What is a fracture?
A fracture refers to the breakage of bones of a certain location. The breakage may be partial or complete. Fractures can be classified into two categories:
- Open fracture: This occurs when the fractured bone is visible through a deep wound or a fractured bone pokes through the skin. It is also known as a compound fracture.
- Closed fracture: This occurs when there is breakage of bones, with overlying skin intact
Types of Fractures
Fractures are of various types. Some of the most common types of fractures are as follows:
Comminuted fracture: Fractures of this kind occur when the bone has broken into multiple fragments
Greenstick fracture: This is an incomplete or partial fracture, wherein bone is broken, from one side & bent from another
Hairline fracture or stress fracture: Repetitive movements or overuse of muscles exert pressure on the surrounding bones leading to a stress fracture. This is especially common among athletes.
Avulsion fracture: When a bone fragment is separated from the main mass, it is known as an avulsion fracture. This is caused when a ligament or muscle pulls on the bone.
Spiral fracture: When a bone breaks in a spiral pattern, it is referred to as a spiral fracture.
Transverse fracture: When the bone breaks transversely, it is called a transverse fracture.
Oblique fracture: As the name suggests, the break happens diagonally across the bone.
Linear fracture: When a bone breaks parallel to the long axis of the bone, it is called a linear fracture.
Displaced fracture: Here, the bone breaks into several fragments, making the bone lose alignment, giving rise to a displaced fracture.
Pathological fracture: This type of fracture is caused as a result of a disease that causes weakening of the bones like osteoporosis, cancer of the bones, etc.
Undisplaced / Stable fracture: When the fracture is not serious enough for the fragments to be displaced for their position, it is known as a stable fracture.
Torus fracture: In this case, the affected bone gets deformed, but does not get fractured. Also known as buckle fracture, it causes pain but is a stable fracture. It is usually the most common fracture among children.
Causes of a fracture
Fractures occur when excessive force is exerted on a bone that it can withstand. This force can be applied by an accident or fall, causing trauma to the affected area. Fractures may be the result of certain medical conditions of the bone like osteoporosis or bone cancer. Bones are the weakest when they are twisted.
Symptoms of a fracture – The symptoms of fractures vary greatly between individuals. Not all possible symptoms may be experienced by all. Some of the most common symptoms of fractures are as below:
crepitus, abnormal mobility, swelling of affected limb, pain, deformity
Diagnostic procedure for a fracture
The diagnosis for fractures generally follow the below process:
Physical examination: The doctor will thoroughly examine the affected area to understand the underlying cause of the symptoms.
Enquiry about medical history: The doctor will inquire about medical history. This will enable him/her to diagnose whether the existing symptoms might be caused due to one of those medical conditions.
Medical tests: The doctor may recommend the following diagnostic tests:
- X-ray: This imaging test recreates a two-dimensional image of bone fragments by using beams of electromagnetic energy.
- MRI (Magnetic Resonance Imaging): This imaging test utilises radio frequencies to produce exact images of bones, organs, and tissues.
- CT or CAT (Computer Tomography) scan: This makes use of X-rays to produce detailed images of a cross-section or slices of bones of the affected area onto a computer, which is then recreated onto a scan. This is again helpful for diagnosing stress or hairline fractures.
- Bone scan: A thesis scan is considered to be the most effective in diagnosing fractures, even those that may not appear in an X-ray. This scan generally requires 2 sessions, 4 hours apart, to capture images from the affected location.
Treatment for a fracture
The primary motive behind treatment for fractures is to join the broken piece back in its original place, give it time to heal, control pain, and prevent fractures from occurring in the same location.
Here are the various treatments that be prescribed:
Medicine: Analgesics may be prescribed to keep pain under control.
Cast or splint: This may be recommended to make the affected area immobile. It offers the much-needed support that fractures need, especially during slight movements. It also aids in keeping the bone accurately aligned.
Traction: This usually involves using weights, strings, and pulleys to stretch and pull certain tendons and muscles around fractures. These weights, pulleys, and strings, along with a metal frame, are installed on or over the bed. This helps in aligning the bone, gradually adding to the healing process.
Surgery: This may be recommended when the nature of the fracture is such that fragments of bones have to be fixed back together in their original place. Surgery, in such cases, can be of two types, depending on the nature of fracture:
- Internal fixation: This involves fixing the broken bones with plates or metal rods inside the bone to align the bones accurately.
- External fixation: In contrast to internal fixation, external fixators are installed outside the body for the necessary alignment of bones.
Despite these measures, it takes months for fractures to heal since it takes time for new bones to develop between the bone fragments and join the broken parts together.
Dr. Rajesh Verma, Director & Senior Consultant – Orthopaedics, Spine Surgery, Dharamshila Narayana Superspeciality Hospital, Delhi.