Sports Medicine

Fractures

Description

A fracture is a broken bone. Although bones are rigid, they do bend with limited flexibility when outside force is applied. When that force is too great, the bone will fracture. Common causes of fractures include: trauma, such as an automobile or sports-related accident; osteoporosis, which can weaken the bone; or overuse caused by repetitive motion that can tire muscles and place excess force on the bone, resulting in stress fractures like those most often seen in athletes.

Types of Fractures

A bone may fracture completely, partially, crosswise, lengthwise, in multiple pieces, or in a variety of other ways. Common types of fractures include:

• Open compound fracture—Fragments of broken bone protrude through the skin, or a wound penetrates down to the broken bone. Infection occurs more easily when skin is broken, making this fracture particularly serious. Healing is also less predictable with this type of fracture, due to an interruption of the blood supply.
• Stable fracture—The broken ends of the bone line up neatly.
• Transverse fracture—The fracture line is horizontal.
• Oblique fracture—The fracture has an angled pattern.
• Comminuted fracture—The bone shatters into three or more pieces.

Symptoms

In addition to extreme pain which may make motion of the injured area difficult or impossible, other common symptoms include: swelling and tenderness around the injury; bruising; or a deformed appearance, such as the limb looking "out of place," or bone that has punctured through the skin.

Examination

Your doctor will assess the extent of your injury by performing a careful and thorough examination that most commonly includes an X-ray. By providing clear images of the bone, an X-ray will enable your doctor to see if the bone is fractured and if so, diagnose what type of fracture has occured and what treatment is required.

Treatment

In a process called "reduction," the parts of broken bone must be restored to their original position and held in place until healed. Depending on the severity of the fracture, surgery may be required. Fracture treatments include:

• Cast immobilization—A plaster or fiberglass cast keeps reduced (repositioned) bone firmly in place while healing.
• Functional cast or brace—Allows limited, or controlled, movement of nearby joints, appropriate for some fractures.
• Traction—Fractured bone is aligned by traction's gentle, steady pulling action.
• External fixation—Metal pins or screws inserted into the broken bone above and below the fracture site are connected to a metal bar outside the skin, creating a stabilizing frame to hold the bones in place while healing. When skin and soft tissues around the fracture are damaged, an external fixator may be applied until surgery can be tolerated.
• Open reduction and internal fixation—Bone fragments are reduced (repositioned) in normal alignment and held together with special screws or by attaching metal plates to the outer surface of the bone. Fragments may also be held together by inserting rods through the marrow space in the bone's center.

Recovery

Soon after a fracture occurs, the body responds by forming a protective blood clot and callus around the fracture. New bone cells on both sides of the fracture line begin growing toward each other, healing the fracture by "knitting" the bone back together with new bone that forms around the broken edges. As the fracture closes, the callus is absorbed. This healing process may require several weeks to several months, depending on the injury and how well you follow your doctor's advice. Pain usually stops long before the fracture is healed enough to handle the stresses of normal activity so you may need to continue limiting movement, even after the cast or brace is removed. During recovery, loss of muscle strength in the injured area is common. Specific exercises will be recommended to help you restore normal muscle strength, joint motion, and flexibility.

Prevention

A diet rich in calcium and Vitamin D and weight-bearing exercise can improve bone strength, which may help to prevent some fractures.

VIDEO: Ankle Injuries with Kirk Cousins & Dr. Bruce Stewart, Holland Hospital Sports Medicine