Did You Break a Bone? All about fractures

19 March 2019

Article by: By Dr Ahmad Hisham, Consultant Arthroplasty, Orthopaedic & Trauma Surgery

Adult human skeleton consists of 206 bones. At birth we have 270 bones in our body but as we grow up, some of the bone fused together to form single bone.  The functions of bone can be divided into

1. Body movement
2. Support for our body
3. Protection for certain organ
4. Production of blood cells
5. Storage of ion
6. Hormonal regulation and production

Bone fracture is the medical term used when there is a break in the continuity of the bone.  Fractures can be as a result of

1. Single traumatic incident where there is high energy stress impacted to the bone for example in fall from height.
2. Repetitive stress to the bone for example in a runner due to improper footwear, repetitive stress to the foot during running can result in fracture of the bone in the foot
3. Pathological fracture in which the bone is weaken by a disease or condition such as tumour and fracture result due to a low force or trauma that normally cause fracture in healthy bone.

Clinical features of fracture

Most of the time there will be obvious history of trauma associated pain, swelling, deformity or inability to use the limb. There can be some bruises and tender at the fractured bone and movement of the limb will likely aggravated the pain.

The moment that the bone is suspected to be fractured, the limb must be put on splint to prevent movement of the fractured bone because movement of the bone will cause severe pain and also the bone end can further damage the surrounding tissue.

Doctors usually after examined the limb and making sure the blood circulation is good and no nerve damage will order plain radiograph to see the bone.

Type of fracture

Fractures can be divided into 2 categories. The first one is open fractures. In this type of fracture, the break in the bone is accompanied by a wound which can expose the bones end to external environment. This type of fracture usually need emergency treatment which may include surgery to clean the wound and bone ends, implants or external fixator to hold the bone together and antibiotic to combat infection.

The second category is closed fracture. This is where there is a break in the bone but the overlying skin is intact. In this type of fracture, the treatment can either be immobilization with a cast or splint or surgery depends of the location of the fracture and also displacement of the fracture. Generally if the fractured bone is not displaced, it can be treated without surgery.

Example 1

This patient had closed fractured at the lower end of his arm bone (radius). On the plain radiograph, the fracture is not displaced and since it is a closed fracture, it can be treated with a cast.

The cast is made from either plaster of Paris or fibreglass. Fiberglass cast is the better option since it is stronger, lighter and waterproof. The roll of either plaster of Paris or fiberglass is applied around the upper limb just below the fingers up to mid-part of the arm. By preventing the movement of the wrist and the elbow joint, the fractured end will not move.

Example 2

This patient had closed fracture of the left femur. In this type of fracture, it is best treated with surgery and metal implant in inserted to hold the bone together.

How the bone heal

There are five stages of bone healing which can be divided into

1. Tissue destruction and haematoma formation
   This stage happens at the time of trauma. Usually the tissue around the bone too will be injured. There will be bleeding from the bone end and surrounding torn tissue. These bleeding eventually will form a blood clot known as haematoma

2. Inflammation and cellular proliferation
   At this stage, there will multiplication of cell around the fracture and the blood clot will be slowly absorbed.

3. Callus formation
   At this stage new bone called callus will start to form and bridge the gap between the fractured bones. This type of bone is still soft and not fully mineralised yet

4. Consolidation
   This is where the soft bone is slowly transformed into dense bone which will be able to withstand normal load. At the end of this stage the fracture is considered heal and patient is able to do his normal activities

5. Remodelling
   Although the fracture had already healed, the will be continuous remodelling of the bone over period of months. Eventually especially in children, the bone resume it former shape.

Healing of the bone depend on the part of the bone fractured, pattern of the fracture, age and general health condition. Generally callus will be visible on plain radiography after 2 to 3 weeks and the fracture healed in 6 to 8 weeks in the upper limb and 12-16 weeks in the lower limb.

Your doctor will advise you regarding treatment options available to treat your bone. In most cases the option of treatment with a cast or splint or surgery will be decided by you after discussion with your doctor. But in certain type of fracture your doctor will advise you for surgery with implant. Some of the types of fracture that will require surgery and fixation with implant are unstable fracture, displaced fracture involving the joint or multiple bones fracture.

Unstable fracture is where the fracture will not stay in an acceptable position and will moves again even though it is pulled into position. Putting a cast will not sufficiently hold the bone end together. In this type of fracture putting a plate and screws is a better option.

Fractures involving the joint will need accurate reduction otherwise this can result in painful joint movement even though the fracture has healed. In most cases of displaced intra-articular fracture, good reduction can only be attained by surgery.

Some patient will have multiple fractures involving more than one limb. It will be cumbersome for the patient to have cast on multiple limbs as it may severely affect the daily activities and making the patient totally dependent on others. In this case it is better to have surgery to reduce and fix the fractures.

All fractured bone will healed as long as the bone end is in contact even if you do not seek any medical treatment but your doctor will make sure that your bone heal in the most proper position to ensure good function.

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