A fracture is a break or crack in a bone. Types of fractures are illustrated in Figure. The more common ones are explained here:
- Closed simple fracture—A break in the bone with no external wound to the skin.
- Open or compound fracture—A break in the bone in which there is an open wound leading down to the site of the fracture or in which a piece of broken bone protrudes through the skin.
- Simple fracture—A break in the rib that is broken into two parts; likely occurs from a blow or direct shock to the thorax.
- Comminuted fracture—A break in which the bone is broken or splintered into pieces, often with fragments embedded in surrounding tissue.
- Impacted fracture—A break in which the bone is broken with one end forced into the interior of the other.
- Incomplete partial fracture—A break in which the fraction line does not include the whole bone (stress fracture).
- Greenstick fracture—A break in which the bone is partially bent and split, as a green stick or twig does when bent; this type of fracture occurs most frequently in children, especially those who have rickets, or among adults with soft bones.
- Colles fracture—A break in the end of the radius causing the wrist to extend and shorten; often occurs when the wrist is extended to break a fall.
FIGURE. Common types of fractures.
Bone fractures are usually caused by physical trauma. A host of pathological processes, though, may occasion a bone fracture after only minimal trauma or following normal muscular contractions. Children are more likely to fracture arms from a fall; teens tend to fracture long bones in sports or motor vehicle accidents. Examples of diseases or conditions that may include fractures are bone neoplasms, osteoporosis, Paget disease, osteomalacia, osteomyelitis, and nutritional and vitamin deficiency disorders.
Elderly individuals may be particularly susceptible to fracture as their bones become more brittle. Sometimes a traumatic incident is unnecessary for a hip or femur fracture.
Signs and Symptoms
Common symptoms of fractures include acute pain at the affected site, deformity, swelling, discoloration, loss of limb function, muscle spasm, and perhaps hemorrhage and shock. Bone may protrude through the skin.
A history of traumatic injury assists in diagnosis. X-rays are used to locate the fracture and determine its severity. A bone scintiscan may be ordered to detect hairline fractures.
Immobilization of the affected parts and control of any bleeding are paramount. Open or closed reduction may be needed to place the parts in their normal position for proper healing. Open reduction is accomplished by surgery, followed by external fixation such as casting or by internal fixation with the use of metal plates, screws, or rods. Closed reduction consists of manipulation and casting without a surgical incision.
Traction may be used, especially for fractures of the leg bones, when a splint or cast fails to maintain reduction, until healing takes place or until internal fixation can be performed. Traction helps to reduce pain and further damage as the muscles stretch, bone fragments separate, and alignment is maintained. Rib fractures may require no treatment, or the chest may be bandaged or taped for support and pain control. Analgesics or muscle relaxants may be ordered to ease the pain accompanying many types of fractures.
No significant complementary therapy is indicated.
Reassuring clients and easing the pain are essential. Teach good cast care and remind clients to drink plenty of fluids. Teach proper use of crutches, if indicated. Physical therapy may be necessary following cast removal.
The prognosis depends on the severity of the fracture, the amount of tissue and vascular damage, and the age of the individual. The existence of an underlying pathological process worsens the prognosis by complicating the healing process. Other complications can occur in any type of fracture and may include embolism (clot), infection, delayed union or nonunion of the fracture, and complications resulting from immobilization.
The best prevention of fractures is conscientious adherence to safety rules at work and in play.