Fractures, commonly known as broken bones, can be of several different types. Recovery takes anything from a few weeks to several months depending on the severity of the fracture, and the best treatment varies. Mild bone fractures heal naturally without any intervention; severe bone fractures may need surgery, immobilisation and physiotherapy once healing has reached a certain stage.

WHAT CAUSES A BONE FRACTURE?

Common causes of bone fracture include traumas such as a car crash, falling from a ladder, or sometimes just slipping over and landing awkwardly. The reason for a broken bone is usually obvious. Stress fractures can occur through repeated exercise, training or some other repetitive activity. These are usually hairline fractures in a weight-bearing bone, commonly the tibia in the lower leg. Stress fractures are common in athletes.

WHAT ARE THE TYPES OF BONE FRACTURE?

A wide range of fracture types are recognised:

• Complete fractures: the bone is broken into 2 or more separate parts; such fractures are severe. Complete bone fractures are classified by direction – transverse, oblique or longitudinal. They may also be spiral or winding.
• Open fractures or compound fractures: these are complete breaks in which a bone pierces the skin. Such bone fractures carry risk of infection and should receive emergency medical care.
• Closed fractures or simple fractures: the bone does not penetrate the skin.
• Incomplete fractures: the bone is cracked, but not separated into 2 parts. Hairline fractures are mild forms of incomplete fractures.
• Displaced fractures: complete fractures in which the bone fragments are misaligned. This usually needs to be treated using surgery to move the 2 parts of the bone back into place so they can heal.
• Comminuted fractures: the bone is smashed into several pieces.
• Greenstick fractures: the bone is cracked but the break does not extend completely through the bone. Greenstick fractures are so-called because they are like breakages caused to a ripe twig when you severely bend it. Greenstick fractures are most common in children, because their bones are more flexible.
• Buckle fractures: greenstick fractures in which the bone bends but does not break.
• Compression fractures occur when bone collapses and starts to break up. Most commonly seen in people with degenerative disorders of the spine.
• Avulsion fractures: a bone breaks because of an injury that causes extensive tearing of muscle and ligament.

A dislocated joint is not classified as a broken bone, but it can occur with a bone fracture in a serious injury.

WHAT ARE THE SYMPTOMS OF BONE FRACTURE?

If you have a broken bone you will feel pain, dizziness and possibly nausea. You will be unable to move the injured limb or apply any pressure to it. You may also experience a grinding sensation within it.

Symptoms of a broken bone also include bruising, swelling, tenderness, discolouration and bleeding if the bone fracture is open. The limb or limb-part may also be misaligned, particularly if the fracture is complete.

WHO IS AT RISK OF BONE FRACTURE?

Everybody is at risk of a broken bone, but some people are more at risk than others:

• Older people: many older people suffer from osteoporosis, or overly porous bones. The porous bones tend to be thinner and more brittle. About 50 % of women and about 20 % of men suffer a broken bone after the age of 50.
• Post-menopausal women: a lack of oestrogen increases the risk of osteoporosis.
• Athletes and dancers: contact sports such as hockey and football carry risk of various types of bone fracture, including open ones. Non-contact sports, even jogging, carry risk of stress fractures. Some non-contact sports – horse-riding, cycling, and skiing are examples – carry risk of very severe fractures. If you are an athlete, ensure you wear the correct clothing, especially body armour and footwear. Improvements in ski-shoes, for instance, have vastly reduced the numbers of ankle and lower leg breaks.
• People with chronic disease or poor health: these include people who have diabetes, osteomyelitis, rheumatoid arthritis, previous or ongoing bone infection and cancers that have spread to the bones.
• People with poor lifestyle: poor diet, particularly in the form of lack of vitamins and minerals, adds to the risk of osteoporosis. It is also important to practise regular exercise. If you exercise vigorously, ensure your exercise is varied. Lack of varied exercise coupled with vigorous exercise increases risk of stress fractures. A good way to reduce your chance of a broken bone is to eat well, exercise regularly and expose yourself to sunlight so that you are not deficient in vitamin D.
• Children: children’s bones are growing, so are supple; they are at special risk of greenstick and buckle fractures.

WHAT TO DO IF SOMEONE HAS A BONE FRACTURE

If there is any suspicion of skull fracture, compound or other serious bone fracture, it is important to call an ambulance immediately. Do not attempt to move the person or to construct a splint; leave such matters to paramedics. Remember that the more quickly a bone fracture is treated, the more quickly and the better it is likely to heal.

DIAGNOSIS AND TREATMENT

Diagnosis will be confirmed using X-rays to determine the extent of the break. Mild pain may be treated with over-the-counter analgesics. Severe pain will require more specialised pain relief, usually delivered intravenously in hospital.  Where possible, the broken bone is immobilised using a splint and sometimes the bone is reset. In compound and other severe fractures, this will involve surgery to reset the bone. If necessary the surgeon will also insert metal pins, rods or plates.

Bone tissue normally heals itself. Muscle tissue, however, also takes time to heal, and there is a danger that a long period of inactivity due to a bone fracture will cause loss of muscle tissue. A serious bone fracture will, therefore, require extensive physiotherapy, sometimes lasting 6 months or more. If you suffer a bone fracture, it is vital that you return to normal physical activity as soon as possible.