Introduction

A fracture occurs when there is a crack or break in a bone. It occurs when the bone cannot withstand the pressure that is applied to it.

What are the types of fractures?

There are several types of fracture :

• Close fracture – fracture with no skin breakage or wound
• Open fracture – open wound with exposed bone
• Complete fracture – the bone breaks into two or more fragments
• Incomplete fracture – bone cracks but does not separate
• Stress fracture – fracture due to repetitive injuries (running or marching). A hairline fracture that is not visible in the x-ray during the early phase.

Causes

There are various causes of fractures. Common causes include :

• Fall from height
• Motor vehicle accidents
• Child abuse
• Repetitive forces (e.g. running or marching)

Symptoms

• Pain and swelling of the injured area
• Loss of function
• Bruising of the injured area
• Deformity of the limb
• Numbness and tingling sensation
• Open wound with exposed bone

Diagnosis

A fractured bone can be diagnosed by good history taking and physical examination. An X-ray is taken to confirm the diagnosis. Special imaging e.g. Magnetic resonance imaging or CT scan may be needed to view the fractured bone more clearly (hip or spine fracture).

Treatment

Treatment of the fractured bone depends on type and location of the fracture. Immediate treatment of suspected fractured bone should consist of immobilization of the injured limbs. Elevation will reduce the swelling and pain.

Treatment of fracture can be divided in to conservative or open method. Conservative methods includes close manipulative reduction (aligning the fractured bone to normal alignment) and splint using cast or brace.

An open method indicates a surgical technique to treat the fractured bone e.g. :

• Fractures in which the 2 ends of the broken bone cannot be lined up correctly
• Fractures that extend to the joint
• Open fracture

Surgical repair is done in the operating room. A variety of tools are used to repair the fracture and hold it in place. These include surgical nails, screws, wires, rods, and metal plates. The surgeon may need to clean out the area around the fracture. This will reduce the risk of infection from the open wound.

Complications of treatment

In conservative or closed technique, the bone may not heal proplerly or may not function properly due to the nature of the fracture.With surgical technique, this carries similar risks as any surgery. These includes infection, damage to other structures (nerves or blood vessels) or anaesthetic complications.

There are several complications that are specific to fractured bone :

• Delay union (healing process take longer time)
• Non union (the bone does not unite at a given time)
• Mal union (the bone unites in abnormal alignment)

Trained orthopaedic specialist will discuss with you regarding the complications and treatment of the conditions.

Rehabilitation

Physiotherapy and rehabilitation play an important role in the treatment of fractured bone. It maintains the integrity of the musculoskeletal unit of the injured parts.