Broken Bone (Types of Bone Fractures) (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Jerry R. Balentine, DO, FACEP
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
In this Article
- What is a broken bone (fracture)?
- What causes a broken bone?
- What are the most common types of broken bones?
- Compression fracture
- Skull fracture
- Stress fracture
- What are the most common bones that are broken?
- Broken hand or fingers
- Broken wrist
- Broken hip
- Broken leg
- Broken toe
- Broken shoulder
- What are the signs and symptoms of a broken bone?
- When should I call a doctor if I think I have broken a bone?
- How is a broken bone diagnosed?
- What is the treatment for a broken bone?
- What about surgery for a broken bone?
- How can fractures be prevented?
- What is the prognosis for a broken bone?
- Find a local Doctor in your town
What is the treatment for a broken bone?
The initial treatment of a fracture begins with stabilization and immobilization. In the field RICE (rest, ice, compression and elevation) may help make the patient more comfortable and prevent the fractured bones from moving. Often the pain associated with a fracture is due to spasm of the muscles surrounding the fracture site trying to prevent movement. Splinting may help relieve some of that pain. Depending upon the injury, EMS providers may consider traction to help with stabilization and pain control.
For non-open fractures, or other fractures that can be treated without emergency surgery, the goal is to immobilize the injury to maintain anatomic alignment to allow the bone to heal.
Bone heals in three stages.
- Reactive stage: The blood clot that forms at the fracture site begins to organize and the body's building blocks start to bridge the gap between the two ends of the broken bone.
- Repair stage: Specialized cells located in the outer lining of the bone (periosteum), begin to form a lattice work or grids of cartilage and bone, called a callus, which spans the fracture. More bone is laid down to provide strength to the area.
- Remodeling phase: Over the next few years, the body will attempt to resculpt this mass of bone into it's original size and shape.
In the emergency department, walk in clinic, or doctor's office, the extremity is usually splinted using a combination of soft padding, casting material (plaster, fiberglass), and ace wraps. This splint is not circumferential like a cast, because a fracture has the potential for swelling of the surrounding tissues, and if a tight cast were in place, that swelling could cause complications including significant pain and potential blood supply issues.
Once the patient is discharged, their instructions are to elevate the injury and ice the area, even with the splint, to help decrease swelling and inflammation.
After a few days, once the initial swelling has resolved, a circumferential cast may replace the splint and will be worn until the fracture is healed. The time frame for healing depends upon the type of fracture and its location. X-rays may be used to help determine when it is time for the cast to be removed.
Finger and hand fractures may be more complicated. The hand is a complex web of tendons, blood vessels, and nerves that allow fine motor function. What might be acceptable healing and alignment in an arm or leg may not be appropriate in a hand. Some finger injuries need nothing more than a metal splint or buddy taping one finger to another for support, while others will need surgery. The type of treatment will depend upon the type of injury.
Most toe injuries heal very well own and need nothing more than buddy taping one toe to another for support.
The treatment for rib fractures involves pain control so that the patient can take deep breaths and allow the lung to expand beneath the injury site to prevent pneumonia. Rib injuries are not wrapped or bandaged to help with pain control because this will limit their movement, and prevent lung expansion. Because of this, rib fractures generally take 4 to 6 weeks to heal and may cause pain throughout the healing process.
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