August 14, 2023 Author : Jorge Pon A bone fracture is what we commonly call a broken bone or a cracked bone . The causes of bone fractures are many, there are different types of fractures, and the treatment is not always the same either. Diagnosing the type of fracture present and knowing the circumstances in which it occurred are the first steps, along with the particularities of each person, for the orthopedist to define what the appropriate treatment is and what the rehabilitation needs will be. Why fractures occur A fracture happens when a bone is hit by a force greater than what it can withstand without breaking. If the force hitting a bone is slight, it can cause a bruise, but if it is stronger, it can cause a fracture. There are several causes of bone fracture , including: Impacts, such as a fall, a blow or other trauma (for example in motor vehicle accidents, like cards); Excessive use, as in the case of repetitive movements that over time put more and more pressure on a bone, giving rise to so-called stress fractures; Diseases that make bones fragile, for example osteoporosis or bone tumors, which give rise to so-called pathological fractures. Types of fractures There are several ways to classify fractures , the most common being: Open and closed A fracture is open, when the broken bone breaks through the skin or makes a break in the skin that allows to see the fracture. They usually take longer to heal and have a higher risk of infection. A fracture is closed when the bone is broken but the overlying skin is intact. Complete and incomplete A fracture is complete when the bone has completely split into two or more pieces. A fracture is incomplete when portions of the bone are not separated, as is often the case in children where the bone is more malleable (greenstick fractures). Pattern and shape of the fracture line When there is only one fracture line: Longitudinal, when the fracture line is parallel to the major axis of the bone. Transverse, when the fracture line is transverse in relation to the major axis of the bone. Oblique, when the fracture line is oblique relative to the major axis of the bone. When there is more than one fracture line Greenstick fractures, frequent in children, when a part of the bone bends like a flexible metallic bar. In these fractures, it is normal for children to maintain limb mobility despite the pain. In adults, the bones are harder and break completely, like glass, and greenstick fractures are not common. Spiral, when the fracture lines form a spiral, which is common when there is a trauma with torsion. Comminuted, when the bone is broken into more than three pieces. Segmentar, when the bone is broken in two places, leaving a loose piece. Signs that there may be a fracture The most common symptoms of a fracture are: Severe sudden pain Deformity of the affected region Difficulty or inability to move the affected area Swelling (edema) and redness (flushing) Hematoma When these symptoms are present and in circumstances that could be the cause of a fracture, medical attention should be sought, usually using a hospital emergency service . The diagnosis is made based on the symptoms and signs present and imaging tests such as radiography, computed tomography or magnetic resonance imaging, depending on what needs to be clarified. Treatment Treatment of a fracture involves immobilization after replacing the fractured bone in its correct position so that new bone tissue can form and resolve the fracture, a process that can take several months. Only the evaluation of a fracture and the characteristics of the patient will allow determining the treatment to be carried out, which includes one or more of the following techniques: Closed reduction (conservative treatment), in which the orthopedist manipulates the limb externally, aligning the fracture in the correct position and then immobilizing it. Surgery to return the bone to its correct position, which may or may not include internal or external fixation (plates and screws) to maintain position during healing. In joint fractures, a minimally invasive surgical approach (arthroscopy) can be used as an adjunct. The use of plaster splints , known as casts, or fiberglass splints, or traction using various devices, is intended to maintain bone alignment and prevent movement during bone healing , and can be used in conjunction with conservative treatment (closed reduction) as well as surgical treatment. In general, in fractures, bone callus forms within the first six weeks. After verifying that this is formed (usually with an imaging test, such as an X-ray), the orthopedist removes the cast and it is possible to start rehabilitation of the affected limb. It should be noted that during the time of immobilization of a fracture there is muscle and functional loss. A lower limb in a cast loses half of its muscle mass if it stays in discharge for 2 weeks. Thus, after removing the cast or other fixation and immobilization devices, it is necessary, as a rule, to follow a rehabilitation program, with physiotherapy , to achieve the most complete recovery possible of previous strength, flexibility and range of motion. Fractures can be treated conservatively or surgically. A quick diagnosis after the event that gave rise to a fracture makes it possible to guide treatment with more available options and to prevent complications that are more when seeking medical intervention is delayed. It is up to the orthopedist to inform the patient of his diagnosis, treatment options and decide together with the patient the best approach for each case . The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
