A bone fracture is a break in a bone. The surrounding tissues are usually injured as well. Bone fractures are classified as:
Bone fractures are also classified by the position of the bone fragments, as follows:
A bone fracture occurs when the force against a bone is greater than the strength of the bone. Most fractures result from an injury, such as that caused by an automobile accident or a fall. Factors that increase a person's risk of bone fracture include:
Signs and symptoms of a bone fracture include:
A bone fracture is recognized by a history of the injury and the results of the physical examination. An X-ray of the area is done to confirm the diagnosis. Special imaging tests such as a CT scan or MRI may be needed to view the damaged area more clearly.
Some fractures can be avoided by following sports safety guidelines for children, adolescents, and adults.
Bone loss, which increases a person's risk of fractures, can be slowed by doing 30 minutes of moderate weight-bearing exercise a day. Weight-bearing exercise includes low-impact aerobics, walking, running, lifting weights, tennis, and step aerobics. A person doing moderate exercise can talk normally without shortness of breath and is comfortable with the pace of the activity. The 30 minutes a day can be done all in 1 session, or it can be broken up into smaller segments of time.
Low-impact aerobics and water aerobics are examples of exercises that minimize joint stress in elderly individuals or people with arthritis. Recent research has shown that people who do high-impact activities such as jogging have less bone loss as they age.
Individuals can lower their risk of bone fractures following osteoporosis by:
Emergency treatment consists of splinting the limb above and below the suspected fracture. This keeps the area from moving. Ice should be applied. The injured area should be elevated to reduce swelling and pain.
Repairing the bone can prevent a deformity of the bone as it heals. The bone repair may be classified as a closed repair, which is done without cutting into the skin, or an open repair, which involves surgery.
A closed repair is used if the bone is cracked completely, but the pieces are not quite in the right place. The healthcare provider pulls on the bone to get the bone pieces back in their proper position. For some fractures, splints or casts that restrict motion are used. Fractures of the collarbone, shoulder blades, ribs, toes, and fingers generally heal well with such treatment.
An open repair is done for more serious fractures, including:
An open repair is done in the operating room. A variety of tools are used to repair the fracture and hold it in place. These include surgical nails, screws, wires, rods, and metal plates. The surgeon may need to clean out the area around the fracture. This will reduce the risk of infection from the open wound.
Sometimes a fracture must be completely immobilized in order to heal. This can be done with a splint, brace, cast, traction, or open repair.
A closed repair may have complications. The bone may not heal properly or it may not function properly. An open repair carries the same risks as any surgery. These include infection, bleeding, damage to blood vessels or nerves, and allergic reactions to the anesthesia.
Fractured bones need at least 4 weeks to heal solidly. In the elderly or someone with diabetes, healing may take longer. A cast may be worn to prevent movement of the bone while it heals. Muscles in a leg or arm can become weak and tight while the bone heals. Therefore, many people who have a bone fracture need physical therapy. The therapy begins while the bone is immobilized and continues after the splint, cast, or traction has been removed.
A person who has had an open repair needs to watch for signs of infection, swelling, or numbness. Any new or worsening symptoms should be reported to the healthcare provider.
The bone is usually strong and fully functional once it has completely healed. The healthcare provider should be consulted about an appropriate weight-bearing exercise program to minimize the risk of future bone fractures.
To avoid further bone fractures in elderly individuals, the home should be made safe to prevent accidents. Ways to increase safety include:
Intriguing new research done in older individuals with arthritis found that brisk walking or weight training improved balance in those individuals. Improved balance could very well help such individuals avoid hip fractures and wrist fractures resulting from falls.
Author:Gail Hendrickson, RN, BS
Editor:Ballenberg, Sally, BS
Reviewer:Eileen McLaughlin, RN, BSN
The Merck Manual of Medical Information, 1997
Professional Guide to Diseases: 6th edition, 1998
Sheehy, Susan, Emergency Nursing Principles and Practice, 3rd Edition, 1997