Brief overview
- What is a fracture? Fracture is the medical term for a bone fracture.
- Forms of fracture: e.g. open fracture (bone fragments are exposed), closed fracture (no visible bone fragments), luxation fracture (fracture close to the joint with dislocation of the joint), spiral fracture (spiral fracture line).
- Symptoms: pain, swelling, limited mobility, possibly malalignment, visible bone fragments in open fracture.
- Treatment: either conservative (e.g. by means of a plaster cast) or surgical.
- Prognosis: depends, among other things, on the location, type and severity of the fracture, the age and general health of the patient. With prompt adequate therapy, a fracture usually heals well and without consequences.
Fracture: Description
Bone structure
Humans have a total of 206 different bones. In some places, bones have “predetermined breaking points” such as the upper arm, which is particularly susceptible to fracture. Each bone consists of mineral, elastic and connective tissue components. Blood vessels also run through the bone. Nerve fibers also run in the periosteum. Depending on the age of the person, the composition of his bones varies:
Adult bones have a balanced proportion of mineral, elastic and connective tissue components.
In older people, the bones lose elastic and connective tissue components and therefore break more easily. In addition, bones become increasingly decalcified in old age due to changes in hormone balance, which makes them brittle and fragile. A 70-year-old is therefore three times more likely to fracture than a 20-year-old.
Fracture healing
The fracture healing time varies depending on the skeletal section. For example, a clavicle fracture takes only about three to four weeks with conservative treatment, while a femur fracture takes about ten to fourteen weeks to heal.
In children, a bone fracture heals more quickly because they are still growing and axial misalignments and shortenings can still be corrected. A bone fracture in children can therefore usually be treated conservatively.
Indirect fracture healing
Most commonly, bone heals via indirect fracture healing. This means that the bone forms a so-called callus at the fracture ends, a scar tissue of the bone that bridges the gap between the bone ends. Bone fracture healing occurs in five phases:
Injury phase: This is where the fracture happens.
Direct fracture healing
Impaired fracture healing
A clearly prolonged fracture healing indicates a disturbed fracture healing. The X-ray shows a widened fracture gap.
If no bony union has formed at the two ends of the fracture after four to six months, physicians speak of a “false joint” (pseudarthrosis).
Fracture: symptoms
Unsafe fracture characters:
- Movement can be performed spontaneously.
- Pain on movement
- Loss of function of the joint
- Swelling
Sure signs of fracture:
- malposition
- incorrect mobility
- crunching during movement
Open and closed fracture
If the skin over the fracture is open, it is an open fracture. It should initially be covered sterilely at the site of the accident and only uncovered again under sterile conditions during surgery. This prevents germs from entering the wound.
Fracture: examinations and diagnosis
The responsible specialist for suspected fractures is a doctor of orthopedics and trauma surgery.
Medical history
He will first ask you in detail about the course of the accident and your medical history (anamnesis). Possible questions are:
- How did the accident occur? Was there direct or indirect trauma?
- Where do you suspect a fracture?
- How do you describe the pain?
- Were there any previous injuries or previous damage?
- Were there any previous complaints?
After the anamnesis interview, the doctor examines the patient. He inspects the affected area looking for malpositions and swellings. He also feels for pressure pain or if the muscles are particularly tense. Furthermore, he checks whether the movement can be performed correctly and whether a creaking or grinding sound is produced.
Imaging
A subsequent X-ray examination in two planes can confirm the suspicion of a bone fracture. If the pelvis or spine is affected, a computed tomography (CT) scan is usually performed for more detailed clarification. This can also detect a so-called occult fracture – a bone fracture that is not visible in the X-ray.
Fracture: Causes and risk factors
When most people hear the term fracture, they think of a traumatic bone fracture: a sufficiently high force has broken what is actually a strong and elastic bone. However, a fracture can also be caused by a disease. Basically, there are three mechanisms of occurrence for a bone fracture:
- A direct fracture occurs when force is applied to the healthy bone from the outside.
- A fatigue fracture (stress fracture) is caused by sustained mechanical stress, such as during long marches or marathon running.
Fracture forms
Depending on the incoming force and the shape of the bone, different forms of fracture result:
- Rotational or torsional fracture: It is caused by indirect force, in that tensile stresses occur in the bone due to a rotation. This fracture can occur, for example, when falling in a ski boot with a blocked safety binding.
- Spiral fracture: It has a spiral fracture gap and is caused by torsional loads. Often, an axial load or gravity also plays a role. A spiral-shaped rotation wedge usually develops.
- Compression fracture: It usually occurs in the longitudinal axis of the body due to an indirect force. This usually affects the loose honeycomb structure of the cancellous bone, which is irreversibly compressed. Typical examples are the vertebral body fracture and the calcaneal bone fracture.
- Luxation fracture: This is a fracture close to the joint in which the joint is also dislocated. There are two mechanisms of origin: either the dislocation is the cause of the fracture or the fracture and dislocation occurred simultaneously. Dislocation fractures can occur, for example, at the ankle joint, tibial plateau or hip joint.
Fracture: AO Classification
The various fractures are classified by the AO, the Association for the Study of Osteosynthesis. The AO classification is used to describe fractures precisely with a four-digit code, thus enabling standardized treatment worldwide. Relevant factors for the classification are:
- In which body region is the fracture?
- @ At which location within this body region?
- Has the stability of the bone been maintained?
- Is there additional cartilage damage?
- Has the capsule-ligament apparatus been injured?
The AO classification is most commonly used for fractures of the long tubular bones such as the humerus, forearm, femur and tibia. However, it can also be used to classify hand and foot injuries, jaw fractures, and fractures of the pelvis and spine.
Fracture: treatment
How to administer first aid correctly in the event of a bone fracture and what treatment options are available to the doctor, you will learn in the article Fracture: Treatment.
Fracture: Course of disease and prognosis
The prognosis for a fracture depends on both the type of injury and the appropriate treatment. The patient’s age and general state of health also have an influence.
Long-lasting complications
Sometimes the ends of the fracture do not grow back together bony, but remain movably connected. Then a “false joint” has developed – a pseudarthrosis. It manifests itself as swelling, overheating and pain during movement and stress. There are the following causes of pseudarthrosis:
- Movement in the fracture gap overloads the bone with the result that connective tissue pulls tear and bone bellows break.
- If the soft tissues are too severely damaged, they may extend into the fracture gap and lead to delayed healing.
- Smoking or non-cooperative behavior of the patient
Other long-lasting complications that can occur with a fracture include instability in the affected joint area, joint wear (osteoarthritis, osteoarthritis), and deformity.