Bone fracture (patient information)

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Overview
A bone fracture is a break in a bone. If more pressure is put on a bone than it can stand, it will split or break. A break of any size is called a fracture. Fractures are usually very painful.

What are the symptoms of Bone fracture?
Symptoms of a fracture are:
 * Out-of-place or misshapen limb or joint
 * Swelling, bruising or bleeding
 * Intense pain
 * Numbness and tingling
 * Limited mobility or inability to move a limb

What causes Bone fracture?
The following are common causes of broken bones:
 * Fall from a height
 * Motor vehicle accidents
 * Direct blow
 * Child abuse
 * Repetitive forces, such as those caused by running, can cause stress fractures of the foot, ankle, tibia, or hip

Who is at highest risk?
Fractures commonly occur because of falls or sports injuries. Additionally, overuse can cause stress fractures, which are very small cracks in the bone. Therefore, those who participate in rigorous physical activities or in high risk activities are more likely to get a fracture. Another common cause of fractures is osteoporosis, which causes weakening of the bones. People with this condition, especially the elderly, are at higher risk of fractures due to falls since their bones cannot withstand as much stress.

When to seek urgent medical care?
Call 911 if:
 * There is a suspected broken bone in the head, neck, or back.
 * There is a suspected broken bone in the hip, pelvis, or upper leg.
 * You cannot completely immobilize the injury at the scene by yourself.
 * There is severe bleeding.
 * An area below the injured joint is pale, cold, clammy, or blue.
 * There is a bone projecting through the skin (compound fracture).

Even though other broken bones may not be medical emergencies, they still deserve medical attention. Call your health care provider to find out where and when to be seen.

If a young child refuses to put weight on an arm or leg after an accident, won't move the arm or leg, or you can clearly see a deformity, assume the child has a broken bone and get medical help.

Diagnosis
A bone fracture can be diagnosed clinically based on the medical history given and the physical examination performed. Imaging by X-ray is often performed to view the bone suspected of being fractured. In situations where x-ray alone is insufficient, a computed tomograph (CT scan) may be performed.

Treatment options
Treatment of bone fractures are broadly classified as surgical or conservative, the latter basically referring to any non-surgical procedure, such as pain management, immobilization or other non-surgical stabilization. A similar classification is open versus closed treatment, in which open treatment refers to any treatment in which the fracture site is surgically opened, regardless of whether the fracture itself is an open or closed fracture.

Since bone healing is a natural process which will most often occur, fracture treatment aims to ensure the best possible function of the injured part after healing. Bone fractures are typically treated by restoring the fractured pieces of bone to their natural positions (if necessary), and maintaining those positions while the bone heals.

A fractured limb is usually immobilized with a plaster or fiberglass cast or splint which holds the bones in position and immobilizes the joints above and below the fracture. When the initial post-fracture edema or swelling goes down, the fracture may be placed in a removable brace or orthosis. If being treated with surgery, surgical nails, screws, plates and wires are used to hold the fractured bone together more directly.

Occasionally smaller bones, such as phalanges of the toes and fingers, may be treated without the cast, by buddy wrapping them, which serves a similar function to making a cast. By allowing only limited movement, fixation helps preserve anatomical alignment while enabling callus formation, towards the target of achieving union.

Splinting results in the same outcome as casting in children who have a distal radius fracture with little shifting.

Surgical methods of treating fractures have their own risks and benefits, but usually surgery is done only if conservative treatment has failed or is very likely to fail. Occasionally bone grafting is used to treat a fracture. Sometimes bones are reinforced with metal. Your doctor will inform you if these procedures might be best for your injury.

Where to find medical care for Bone fracture?
Directions to Hospitals Treating Bone fracture

What to expect (Outlook/Prognosis)?
For most fractures, the whole process can take up to 18 months, but in adults the strength of the healing bone is usually 80% of normal by 3 months after the injury.

Several factors can help or hinder the bone healing process. For example, any form of nicotine hinders the process of bone healing, and adequate nutrition (including calcium intake) will help the bone healing process. Weight-bearing stress on bone, after the bone has healed sufficiently to bear the weight, also builds bone strength. Although there are theoretical concerns about NSAIDs slowing the rate of healing, there is not enough evidence to warrant withholding the use of this type analgesic in simple fractures.

Possible complications
Some fractures can lead to serious complications including a condition known as compartment syndrome. If not treated, compartment syndrome can result in amputation of the affected limb. Other complications may include non-union, where the fractured bone fails to heal or mal-union, where the fractured bone heals in a deformed manner.

In children, whose bones are still developing, there are risks of either a growth plate injury or a greenstick fracture.
 * A greenstick fracture occurs due to mechanical failure on the tension side. That is, since the bone is not as brittle as it would be in an adult, it does not completely fracture, but rather exhibits bowing without complete disruption of the bone's cortex in the surface opposite the applied force.
 * Growth plate injuries, as in Salter-Harris fractures, require careful treatment and accurate reduction to make sure that the bone continues to grow normally.
 * Plastic deformation of the bone, in which the bone permanently bends but does not break, is also possible in children. These injuries may require an osteotomy (bone cut) to realign the bone if it is fixed and cannot be realigned by closed methods.
 * Certain fractures are known to occur mainly in the pediatric age group, such as fracture of the clavicle & supracondylar fracture of the humerus.