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bone fracture

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Fracture of the leg

Alternative Names 
broken bone

A bone fracture is a break in a bone. The surrounding tissues are usually injured as well. Bone fractures are classified as:
  • simple or closed fracture, in which the broken bone does not come through the skin
  • compound or open fracture, in which the bone pierces the skin or the skin is torn or scraped
Bone fractures are also classified by the position of the bone fragments, as follows:
  • comminuted, in which the bone breaks into small pieces
  • impacted, in which one bone fragment is forced into another
  • angulated, in which fragments lie at an angle to each other
  • displaced, in which the fragments separate and are deformed
  • non-displaced, in which the two sections of bone keep their normal alignment
  • overriding, in which fragments overlap and the total length of the bone is shortened
  • segmental, in which fractures occur in two nearby areas with an isolated central segment
  • avulsed, in which fragments are pulled from their normal positions by muscles or ligaments
What are the signs and symptoms of the injury? 
Signs and symptoms of a bone fracture include:
  • pain that is usually severe and gets worse with time and movement
  • swelling
  • bruising
  • a limb or joint that is visibly out of place
  • limitation of movement or inability to bear weight
  • numbness and tingling
  • paleness of the injured area
What are the causes and risks of the injury? 
A bone fracture occurs when the force against a bone is greater than the strength of the bone. Most fractures result from an injury, such as that caused by an automobile accident or a fall. As a person ages, the bones become more brittle. This leads to an increased risk of fractures. Certain conditions, such as osteoporosis, cause bones to be more fragile. These bones can be fractured with very little force. Fractures are also commonly the result of child abuse.

What can be done to prevent the injury? 
Some fractures can be avoided by following sports safety guidelines for children, adolescents, and adults.

How is the injury recognised? 
A bone fracture is recognised by a history of the injury and the results of the physical examination. An x-ray of the area is done to confirm the diagnosis. Special imaging tests such as a CT scan or MRI may be needed to view the damaged area more clearly.

What are the treatments for the injury? 
Emergency treatment consists of splinting the limb above and below the suspected fracture. This keeps the area from moving. Ice should be applied. The injured area should be elevated to reduce swelling and pain.

Repairing the bone can avoid a deformity of the bone as it heals. The bone repair may be classified as a closed repair, which is done without cutting into the skin, or an open repair, which involves surgery.

A closed repair is used if the bone is cracked completely, but the pieces are not quite in the right place. The doctor pulls on the bone to get the bone pieces back in their proper position. For some fractures, splints or casts that restrict motion are used. Fractures of the collarbone, shoulder blades, ribs, toes, and fingers generally heal well with such treatment.

An open repair is done for more serious fractures, including:
  • fractures in which the two ends of the broken bone can't be lined up correctly
  • fractures that extend into a joint
  • broken bones that are visible or stick out through the skin
An open repair is done in the operating room. A variety of tools are used to repair the fracture and hold it in place. These include surgical nails, screws, wires, rod, and metal plates. The surgeon may need to clean out the area around the fracture. This will reduce the risk of infection from the open wound.

Sometimes a fracture must be completely immobilised to heal. This can be done with a splint, brace, cast, traction, or open repair.
  • A splint is a firm object that is affixed to the areas surrounding the bone. A fractured finger is an example of a fracture that can be splinted.
  • A cast is a firm material made of either plastic or plaster. The cast is wrapped around the area of the broken bone. A layer of softer material is placed against the skin to protect it from injury and irritation. A fractured wrist is an example of a fracture that could be casted.
  • Traction holds a limb in alignment using pulleys and weights. It is not used very often anymore. It is sometimes used as a temporary measure until surgery can be done on a hip fracture.
  • Open repair uses a variety of tools to hold the bone pieces in place. These include surgical nails, screws, wires, rods, and metal plates.
What are the side effects of the treatments? 
A closed repair may have complications. The bone may not heal properly or it may not function properly. An open repair carries the same risks of any surgery. These include infection, bleeding, damage to blood vessels or nerves, and allergic reactions to the anaesthesia.

What happens after treatment for the injury? 
Fractured bones need at least 4 weeks to heal solidly. In the elderly or someone with diabetes, healing may take longer. A cast may be worn to prevent movement of the bone while it heals. Muscles in a leg or arm can become weak and tight while the bone heals. Therefore, many people who have a bone fracture need physiotherapy. The therapy begins while the bone is immobilised and continues after the splint, cast, or traction has been removed.

A person who has had an open repair needs to watch for signs of infection, swelling, or numbness. Any new or worsening symptoms should be reported to the doctor.

The bone is usually strong and fully functional once it has completely healed.

Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 10/05/2005
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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