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Broken bones are a common occurrence in sports, road accidents and falls. As the bones become thinner and more brittle with age, they fracture more easily.


It can often be difficult to distinguish between a fracture and a sprain. With serious damage, the broken ends of bone may become displaced and cause an obvious deformity; occasionally the separate ends of a fractured bone may grate on one another, producing a noise (crepitus). Tenderness and pain can be useful in distinguishing between a serious sprain, which has a diffuse painful area, and the pain of a break, which is localized. Confirmation of a fracture is made by X-rays.

There are several types of fracture. In the simple type, the bone breaks in one place. A compound fracture is one in which the broken bone has pierced the surrounding tissues to emerge through the skin. It is open to the air - a hazardous situation because it may become infected. A comminuted fracture is one where the bone is broken in two or more places; an impacted fracture is one where the bony fragments are pushed into each other. In some impacted fractures of the upper thigh bone the victim may manage to hobble about with a slight limp and pain, unaware of the nature of the injury. A stress fracture is a fine crack appearing in bone after repeated minor injury. A greenstick fracture occurs only in children; the bone bends and stays bent and, as the name suggest, the inside of the bend cracks and crumples in the same way as when a supple green twig is bent.


Although there are different kinds of fracture, and there are many different bones that can fracture if they suffer enough damage, the basic treatment is straightforward. The first stage is to immobilize the fractured bone and the joints above and below the fracture. This will prevent the free ends of the broken bone from causing any more damage to surrounding tissues, and also prevent the severe pain that comes with movement of the fragments. In an emergency, a fractured arm can be strapped or splinted against the body, a leg against the other leg.

As bone is a living tissue with a blood supply, bleeding can occur when it breaks. Prompt medical attention is important to prevent shock. Bone also contains marrow am fat in its central core, and in major fractures marrow and fat can be squeezed out into blood vessels and occasionally cause a blockage (embolus) elsewhere in the system.

In hospital, the aim is to 'reduce' the fracture that is, to move the broken pieces into a good position so that the bone will heal and function again. The bone is held in this position by a plaster cast, although sometimes it is necessarv to screw or nail the fragments together with a pin or plate to keep them in place. In some situations the muscles, particularly in the upper leg, are so strong that they pull the reduced fracture apart again, unless the limb is put in traction, that is, by weights suspended from pulleys attached to the limb and arranged to counteract the muscle pull.

Once the bone fragments have united the next stage is to return the injured person to full activity in the shortest time possible. This rehabilitation phase requires effort from both patient and physiotherapist to maintain circulation, minimize the wasting of muscles and reduce joint stiffness.

In elderly patient, particularly if they are bedridden, pneumonia may develop following fractures. Another complication is the slow or ineffective healing of the bone Union of the fragments can be very slow, and although it should be complete in six to ten weeks it may take up to six months. Occasionally it may never occur, and surgery is then needed to join the fractured ends with a plate or metal pins. Surgery may be necessary for another complication, 'mal-union' when the bone heals in the wrong position.

A 'fracture dislocation' is a fracture complicated by a dislocation, when both result from the same injury.

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