© Cambridge Fracture Clinic - Mr Lee Van Rensburg - Cambridge; United Kingdom
Fractures overview
General
A fracture is technically any break in the continuity of the bone. People often ask is it a fracture or a break, these are one and the same. Several words are used to describe the same thing and when doctors try to simplify things it may create more confusion. Certainly some fractures are worse than others, it depends what bone is broken, where it is broken, how many pieces it has broken into and how the pieces are lining up There are a few special kinds of fractures: Buckle or greenstick fracture In young children the bone is not brittle, a bit like a green twig and often don't snap cleanly but may buckle up or only break on one side, much like trying to break a greenstick hence the name Stress fractures These are an accumulation of micro fractures of the bone, often due to overuse, an example is shin splints in runners. Pathological fractures This is where the bone has been weakened by something, the fracture occurring with relatively low energy.Describing fractures
Doctors often describe fractures in several ways. Open Vs Closed An open fracture is where the skin overlying has been cut or split by the bone The significance is open fractures are more prone to infection and often require surgical treatment to clean, washout and stabilise the fracture. A closed fracture is where there is no break in the skin. Compound is an old fashioned term for an open fracture. Simple Vs Multifragmentary A simple fracture is where the bone has been broken into 2 pieces. If it has been broken into several pieces it is said to be multifragmentary. Comminuted is another term used to describe where a bone has been broken into several pieces, not to be confused with compound(open). Displaced Vs Undisplaced A displaced fracture is where the bone fragments have moved apart. An undisplaced fracture is where the fracture fragments have not moved far apart and are in a good position. Intra-articular Vs Extra-articular Intra articular fractures are where the fracture involves the joint surface. When a fracture involves the joint surface the fragments need to be perfectly reduced to avoid future arthritis of that joint. Extra-articular fractures are fractures that do not involve the joint surface. They require the bones to be in an overall good alignment.Fracture treatment
There are a lot of variables taken into account when deciding the perfect way of treating a fracture. There is no one size fits all. In some patients it may be best to let it heal on its own in a cast, in another an operation might be best. The general principles of fracture treatment include: • Reduce • Hold • Heal • RehabilitateReduce
It is important that the fracture fragments are placed in a position where they will heal and optimize function. In undisplaced fractures the pieces are often already in a good position and as such only need to be held and protected in that position till they heal. If displaced, particularly if involving the joint, then the pieces need to be reduced/ placed in a near perfect position. This may be possible with a simple manipulation of the fragments. If it is not possible to reduce the fragments into a satisfactory position then an open reduction may be needed, ie the skin is cut open and the bone fragments placed in the optimal position.Hold
Once the bone fragments are in a satisfactory position they need to be held there until they heal. Healing times for different fractures vary from weeks to months. It is possible to hold bone fragments in place with a splint or a cast in undisplaced or stable fractures, that are likely to heal well and fairly quickly. If displaced or unstable or if it is critical to hold the pieces in a perfect position, eg in intraarticular fracture, then often some form of fixation would be used. If a fracture is likely to take a very long time to heal it may be fixed to optimize function and allow early return to function. The various forms of fixation include: K wires- Thin stainless steel wires usually placed through the skin. External fixation - A frame is built outside the body and anchored to the bone with long screws or fine wires in the bone. Internal fixation - There are two main ways to internally fix fractures. Plates and screws or an Intramedullary nail. An intramedullary nail is a metal rod that is placed in the marrow cavity (centre of the bone). Joint replacement - If the joint is badly damaged and not reconstuctible then it may be best to simply replace it with an artificial joint.Heal
If a bone has healed it is said to have united or achieved union. Healing times are very variable shorter when we are younger and longer as we get older. In general adults take twice as long as children to heal. Some bones themselves are prone to healing slowly, usually bones where the blood supply is not very good. If a bone is being slow to heal it is called a delayed union, if it does not heal in the expected time it is called a non union. (See fracture healing for more information)Rehabilitate
The whole aim of fracture and injury treatment is to return the patient to optimum function safely and as soon as possible after an injury. Muscles waste very quickly if they are not used. Rehabilitation starts as soon as you have injured yourself, don't wait till the plaster comes off. For example if you have broken your wrist and are in a cast, keep the elbow and the shoulder moving so the muscles don't waste away and stiffen up. Physiotherapy may be prescribed before or after an injury to help you recover. Children in general do not need physiotherapy.
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Fractures overview
General
A fracture is technically any break in the continuity of the bone. People often ask is it a fracture or a break, these are one and the same. Several words are used to describe the same thing and when doctors try to simplify things it may create more confusion. Certainly some fractures are worse than others, it depends what bone is broken, where it is broken, how many pieces it has broken into and how the pieces are lining up There are a few special kinds of fractures: Buckle or greenstick fracture In young children the bone is not brittle, a bit like a green twig and often don't snap cleanly but may buckle up or only break on one side, much like trying to break a greenstick hence the name Stress fractures These are an accumulation of micro fractures of the bone, often due to overuse, an example is shin splints in runners. Pathological fractures This is where the bone has been weakened by something, the fracture occurring with relatively low energy.Describing fractures
Doctors often describe fractures in several ways. Open Vs Closed An open fracture is where the skin overlying has been cut or split by the bone The significance is open fractures are more prone to infection and often require surgical treatment to clean, washout and stabilise the fracture. A closed fracture is where there is no break in the skin. Compound is an old fashioned term for an open fracture. Simple Vs Multifragmentary A simple fracture is where the bone has been broken into 2 pieces. If it has been broken into several pieces it is said to be multifragmentary. Comminuted is another term used to describe where a bone has been broken into several pieces, not to be confused with compound(open). Displaced Vs Undisplaced A displaced fracture is where the bone fragments have moved apart. An undisplaced fracture is where the fracture fragments have not moved far apart and are in a good position. Intra-articular Vs Extra-articular Intra articular fractures are where the fracture involves the joint surface. When a fracture involves the joint surface the fragments need to be perfectly reduced to avoid future arthritis of that joint. Extra-articular fractures are fractures that do not involve the joint surface. They require the bones to be in an overall good alignment.Fracture treatment
There are a lot of variables taken into account when deciding the perfect way of treating a fracture. There is no one size fits all. In some patients it may be best to let it heal on its own in a cast, in another an operation might be best. The general principles of fracture treatment include: • Reduce • Hold • Heal • RehabilitateReduce
It is important that the fracture fragments are placed in a position where they will heal and optimize function. In undisplaced fractures the pieces are often already in a good position and as such only need to be held and protected in that position till they heal. If displaced, particularly if involving the joint, then the pieces need to be reduced/ placed in a near perfect position. This may be possible with a simple manipulation of the fragments. If it is not possible to reduce the fragments into a satisfactory position then an open reduction may be needed, ie the skin is cut open and the bone fragments placed in the optimal position.Hold
Once the bone fragments are in a satisfactory position they need to be held there until they heal. Healing times for different fractures vary from weeks to months. It is possible to hold bone fragments in place with a splint or a cast in undisplaced or stable fractures, that are likely to heal well and fairly quickly. If displaced or unstable or if it is critical to hold the pieces in a perfect position, eg in intraarticular fracture, then often some form of fixation would be used. If a fracture is likely to take a very long time to heal it may be fixed to optimize function and allow early return to function. The various forms of fixation include: K wires- Thin stainless steel wires usually placed through the skin. External fixation - A frame is built outside the body and anchored to the bone with long screws or fine wires in the bone. Internal fixation - There are two main ways to internally fix fractures. Plates and screws or an Intramedullary nail. An intramedullary nail is a metal rod that is placed in the marrow cavity (centre of the bone). Joint replacement - If the joint is badly damaged and not reconstuctible then it may be best to simply replace it with an artificial joint.Heal
If a bone has healed it is said to have united or achieved union. Healing times are very variable shorter when we are younger and longer as we get older. In general adults take twice as long as children to heal. Some bones themselves are prone to healing slowly, usually bones where the blood supply is not very good. If a bone is being slow to heal it is called a delayed union, if it does not heal in the expected time it is called a non union. (See fracture healing for more information)Rehabilitate
The whole aim of fracture and injury treatment is to return the patient to optimum function safely and as soon as possible after an injury. Muscles waste very quickly if they are not used. Rehabilitation starts as soon as you have injured yourself, don't wait till the plaster comes off. For example if you have broken your wrist and are in a cast, keep the elbow and the shoulder moving so the muscles don't waste away and stiffen up. Physiotherapy may be prescribed before or after an injury to help you recover. Children in general do not need physiotherapy.
