Bone fracture
Also known as: broken bone, fractured bone
A break in the continuity of a bone, from a hairline crack to a shattered, displaced or open injury.
Overview
Bones break when the force exceeds their strength: a fall on the outstretched hand fractures the wrist, a twist the ankle, a car crash the femur. In weakened bone (osteoporosis, cancer) a minor force is enough. Bone heals by forming a callus that is remodelled over months; the aim of treatment is to hold the fragments in a good position while it does.
Causes
- Trauma: falls, sport, road accidents, assaults
- Repeated stress (stress fractures in runners and soldiers)
- Weakened bone: osteoporosis, tumours, infection
Risk factors
- Osteoporosis and older age
- Contact and high-speed sports
- Poor balance, medicines that cause falls
- Smoking, low vitamin D
Symptoms
What a clinician may find
- Pain, swelling, bruising, deformity
- Inability to bear weight or use the limb
- Crepitus
- Open wound over the bone in open fractures
Complications
- Damage to nerves and vessels
- Compartment syndrome
- Infection in open fractures
- Non-union or malunion
- Fat embolism, DVT
- Post-traumatic osteoarthritis
Diagnosis
X-rays in two views; CT for complex joint, spine and pelvic fractures; MRI for occult fractures such as the scaphoid or stress fractures; assessment of circulation and nerves beyond the break.
Treatment
Realign (reduce) if displaced, then hold: a cast or splint for stable fractures, or surgery with plates, screws, nails or external fixation for unstable ones. Pain relief, elevation, early movement of neighbouring joints, and physiotherapy. Open fractures need urgent cleaning and antibiotics.
Prevention
Fall prevention and bone health in older adults, protective equipment in sport, road safety, treating osteoporosis.
When to seek care
Emergency care for deformity, a bone through the skin, numbness or a cold pale limb, or a suspected hip, spine or pelvic fracture; same-day care for any inability to bear weight or use a limb after injury.