Definition and Overview

A fracture refers to a broken bone. It can be either closed (does not penetrate the skin) or open (pierces through the skin and causes an open wound). It is further classified as either complete (bone breaks all the way through) or incomplete (bone cracks but is not totally broken).

A closed fracture commonly occurs in the wrist, hips, and ankles.

Causes of Condition

Fractures occur when the bone breaks usually due to:

Some people are more prone to fractures than others. Factors that can increase one's risk of suffering from this condition include the following:

  • Advanced age, as bones become more brittle as a person ages

  • Osteoporosis

  • Endocrine problems

  • Intestinal disorders

  • Alcohol consumption

  • Smoking

  • Corticosteroid medications

Key Symptoms

Closed fracture symptoms include the following:

  • Intense pain at the time of injury and when moving or touching the affected body part

  • A snapping and/or grinding sound

  • Swelling

  • Redness and bruising in the affected area

  • Difficulty supporting weight

  • Visible deformity

A person suspected of having a closed fracture must consult a doctor for the physical examination of the affected area and an x-ray. The patient may be asked to move the affected body part in different ways to check for other symptoms or signs of injury. In some cases, doctors also order magnetic resonance imaging (MRI) or computed tomography (CT) scan, but they are less often used and are usually only performed if soft tissue injury is also suspected.

Who to See and Types of Treatments Available

Patients with a closed fracture are treated by orthopaedic specialists or orthopaedic surgeons, who decide on the best treatment method based on the following factors:

  • Severity of the injury

  • Whether the broken bones are aligned or not

  • Location of the injury

  • The patient’s expectations regarding treatment or recovery

In cases of closed simple fracture or closed non-displaced fracture (the broken bone remains in the correct position and alignment), doctors may simply provide a sling or walking boot that the patient must wear until the bone heals.

If the injury causes the ends of the broken bone to become misaligned (closed displaced fracture), the patient has to undergo a procedure called fracture reduction before receiving further treatment. Fracture reduction is performed using specific maneuvers and aims to properly re-align broken bones.

If the patient is immobilised, treatment options include:

  • Cast immobilisation - If the closed fracture is unstable, the affected limb or body part needs to be immobilised to make sure the bones are properly aligned as they heal. While this can be done using splints and braces, the most common method of immobilisation involves the use of a cast made of plaster or fiberglass. The cast is wrapped around the injured body part and is allowed to harden. It is very effective in keeping the broken bones aligned as they heal.

  • External fixation - A treatment method for closed fractures that involves holding the bones securely in place without open surgery. This option is used when there is soft tissue injury that makes open surgery unsafe, such as when there is severe swelling in the injury site. In some cases, an external fixation is performed as a first aid measure and is followed up by an internal fixation procedure once the swelling or soft tissue injury improves.

  • Internal fixation - Refers to the surgical realignment of a closed fracture by making an incision through the skin and holding the broken bones together using plates, pins, and screws. Pins are effective in stabilising smaller bones, such as those found in the hands and wrists. This procedure is often combined with an open reduction so that the patient only needs to undergo one surgery.

One type of internal fixation treatment is called intramedullary rodding, a procedure in which a metal rod is inserted into the hollow medullary canal of the broken bone. This is the part of the bone where the marrow is. This method is more commonly used for lower extremity fractures or those that are far from the joints. Patients who undergo this procedure are able to walk and bear weight faster.

Sometimes, these procedures are combined, depending on the unique circumstances surrounding each case. For example, a closed fracture may be treated with a closed reduction procedure, followed by the placement of pins, which are placed percutaneously or without an open incision. Percutaneous pin placement is also performed during external fixation.

References:

  • Parmet S, Lynm C, Glass R. “Bone Fractures.” JAMA. 2004;291(17):2160. http://jamanetwork.com/journals/jama/fullarticle/198687

  • Zuckerman JD. “Hip Fracture.” N Engl J Med. 1996; 334:1519-1525. http://www.nejm.org/doi/full/10.1056/NEJM199606063342307

  • Griffin D, Parsons N, Kulikov Y, Thorogood M, et al. “Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomized controlled trial.” BMJ. 2014; 349. http://www.bmj.com/content/349/bmj.g4483

  • Meals C, Meals R. “Hand Fractures: A review of current treatment strategies.” American Society for Surgery of the Hand. 2013;38(5):1021-1031. http://www.jhandsurg.org/article/S0363-5023(13)00243-8/abstract

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