[20]

Effects of nicotine

Smokers generally have lower bone density than non-smokers, so have a much higher risk of fractures. There is also evidence that smoking delays bone healing. Some research indicates, for example, that it delays tibial shaft fracture healing from a median healing time of 136 to a median healing time of 269 days[21]. This means that the fracture healing time was approximately doubled in smokers. Although some other studies show less extreme effects, it is still shown that smoking delays fracture healing.

Diagnosis

A bone fracture can be diagnosed clinically based on the history given and the physical examination performed. Imaging by X-ray is often performed to view the bone suspected of being fractured. In situations where x-ray alone is insufficient, a computed tomograph (CT scan) may be performed.

Treatment

X-ray showing the proximal portion of a fractured tibia with an intramedullary nail.

X-ray showing the distal portion of a fractured tibia and intramedular nail.

Treatment of bone fractures are broadly classified as surgical or conservative, the latter basically referring to any non-surgical procedure, such as pain management, immobilization or other non-surgical stabilization. A similar classification is open versus closed treatment, in which open treatment refers to any treatment in which the fracture site is surgically opened, regardless of whether the fracture itself is an open or closed fracture.

Pain management

In arm fractures in children, ibuprofen has been found to be equally effective as the combination of acetaminophen and codeine.[22]

Immobilization

Since bone healing is a natural process which will most often occur, fracture treatment aims to ensure the best possible function of the injured part after healing. Bone fractures are typically treated by restoring the fractured pieces of bone to their natural positions (if necessary), and maintaining those positions while the bone heals. Often, aligning the bone, called reduction, in good position and verifying the improved alignment with an X-ray is all that is needed. This process is extremely painful without anesthesia, about as painful as breaking the bone itself. To this end, a fractured limb is usually immobilized with a plaster or fiberglass cast or splint which holds the bones in position and

immobilizes the joints above and below the fracture. When the initial post-fracture edema or swelling goes down, the fracture may be placed in a removable brace or orthosis. If being treated with surgery, surgical nails, screws, plates and wires are used to hold the fractured bone together more directly. Alternatively, fractured bones may be treated by the Ilizarov method which is a form of external fixator.

Occasionally smaller bones, such as phalanges of the toes and fingers, may be treated without the cast, by buddy wrapping them, which serves a similar function to making a cast. By allowing only limited movement, fixation helps preserve anatomical alignment while enabling callus formation, towards the target of achieving union.

Splinting results in the same outcome as casting in children who have a distal radius fracture with little shifting.[23]

Surgery

Surgical methods of treating fractures have their own risks and benefits, but usually surgery is done only if conservative treatment has failed or is very likely to fail. With some fractures such as hip fractures (usually caused by osteoporosis or osteogenesis Imperfecta), surgery is offered routinely, because the complications of non-operative treatment include deep vein thrombosis (DVT) and pulmonary embolism, which are more dangerous than surgery. When a joint surface is damaged by a fracture, surgery is also commonly recommended to make an accurate anatomical reduction and restore the smoothness of the joint.

Infection is especially dangerous in bones, due to the recrudescent nature of bone infections. Bone tissue is predominantly extracellular matrix, rather than living cells, and the few blood vessels needed to support this low metabolism are only able to bring a limited number of immune cells to an injury to fight infection. For this reason, open fractures and osteotomies call for very careful antiseptic procedures and prophylactic antibiotics.

Occasionally bone grafting is used to treat a fracture.

Sometimes bones are reinforced with metal. These implants must be designed and installed with care. Stress shielding occurs when plates or screws carry too large of a portion of the bone's load, causing atrophy. This problem is reduced, but not eliminated, by the use of low-modulus materials, including titanium and its alloys. The heat generated by the friction of installing hardware can easily accumulate and damage bone tissue, reducing the strength of the connections. If dissimilar metals are installed in contact with one another (i.e., a titanium plate with cobalt-chromium alloy or stainless steel screws), galvanic corrosion will result. The metal ions produced can damage the bone locally and may cause systemic effects as well.

Electrical bone growth stimulation or osteostimulation has been attempted to speed or improve bone healing. Results however do not support its effectiveness.[24]

Complications

An old fracture with nonunion of the fracture fragments.

Some fractures can lead to serious complications including a condition known as compartment syndrome. If not treated, compartment syndrome can result in amputation of the affected limb. Other complications may include non-union, where the fractured bone fails to heal or mal-union, where the fractured bone heals in a deformed manner.

In childrenMain article: Child bone fracture

In children, whose bones are still developing, there are risks of either a growth plate injury or a greenstick fracture.

A greenstick fracture occurs due to mechanical failure on the tension side. That is, since the bone is not as brittle as it would be in an adult, it does not completely fracture, but rather exhibits bowing without complete disruption of the bone's cortex in the surface opposite the applied force.

Growth plate injuries, as in Salter-Harris fractures, require careful treatment and accurate reduction to make sure that the bone continues to grow normally.

Plastic deformation of the bone, in which the bone permanently bends but does not break, is also possible in children. These injuries may require an osteotomy (bone cut) to realign the bone if it is fixed and cannot be realigned by closed methods.

Certain fractures are known to occur mainly in the pediatric age group, such as fracture of the clavicle & supracondylar fracture of the humerus.

Symptoms of Broken Bones

When we have bone fractures, it means that our bones are under pressure at a level that is more than the bone structure can take. This often leads to the crack on the structures of the bone. The severity of the fracture, therefore,

depends on the strength of the impact, the position of the bone when it was hit, and what type of bone has been affected. This is why bones can break in many different ways. The different cases of broken bones could be compound fractures, closed fractures, stress fractures, and fractures caused by pathological diseases such as osteoporosis.

These types of bone injuries occur because there is difference in the application of the force while osteoporosis weaken the structure of the bones and can cause the bone to fracture even with slight force applied to the bone. Moreover, unlike any part of our body when become diseased or wounded, our bones can show broken bones symptoms with different manifestations.

Types of Bone Fractures / Broken Bones

For open and compound bone fractures, the injured bones can show through the skin because the jagged edges of the broken bones can destroy the covering muscles and tissues. Closed fractures are fractures that are confined inside the body. The condition of the bones will be revealed by the x-ray or other powerful machines like CT scans or MRI scanner.

Stress fractures, on the other hand are caused by the unequal stress and forces of tension that is repeatedly applied on the bone which can cause the bone to develop small cracks and can lead to bigger cracks when more force is applied. Pathological bone fractures are caused by bone degenerating diseases such as osteoporosis, bone cancer, or tumor growing on the bone tissues. The broken bones in foot or hand become weakened and with only trivial pressure, this can already lead to bone breaks.

Diagnosis

Bone fracture diagnosis is done by the doctor by initially asking the patient the cause of the injury, when the injury occurred and what other part of the body is in pain. xrays will be taken if the doctor sees bone fracture symptoms through physical examination. If there is a complete fracture with total dislocation of the bone and with fragmented bones, this injury will be considered an emergency case and require surgery and internal fixation. Some doctors straightly recommend the use of MRI or CT scans to see clearer images of the bones and so even the hairline fractures can be detected. If the patient is suffering from osteoporosis, bone scans or xrays may also be recommended to know total coverage of the fracture. Rehabilitation or rehab is necessary.

Signs and Symptoms of broken bones

Broken bone symptoms in children or elderly people will surely manifest once there is the disruption on the normal structures of the bone. The following are the most common signs or symptoms of broken leg, neck, tibia fibula, humerus, radius, wrist, ankle, foot, toe, ribs or other body parts:

• Swelling around the broken bone area• Bruises will appear in due time after the bone is fractured• Bleeding when there is an open fracture• Severe pain in the injured area• Failure of free movements for the injured body part• Inability to move the fractured limb when there is nerve damage• Deformity when there is the displacement of the bone

Treatment Process:

There are also different ways to treat bone injuries but the most popular type is the use of cast especially if the injured part is anywhere on the limb. The bones that are displaced will be put back in place with the use of bone traction. No surgery is needed if there are no bone fragments that will be revealed by the x-rays. The cast will immobilize the limb until the bones heal. The person will have to undergo physical therapy when the bone has finally joined again but the person must avoid heavy stress to avoid the recurrence of the fracture.

The second option is the surgery and the use of internal fixation. This is done for complete fractures with multiple fragments. The use of wires, pins, and plates is inevitable because there is the need to reattach the bones altogether. For long bones, metal rods are inserted through the bones to join the bones together. External fixation can also be

used to properly align long bones. In this type of treatment, the long bones are connected with metal pins and these pins are attached to the external fixator that is placed outside the skin over the injured area. The external fixator is also made up of metal rods with adjusters and it is there to keep the bones from getting out of their position until it heals.

How The Treatment Works:

In internal fixation, when the bone are fixed through wires, pins or metal rods, the bone will produce calluses within the fractured part once bones are joined together. These calluses will hardened into calcium deposits and will be closing the cracks altogether. The same thing goes for bones that underwent bone reduction or casting. Bone healing time or recovery time may be from weeks to months depending on the severity of the fracture and if there are no complications that went along with the treatment. Physical therapy follows after the bone has been removed off its cast. This is to strengthen the muscles and condition the bone so that bone remodeling can take place.

Prevention

There are many ways in preventing fractured bones from happening but the best way is to avoid doing anything that could cause harm to your body. In sports, there are protective gears which you could wear to protect your body’s bony parts such as knee pads, wrist bands, elbow pads, helmets, and shin pads and so on. Although these things cannot entirely stop the injury, at least the risk of having a severe fracture can be minimized.

When to Seek Medical Help

Broken bone symptoms are the manifestations that the person needs medical help. If the fracture happens and signals nerve damage, internal hemorrhage or an open fracture, call the hospital’s emergency hotline immediately.

Simple Fracture Treatment, Simple Bone Fracture Surgery, Healing Time, Recovery, Symptoms

Fractures refer to a medical condition wherein a bone is broken. Usually, breaks and fractures are often treated as different but they are actually the same. If any of your bone has been hit by a strong force coming from the outside, the result would likely be a crack or a break on your bone.  The amount of force that can be taken by the bone is only limited and when the applied force exceeds what your bones can take, a fracture can be expected to happen. Although there are many different classifications, there are two basic classifications, which are also commonly used that will be discussed in this article.

Two Basic Types of Fractures / Classification:

• Simple fracture. This is the type wherein the broken bone does not pierce the skin. Moreover, the bone is only broken into only two pieces and not more. The surrounding tissues of the broken bone are only slightly affected. It is also called as closed fracture.

• Compound fracture. This is the type of injury wherein the broken bone has pierced through the skin, hence forming some wounds. This is why it is also called as an open fracture. When compared to the simple fracture, the open wound has made this one even more dangerous as the person suffering from it is exposed to infection from external agent. Thus, operation will likely be needed in order to keep the skin from any possible infection.

Simple Fracture Symptoms

For simple fracture, there are a couple of symptoms that you need to take note of so that you would not immediately be worried about what kind of fracture you are having.

• Swelling• Bruising• Recurring severe pain that never goes away so easily• Pale area surrounding the broken bone• Tingling and numbness• An obviously misplaced limb or joint• Difficulty in carrying some weight

For compound fracture, all the other symptoms apply except that there is this single obvious thing that makes the difference obvious – a protruding bone that pierces through the skin. There are cases when you can no longer see the bone actually peeking out of the wounded skin but the piercing of the bone would visibly leave an open wound. The broken bone might have went out of the skin but pulled itself back in. The wound is reason enough for worry of exposure to infection that might be caused by dirt, debris, and many other external elements.

First Aid Treatment for Both Fractures

In order to not worsen the fracture, the first aid treatment should be applied. People who do not have any knowledge on such should not move or touch the person in any way to avoid further complications.

1. Assess the bone fracture and locate where it is.2. Do not allow the person to move or be moved so as to avoid making the injury worse.3. Realign the fracture if necessary.4. Clean all wounds.5. Remove any tight clothing or jewelry to let the blood flow better. Broken bones need more blood to reach them.6. Check the circulation, motion, and sensation in the surrounding area of the fractured bone.7. Make a splint for the fracture.8. Do step six again.9. Put the bone injury in elevation at six to ten inches to avoid too much swelling.10. Put a cold pack to the bone injury but make sure that there is no risk to frostbite.11. Monitor possible shock. Prevent shock by letting the person lay on a flat surface but elevate the feet twelve inches high above the head. Use blanket or coat to cover the head but be careful in moving the head especially with back, head or neck injury.12. If the person is not under shock, give ibuprofen for pain relief.13. Evacuate.

Simple Fracture Treatment

Simple bone injuries are quite easily treated than do compound fractures. What makes the latter more complex and more of an urgent case is the wound that has to be addressed immediately. There are certain problems which are related to bone fractures. The person could suffer from the danger of blood loss, stunted bone growth, and possible injury to organs.

Simple fractures would still need much medical attention for such fracture can also be deemed harmful when broken bones are moved unnecessarily. In most cases, this kind of fracture will need ice, pain medication, elevation, and bracing. If some operation is needed, this might be done to align the bones and keep them in place. Limbs would be secured with bandage before the wet plaster is applied for casting. For expected swelling, the plaster can be split into two but wrapped with another layer of plaster outside.

Simple Fracture Healing Time, Recovery Time: It may take more than 8 weeks.

On the other hand, compound fractures should have wounds cleansed well before the person should be brought to the operating room. The cleansing will try to remove debris, dirt or many other elements that might infect the wound. Immobilization is also needed to give the bones some time to heal on their own. This might use external or internal splints plus plates and screws if the fracture is even more severe.

Open Fracture Treatment | Open Bone Fracture Surgery | Healing Time, Symptoms and Recovery

There are two classifications of fractures- open and closed. This article will talk about open fracture in detail. This kind of fracture is a condition wherein the bone penetrates the skin. It is a more complicated condition, compared to the closed fracture, and requires immediate treatment. This is because if left untreated, infections could set in causing delayed healing and even bigger problems. While most fractures are of the closed kind, open bone injuries do happen and when they do, they can be potentially dangerous.

Open Fracture Types or Classification:

There are four types of open fractures, namely: Type 1, Type II, Type III-A, and Type III-B.Type 1- the wound is less than a centimeter, and there is only minimal injury of the tissues without contamination.

Type II-the wound is about 1-10 centimeters; the damage is quite extensive in the tissues. You would notice mild to moderate crushing, and there is contamination in the fractured area.Type III-A- the wound is much larger than 10 centimeters. The extent of damage is very large. There is severe crushing and contamination.

Type III-B- the wound is also larger than 10 centimeters. There is severe contamination, and a lot of tissue loss.

Diagnosis

It is much easier to diagnose an open fracture due to the fact that it is visible in the skin. However, for more accurate diagnosis, the following are done:

1. Physical examination to see the extent of the damage2. CT Scan3. X-ray radiograph

The above tools should be sufficient to check the severity of the open bone injury. Other doctors may request more advanced diagnostic procedures especially for small wounds, but for the most part, these should be enough to properly assess the condition. Rehabilitation or rehab is required.

Open Fracture Causes

Most common causes of open fractures are sports-related injuries, vehicular accidents, and falls. It is the high impact that triggers the bones to protrude and become visible in the skin. It is almost impossible for open bone fractures to be brought about by diseases and other health conditions.

Symptoms

Aside from the excruciating pain, it is easy to find out if a person has an open bone injury. This is because the wound is visible to the naked eye. If there seems to be a bone protrusion in the skin, then this means the person has an open fracture.

Open Fracture Treatment

First aid treatment of open fractures includes assessment of the fracture to determine severity. Next is to make sure the injured area is immobilized because the condition could worsen when moved. Then, because it is an open wound, it has to be disinfected immediately using iodine tablets or solutions. Dress the wound using the appropriate bandage, and seek medical assistance. The doctor would usually perform surgery to prevent infection and restore bone function. Surgery can be major or just as simple as closing the wound, depending on the severity of the condition. Additionally, antibiotics will be given for the same purpose because it has been found to reduce open fracture infection risk by about 59%. The commonly prescribed antibiotic medications are Ciprofloxacin and Levofloxacin. Prophylaxis is also used.

Another treatment method, which is in fact a standard operating procedure, is irrigation. This is necessary to prevent infection for open bone injuries, because it is effective in removing foreign matter. Irrigation usually requires about 3 liters of fluid is required although the common practice is 3 liters for type I, 6 liters for type II, and 9 liters for type III-A and III-B. Emedicine is also important.

Open Fracture Healing Time or Recovery Time: It may need more than 8 weeks.

Prevention

The best way to avoid open fractures is to stay away from accident-prone areas and to practice defensive driving. As mentioned, open fractures are a result of trauma from accidents and injuries so preventive measures should focus on these aspects.

When to Call a Doctor

Some people think that when the wound is small, they can simply clean it and cover with bandage. But this is actually a risky move. Doctors agree that immediate medical attention should be given when there is an open fracture. This is because the risk of infection is very high. Ideally, operative treatment should be given within 5-6 hours. People who do not see a doctor when they have open bone inujuries are potentially at risk for more severe infections, which could lead to bigger problems. When you or someone you know has an open wound, proceed to the hospital right away.

Stages of Bone Healing after fracture

When a person subjects himself to physical blow, with strength that overcome that of the bone itself, it will result to a bone fracture.  Bone are made up of connective tissue that are fortified by calcium and a combination of bone cells. They have a soft center where blood is formed, and its main function in the body is support the body, protect the internal organs and allow mobility.

Bones can fracture in several ways and healing that will follow will be dependent on the kind of fracture that the bones incurred. There are several stages bone healing process and all bones need to successfully undergo each stage in order to completely heal:

Stages of bone healing following a fracture

a. Inflammatory stage: in this stage, a hematoma forms on the fracture site, just a few hours or days after the injury. Inflammatory cells infiltrate the bone to form granulation tissue, vascular tissue and immature tissue. These tissues come together to facilitate bone repair and this can go on for two to four weeks.

b. Repair stage: the healing process takes place in this stage. As long as the bones are properly positioned or aligned together, bone cells will lay down new tissues on the bone repair site to replace the fractured fragments. Blood vessels are also formed in this stage to provide complete nourishment for the bone and the entire process of healing can take about 1 to 2 months

c. Late remodeling stage: in this stage weak one material that has been formed in the repair stage will  be replaced by strong bone material and this entire stage takes place the longest: months to over years.

Rehabilitation or rehab is must.

Types of bone fractures

How does bone heal? Bone healing usually depend on the severity of the fracture and the following are the different types of fractures:

• Greenstick fracture – a type of fracture that is characterized by a small crack and is most commonly found on children.• Comminuted fracture – a type of fracture that involves the shattering of bone into several pieces; due to the severity of the damage this usually takes the longest to heal.• Simple fracture – it is a type of close’ fracture, meaning the broken bone has not penetrated through the skin.• Compound fracture – also known as an open fracture or a type of fracture where the broken bone is seen piercing through the skin. Due to the exposure, this has the most risk for infection, so fractures such as these are given immediate attention.• Pathological fracture – these are bone fractures resulting due to bones weakened by various diseases. Such illnesses render the bone some weakness and so they tend to fracture more easily compared to healthy bones.• Avulsion fracture – this type of fracture is more common in the knee and shoulder joints.• Compression fracture – when two  bones are forced against each other such as the bones of the spine.

Diagnosis of fractured bone

The first thing that the doctor will do is to ask for the history of the injury. He will then examine your for signs of fractures and if the doctor needs further confirmation, he will prescribe you with x-rays or a computed tomography (CT scan) to further detect any deformity or injury in the bone.

Causes

Fractures can occur after the following:• Hitting your one with much force; or twisting or bending bone awkwardly as a result of a fall or a collision• Repeated stresses, that are not necessarily forceful, can result to bone fractures• Old age or if you have an illness that makes your bone weak

Symptoms

You could be suffering from a bone injury if you observe any of the following:• Pain• Swelling• Bruising• Deformity• Immobility

Treatment For Bone Injuries:

When a patient comes to the doctor the first time, he is loaded with a lot of questions and one of these are: how does bone heal? The truth is, bone heals depending on the fracture, and the treatment required for the bone to heal will also be dependent on the kind of fracture on the bone.

a. First aid – there is so much that one should know about handling the fractures on the moment it happens. First of all, make sure not to movie the person because movement may cause a more unfavourable complication. Attend to the bleeding wound first, before anything else, and never attempt to straighten any bones. Support the limbs with pillow or anything that will keep it elevated or if you can, apply a splint. Apply an ice pack to resolve the swelling and contact a doctor at once.

b. Hospital treatment – minor bone fractures find a way to heal on its own, but when the injury is more severe, the patient will have to undergo surgical procedure that will involve the insertion of metal hardware. These pins, plates and rods can remain in the bones permanently or they could be removed after some time.

c. Physical therapy – this is necessary in order to build the right strength to return to your normal routine. You cannot force yourself and you should always be supervised by a professional so therapies are the best way to recuperate.

Prevention of bone injuries

• Always wear protective gear when engaged in physical activity• Drink milk and take supplements that will render your bones to be stronger

When to Call a Doctor

If there is one thing that you should realize about bone fractures, it is that they are serious even if it seems as though it is not, so consult your doctor in the presence or absence of pain.

Why Broken Bones Heal Stronger and the Common Types of Fracture

When you fell and you felt pain in your arms or any part of your body, you should consider having it checked by a doctor. You may already have a broken bone or bone fracture. Bone fracture refers to the medical condition wherein the patient or any person concerned has encountered a broken bone.

There are talks about whether broken bones heal stronger, stronger than the original ones. This is also one of the things that will be discussed later in the article to possibly contemplate whether the talks are true or not.

Types of Injury that Cause Broken Bones

There are three main reasons why a fracture might happen to a person. These are all the types of injuries classified into three main categories for there are truly many reasons why a person might break a bone.

• High-energy injury. Broken bones are caused by a very strong force that also made a significant impact on the bones. This category would include falls, sports injuries, and car accidents. Injuries caused by these are also dubbed as traumatic fractures.• Pathologic injury. A pathologic fracture is caused by some other problems with the body such as certain diseases. These are broken bones triggered by osteoporosis, infections, and tumors.• Stress injuries. These are the factors that impose repetitive microtrauma to the bone. These factors are silently making an impact on the bones until the poor bones could not take the impacts any longer. No sudden changes can be observed but the condition of the broken bones eventually becomes worse as time passes by.

Common Types of Bone Fracture

Bone fracture may happen to any person of any gender and at any walk of life. What will be discussed here would be the most common types of bone fracture.

a. Stress fracture

What it is. It is basically an overuse injury. Microtrauma is inflicted on the bones which weaken them eventually when the bones can no longer put up with each shock. This usually happens to bones in the lower legs, foot or the shin bone. Athletes and marching soldiers are the usual victims of this fracture.

Diagnosis. The doctor has to study your history and the result of your physical exam. A bone scan is also done occasionally only for further confirmation.

Treatment. The patient needs rest, anti-inflammatory medication, and ice. The broken bones may take a healing time of six to eight weeks. In order to avoid re-injury, it is advisable to make the fractured bones take a rest or there might be a risk of the injury extending all throughout the entire bone.

b. Rib fracture

What it is. A direct blow to the ribs is all it takes for any of the bones to get injured. A person with a rib injury would find it hard to take deep breaths which could possibly lead to pneumonia, shortness of breath, cough, and fever. This

is because without taking deep breaths, the lungs would be exposed to infection. Unlike other broken bones, you cannot relax your ribs for you still need to take deep breaths.

Diagnosis. Instead of rib x-rays, chest x-rays are usually taken in order to make sure that the lungs are still safe and have not collapsed or bruised.

Treatment. In order to help the ribs heal, it is recommended to put ice to the chest wall, take deep breaths, and take anti-inflammatory drugs and pain reliever. The patient would have to suffer four to six painful weeks.

c. Compression fracture

What it is. An example of this fracture is the compression fracture to the spine, more specifically the lumbar or thocacic spine. Such fracture is usually caused by aging and diseases such as osteoporosis that diminishes the calcium content of the bones. Pain is usually felt by patients especially with every movement.

Diagnosis. This can be detected by using an x-ray, CT scan or MRI in order to check the spinal cord for possible injuries.

Treatment. This can be treated with vertebroplasty, a back brace plus pain medication. Vertebroplasty is a procedure that consists of inserting some glue-like materials into the collapsed spinal vertebra so that when the glue hardens, it will act as the cast that will stabilize the weakened bone.

d. Skull fracture

What it is. This is usually caused by a head injury. Although the skull is a hard and compact bone, there is still a possibility of it cracking which is dangerous as this might mean possible bleeding in the brain.

Diagnosis. CT scans are usually done to check the extent of the damage. The doctor will examine the scalp and the skull closely and see if there is blood behind the ear drum. A neurologic exam may also be necessary.

Do Broken Bones Heal Stronger?

When bones actually become fractured and healed from it, there are still differing answers. There are some people who would say that if the bones are healed well, there is a chance that they will grow even stronger than the original ones. However, there are also others who would claim that is broken bones are healed, they might become as strong as the original ones with the passage of time but maybe not stronger.

Primary Bone Healing

Bone fractures is a combination of a tissue injury and a complete or incomplete breakage of bone caused by a traumatic force  or physical blow that was far greater than the strength of the bone itself. Bones can be fractured in several ways and they are classified into different categories to making diagnosis easier for physicians.

The skeletal system serves a big function in the body because not only does it give the person its structural form, bones support and protect the internal organs. Bones naturally break and build; and are therefore self-healing but there are several methods to promote bone healing and you shall find out more about further into this article.

Types

• Avulsion fracture – a type of bone fracture that involve the pulling of the tendon form the bone; the tendon carrying a piece of the bone with it.

• Closed fracture – fracture where the fractured bone is within the skin

• Comminuted fracture – bone fracture involving the bone being broken into multiple fragments

• Greenstick fracture – this is an incomplete fracture of the bone that is commonly seen on children

• Impacted fracture – this is a fracture that is a result of a compression

• Intra-articular fracture – a type of bone fracture wherein that involves the articular joint surface of the bone

• Longitudinal fracture – when the fracture on the bone follows the long axis of the bone

• Open fracture  –  also known as compound fractures; this is a kind of fracture wherein the bone is seen penetrating through the skin

• Oblique fracture –  a bone fracture that follows an oblique or slanting line

• Pathologic fracture – a fracture caused by a pathological condition that has affected the bone

• Periarticular fracture – fractures that does not involve the joint space

• Simple fracture –  fracture that involves just two bone fragments

• Spiral fracture – this is a severe kind of olique fracture caused by a rotational force

• Stress fracture – this is a fracture that is a result of repeated and excessive; usually the injury of athletes

• Transverse fracture – fractures on the bone that are perpendicular to the long axis of bone.

Diagnosis

The complete diagnosis of a bone fracture follows several steps. First of all, the doctor will carry out a physical examination to identify whether you have the signs and symptoms present. The doctor will also ask some questions and obtain the history of the injury from you. If a patient is unconscious at the point of consultation, his or her companions would have to take over for the patient. Rehabilitation or rehab is required.

Should the doctor find it difficult to diagnose the presence of  a fracture from examination, he will definitely request for the patient to undergo further examinations and tests to properly identify any irregularities:

a. X-raysb. Magnetic Resonance Imaging (MRI)c. Computed Tomography (CT scan)

After successful diagnosis, the patient can be on his way to treatment and the doctor will do all he can to promote bone healing.

Causes Of Such A Bone Injury:

• Falling from a height• Vehicular accidents• Physical injuries form activities or sports• Dangerous lifestyle• Disease that renders bone to be susceptible to fracture• Stress fractures are a result of continued or repetitive blows which is usually the problem with athletes who endure repetitive injuries

Symptoms of Such Bone Injuries:

If the patient present any of the following signs and symptoms, he or she could be suffering from bonr fractures

• Bone Pain (that may be severe or not)• Swelling• Bruising• Discoloration of the skin, especially around the affected area• If there is any area in the limbs in an abnormal position• If the patient is finding it difficult to put pressure on the injured area• If the patient is finding it difficult to move the injured area• If the affected bone or joint presents a notable grating sensation• If it is an open fracture there may be bleeding• If the patient looks pale and clammy• If the patient is feeling dizzy or faint• If the patient is quite feverish and nauseous

Treatment for bone injuries

Primary bone healing is desired for every bone fracture. If this is achieved then the bone can easily accelerate to the complete healing process, which is of course, the goal that every doctor looks for in their patients. Before any healing can be expected however, it is first important for the patient to receive the right treatment first. Bones, naturally heal itself, so minor fractures usually heal on its own and therefore only require immobilization with cast, brace, splint and sling. Stabilization promotes primary bone healing and because bone infiltrate will migrate properly to fill in the gaps well if the bone pieces are positioned properly.

If the bones cannot be positioned properly through the methods mentioned above, surgical treatment is required. This kind of bone treatment involve the use of pins, plates and rods. The metal hardware will be used to keep the broken fragments in place, so that they can be allowed to heal properly.

Healing Time or Recovery Time: It may take more than 1 month.

Prevention of Bone Injury:

Bone fractures cannot be prevented easily but it is not bad to try. Exposing the body to an ample amount of sunlight will keep the bones healthy and supplied with vitamin D. Eating foods rich in calcium is good too. One more way to prevent bone injuries is to avoid physical activity, or if you cannot, you should make sure to protect yourself from any unexpected injuries. Wear protective gear at all times and make sure to support the delicate parts of your body.

When to Call a Doctor

Broken bones are a serious matter, therefore contact a doctor right away, as soon as the accident happens. Fractures can occur in different ways and they can be too severe and can lead to further complications. Be smart and seek for professional help, to better address the condition.

Primary and Secondary Bone Healing

Once you would have a single broken bone in your body, you are already said to have experienced this medical condition called bone fracture. When this happens, the normal bone architecture has been disturbed. Thus, you should do something in order to solve this medical condition in the soonest time possible in order for you to restore your activities to the routine one.

Causes of Bone Fracture

A broken bone usually happens when the bones would experience high impact or bone injury. There are also certain diseases which can trigger broken bones occurrence. When you have overused and overstressed the bones in your

body, the result would be small cracks that will weaken these injured bones. There are also some causes which are pointed to as triggers of bone fracture.

• Falls• High impact and all out sports injuries• Osteoporosis• Quick and unnatural movements• Overuse• Bone injuries in Accidents• Tumors

Two Kinds of Bone Healing

The moment that you will break a bone, new cells will then be working immediately to get you some new bones that will spring from the same area as the fractured one. Bone healing is one of the most interesting processes that the human body has to go through. If healing is done in the best manner possible, scars may not even be visible after wards. There are also two different kinds of bone healing – primary and secondary bone healing. Each has different approaches in healing broken bones. The main difference between these two is the formation of callus.

Rehabilitation or rehab is required.

Primary Healing

The most distinguishable feature of this bone healing is that is that it does not involve any callus at all with the recovery of the fractured bones. Instead, it has the cortex working in order to rebuild itself after the break or the crack. In order to continue working and functioning, the cortex on the left should be reconnected to the cortex on the right. However, this process requires that little fracture fragments should also be restored via rigid internal fixation. It also needs to a significant reduction on the inter-fragmentary strain. Blood vessels will once again be created once the bone cells will already make a tunnel-like structure and with the proper flow of blood will once again resume.

Secondary Bone Healing

As this is opposite to primary bone healing, this kind of healing involves callus formation in almost every stage that the process has. These stages would include impaction, inflammation, formation of the primary soft callus, mineralization and remodeling of the callus formation. Each stage will be described in the following manner.

• Impaction stage. This requires an impact to be made in order for the bone fracture to be seen just on the area with the least resistance. As this is the impaction stage, you can expect that after the impact, certain damages will ensue on certain parts such as the periosteum, the bone marrow (local), living bone, and the adjacent soft tissue. Blood supply is also cut off when the blood vessels are cutoff as well. Local cells are sensitized and as per other studies, this lasts for around seven days.

• Inflammation stage. In this stage, hemorrhage and hematoma are formed as a result of the lack of blood flow in the endosteal and periosteal blood vessels. Thrombosis is also involved in this stage especially with the involvement of blood vessels. The lysosomal enzymes would be activated while the right acidic pH will also be given to you. Along with the invasion of inflammatory cells, the patient has to face swelling, pain, and heat.

• Primary soft callus formation stage. The sensitization and stimulation of the cells found in previous stages will now provide new blood vessels, supporting cells, fibroblasts, and intracellular material. For fracture fragments to be connected to each other once more, a tissue has to appear around the fractured area. Granulation tissues should then be removed. This happens for two weeks.

• Callus mineralization stage. This happens one week after new callus can be seen springing in the injured part. Increased oxygen tension will produce osteoid which makes the callus rigid. This will take four to sixteen weeks in order to hasten the healing process

• Remodellation stage. Instead of callus, new bones will be replaced with new bones. The new bone will be created by osteoclasts acts. Cartilage that underwent mineralization forms the first spongiosa. Woven bones will be replaced with lamellar bones with secondary osteons. This stage takes about one to four years in all.

Healing Time or Recovery Time is more than 1 month.

NSAIDS Bone Healing

People break one of their bones at one point of their life. Breaking bones and getting bruised have always been a part of one’s childhood and parents, especially mothers, have to endure taking their children to the orthopaedic surgeon for a treatment. About 6.8 million people have been given medical attention because of bone fractures every year in the United States, alone.

Fractures occur because there was not enough support placed in a specific area. It could be dependent on the energy of the event or the blow and the strength of the bone being subjected to the impact. Energy can be classified as acute, high-energy, chronic or low-energy. Bone strength can be normal and therefore can effectively provide protection for typical blows, but if a bone is diseased then the strength will definitely be lesser.

Types

There are several kinds of fractures and they are the following:a. Delayed union fracture: bone fractures that are taking a long time to healb. Comminuted fracture: this is a fracture caused by a severe force and resulting to the shattering of bone into several piecesc. Greenstick fracture: this usually occurs in children and it is characterize by splintering of bones without breakingd. Malunion fracture: this is the fracture of bones that was previously fractured and healed with incorrect anatomical alignmente. Nonunion fracture: these are sustained fractures that present no healing even after some timef. Oblique fracture: this is a kind of fracture that runs across the bone as a result of a sharp angled blowg. Spiral fracture: this is a fracture caused by a twisting forceh. Transverse fracture: this is a fracture that runs straight across the bone

Diagnosis

Fractures can be diagnosed properly with proper physical examination and radiographs of the specific area. When you suspect a fracture in your bones, you need to see a doctor to get his expert opinion. He can assess, right away. Some fractures cannot be detected through x-rays. If this is the case, you may be prescribed to get imaging tests such as computed tomography (CT scans) magnetic resonance imaging (MRI) or bone scans. Dealing with open fractures is another thing; for such cases it will be required for the doctor to undergo some laboratory examinations to check whether there is some blood loss and if infection has already set in.

Causes

Trauma is the primary cause of bone fractures. Trauma can occur after a fall, motor vehicle accident, because of physical abuse or disease. People who have unknown bone disease can be suffering from multiple bone fractures without them knowing. People who have bone disease and weakened bones can get fractures from simple day-to-day activities even without putting harmful pressure.

Symptoms

• Bone Pain resulting to immobility and discomfort• Numbness and tenderness on the area approximating the bone injury due to loss of pulse• Swelling• Bruising because of internal bleeding

Bone Healing

The bone is continuously breaking and forming, as part of the bone’s normal physiologic process. In order for fractures to heal properly, it is important that a reduction or placement of bones be attained.Bone reductions mean improving the alignment of the broken ends of the bone. To successfully reduce bone, casting is usually done after some sessions of pulling and tugging.

The kind of treatment that a bone fracture receives is usually dependent on a mixture of factors and they are the following:

• Age of the patient• Location of the fracture• Angulation and severity of the fractured bone• Potential for healing• Other bone injuries

Types of treatment – Nsaids bone growth

a. Immobilization is the first and most common treatment for fractured bones. Regardless of the severity, it is important for the affected area to be immobilized to prevent and complication and promote healing. Immobilization technique involve casting, bracing, splinting and slinging.b. Stress fractures require rest, ice packs and doses of anti-inflammatory medicinec. Fractures that are sever, open and involving surrounding structures are usually treated with surgery. Severe structures may need the use of  plates, rods and pins to keep the bone in place. Bone grafts may be required for fractures that have lost a big amount of bone.d. Patients who are recovering from bone fractures may require the need to undergo physical therapy for some time or until full health has been restored.

NSAID Bone Healing Effects

There had been evidence that reveal NSAIDS to have some effect on the healing of bone. With the continuous intake of NSAIDS bone healing has been seen to slow down.

Prevention of Bone Injuries

There really is no precise way to prevent one fractures but to just be careful at all times. There are vitamins and supplements that you can take to ensure the health of your bones but more or less you just really have to be careful and keep away from dangerous activities where you can harm yourself.

When to Call a Doctor

With every condition it is always safe the doctor, especially if pain is felt. Do not underestimate fractures because it may lead to something much worse.

Multiple Fracture Treatment | Multiple Bone Fracture Surgery | Healing Time, Symptoms and Recovery

Multiple fractures would refer to a bone fracture wherein there is more than one area that has damage. In a sense, it is basically a simultaneous fracture of two or more fractures in one bone, although in some cases, it would consist of two or more fractures for several bones. Such type of fracture is not a common occurrence, nevertheless, it does happen and people need to be well aware of the signs and symptoms in order for proper treatment to be given.

Not many people are familiar with multiple fractures. This article will help you gain more knowledge about this condition so that should it happen to you or your loved ones, you will know what to do.

Types

There are two types of multiple fractures and these are: comminuted and segmental. Essentially, comminuted fractures are those wherein the fractures are located quite close to each other, whereas the segmental fractures would happen when they are located further apart from each other. The type of multiple fractures can be diagnosed through various advanced medical examinations. There can be multiple fractures of the pelvis, foot or even multiple fractured ribs. These can occur in children or elderly alike.

Diagnosis of Multiple Bone Injuries

People might be wondering how multiple fractures can be diagnosed. As mentioned, this is quite different from other types of bone fractures in such a way that it has more than one damage area in the bone. To be able to accurately determine the condition, it will require the following:

1. Physical examination2. Family history3. Skeletal survey4. Tomography5. CBC or complete blood count6. Bone densitometry7. Complete documentation of injuries and bruises8. DNA sequencing9. Skin biopsy10. MRI (Magnetic Resonance Imaging)

Rehabilitation or rehab is necessary.

Causes

There are many reasons why individuals could develop multiple fractures. Usually, it happens if there is trauma from a fall, injury from accidents, and also because of abuse (domestic violence). Other times, certain diseases also give rise to the condition osteopenia, osteogenesis imperfecta, osteomyelitis, rickets, paralysis, Menkes syndrome, and copper deficiency. People with dwarfism condition also have brittle bones, which can easily trigger multiple fractures. The tests and examinations should be able to pinpoint the real cause of the condition, which is why it is very important to see a medical doctor if symptoms occur (will be discussed below).

Multiple Fractures Symptoms

Due to the fact that multiple fractures could be triggered by various factors, a lot of symptoms could also be identified. Take note that these symptoms may or may not be present, and most certainly, not all of them will be observable. The list below is given to serve as a guide but should not be the basis for finding treatment. Again, an appointment with a qualified doctor is necessary.

1. Poor linear growth2. Presence of blue sclera3. Limb deformities4. Bruises5. Scoliosis6. Triangular-shaped face7. Macrocephaly8. Otosclerosis9. Umbilical hernias10. Teeth discoloration

And of course, the bones for such condition would be very fragile and very easy to break. The person who has multiple fractures associated with certain diseases is more likely to have brittle bones that easily hurt.

Multiple Fractures Treatment

Because multiple fractures may be due to certain diseases, to treat it, the doctor must treat the disease itself. However, there are some diseases without any cure such as osteogenesis imperfecta. In this case, the only option would be to reduce possible deformities. Doctors prescribe bisphophonate, which can reduce pain in bones and make the bones stronger. For multiple fractures brought about by accidents and injuries, treatment would vary, from surgery, casting, or antibiotics.

Prevention of Multiple Bone Injuries

Preventive measures vary for multiple bone fractures. The first thing a person needs to remember is to steer clear of accident-prone areas and injury triggers. People who live with abusive individuals should stay away from them in order to prevent getting hurt. Diet and lifestyle must also be adjusted, making sure that you eat plenty of calcium-rich food to strengthen the bones. Taking of supplements also help increase bone density, thereby preventing the occurrence of brittle and fragile bones.

Multiple Fracture Healing Time or Recovery Time: It requires longer than 8 weeks to heal completely.

When to Call a Doctor

We always recommend seeking medical attention in the event that an accident happened. Even though you might feel that there is nothing wrong with you, we can never be too sure and to avoid complications, you need to see a doctor. In addition to that, when a person feels pain in the bones or in surrounding areas (muscles), it is necessary to give your doctor a call just to isolate the problem. And of course, if the abovementioned symptoms are present, make an appointment with the doctor as soon as possible. The soonest you will be treated, the better.

How to Make Broken Bones Heal Faster

A broken bone would inconvenience you much for your every move might resonate with pain. The hurt that you will feel is because when your bones get broken, you will expose the nerve endings of the pain fibers which when irritated, will cause pain. Moreover, broken bones would hurt since the muscles around the fractured area will do the job of holding the bones together as though they were still unbroken. However, in order to maintain this task, the muscles have to experience spasms which will cause your pain.

If you no longer want to experience such pain, inconvenience, and even possible dependence on other people due to your restricted movements, you have to find ways to make fractured and broken bones heal faster.

• Stop smoking. If you want the broken bones to heal faster, you should stop smoking since this will hinder the progress of the blood flow towards the bones. When not enough amount of blood can reach the bones, this might all the more delay the healing time of your fractures. The blood flow is supposed to be the carrier of cells and nutrients that will hasten the healing of the bones. Thus, when you continue smoking, you are exposing yourself to nonunion.• Maintain a balanced diet. As with handling any other diseases or even when you are robust and healthy, you should maintain a balanced diet for sustained health. For the bones to heal faster, they need to consume lots of nutrients. Thus, the more nutrients you will take, your broken bones healing time would be shorter.• Control calcium intake. Although calcium is proven to make bones healthy, your balanced diet should still be a priority over this. Calcium is needed to make your bone injuries get healed faster and your other unharmed bones to stay stronger. There is an advisable dosage of calcium supplements that you can take but taking more would not help

you any better. Just make sure that you follow the recommended dosage.• Follow your treatment plan. Upon consulting a doctor about your fractured bone, you will go home with prescription and the doctor’s advised treatment plan. You may have treatments such as cast, crutches, surgery or other procedures and you have to follow what the doctor says or you will just lengthen your healing time.• Consider your options well. There are several choices to treat broken bones. However, you may not be able to land a good choice if you will decide all on your own. It would be better if you will consult your doctor about it aside from researching about customer reviews about certain treatments. When you are considering surgery, you should know the risks that you have to face in order to make your decision carefully.• Augmenting healing for fractures. There are certain devices that are thought of to help heal broken bones. However, even without solid scientific evidence, many fractured patients would resort to these devices to try if they will work.

a. Electrical simulation. This is a process wherein two skin electrodes are placed near the broken bones and a small current that is simulated by a 9-volt battery passes between the electrodes. It is said to help grow bone cells faster by dividing themselves faster as well, causing bone healing to speed up. In order for this progress in healing to be continuous, you need to wear the skin electrodes for the longest time possible until these bones will be completely healed. This is ideal for people with bones which heal slowly.

b. Ultrasound. The machine produces barely-heard sounds that are inaudible to human ears. The machine will be connected to the skin surface through a probe. According to the advocates who have used the machine to help repair broken bones and serious bone injuries, it is said to cause increased gene expression and slight changes in temperature. However, there is no scientific evidence as to how this can help bones heal faster than usual. You may opt to try this though if you have limited healing potentials with other kinds of treatments.

c. Magnets. These are usually used to relieve joint pain and cure systemic illnesses. They are said to be effective in increasing blood flow to the broken bones so that these bones will receive the nutrients that they need. In order to take effect in healing fractured bones, magnets should be closely positioned to the affected area. They can be found in wraps or in some pieces of jewelry. Like the other two external devices mentioned above, there is no scientific proof of how effective these magnets are in helping repair broken bones quicker.