Bone fractures

There is no difference between a bone fracture and a broken bone; they are just different terms for the same condition. Bone fractures are more common than most people think; typically, people experience two fractures during their lifetime. Essentially they happen when the force exerted on the bone is greater than the strength of the bone tissue (osseous tissue), the rigid tissue that gives the bone its physical strength. Bone tissue includes bone mineral (cortical bone) which is hard and collagen which is flexible; it is this combination that gives the bone both strength and flexibility. Bones also contain bone marrow, blood vessels, nerves and epithelium.

 

Types of bone fracture

Many different kinds of bone fractures can occur, and some are more serious than others. While some bone fractures, such as a broken rib, can be left to heal naturally, most require treatment which can involve reduction (bone realignment), splinting, and even surgery.

 

Stress fractures

A stress fracture is a hairline fracture caused by accumulated stress over time. It is a common kind of fracture in athletes, and generally occurs in weight bearing bones, for instance the metatarsals, tarsals and tibia.  Typical symptoms of a stress fracture include pain which tends to be exacerbated by exercise, tenderness, and inflammation. The area may also be sensitive to touch.

Bones are constantly repairing themselves to remove damage caused by stress, but if stresses are placed on the bone faster than its ability to self-repair, a stress fracture may occur. High impact training is a typical cause, but stress fractures can also happen when people exercise without adequate preparation. Muscle fatigue can also increase the risk.

 

Treatment

The usual treatment involves long rest times with no stress applied to the affected area for up to sixteen weeks, though often four to eight weeks can be sufficient. This is followed by slowly increasing activity to rebuild bone and muscle strength. Sometimes surgery may be required.

 

Complete and incomplete fractures

In a complete fracture, the bone snaps into two or more separate parts, whereas in an incomplete fracture the bone cracks but does not separate. Incomplete fractures include:

·         Hairline fractures where only the outer layer of the bone is fractured.

·         Greenstick fracture where the bone is bent and only one side fractures. This typically happens with children who have more flexible bones.

 

Open and closed fractures

Open or compound fractures occur when the bone penetrates the skin. An associated danger of this is infection, and there could also be muscle, tendon and ligament damage.

Closed fracture is literally enclosed in that the bone does not penetrate the skin.

 

Treatment

The basic treatment involves repositioning the broken pieces and keeping them in place until the natural healing processes have repaired the damage. Following this physiotherapy will be needed to rebuild strength and restore function.

 

Malunion

A malunion is a possible complication following a bone fracture. It is a condition in which a fractured bone has healed, but in a non-ideal position. This can happen with all kinds of bone fracture and can have a variety of causes. For instance, it can happen when the bone is shorter than normal, badly positioned, or bent. It can also happen when the surface of a joint has been displaced so that the cartilage is damaged. Typical symptoms of a malunion include pain, inflammation, tenderness, deformity and an inability to bear weight.

 

Treatment

 

Generally, a malunion is treated by cutting the bone in the region of the original fracture, correcting the misalignment, and securing the bone sections in place with plates, rods or an external frame. If the bone is too short, then it might be necessary to lengthen it.

 

Non-union

The other possible serious complication following a bone fracture is a non-union. This is when the fractured bone fails to heal. Essentially it happens because your body has failed to generate sufficient bone tissue to heal the fracture. Often this is due to loss of blood vessels from the fractured surfaces with the result that insufficient nutrients are delivered to facilitate the healing process.  Typical symptoms are pain, inflammation, bruising and loss of functionality.

 

Treatment

Treatment may involve re-establishing the blood supply, possibly by removing scar tissue and replacing it with healthy tissue; stabilising the fracture site with plates, rods and screws; and bone grafts.

 

Accelerated fracture recovery

Research into bone fracture healing is ongoing and new discoveries are being made on a regular basis, though even today the process is not fully understood (Oryan, Monazzah, & Bigham-Sadegh, 2015). Even so, recent advances in the science of bone healing have led to the possibility of accelerated fracture recovery.

One such technique that has received much attention in recent years is low-intensity pulsed ultrasound. A meta-analysis designed to analyse the effects of LIPUS on stimulating bone regeneration and bone maturation during distraction osteogenesis in reducing the associated treatment time (Saltaji, Raza, Kaur, & Flores, 2016) found a statistically significant reduced treatment time.  LIPUS is the subject of the associated article Low Intensity Pulsed Ultrasound (LIPUS).

Other ways of accelerating fracture recovery include providing your body with sufficient energy as fracture healing places increased calorific requirements on your body, possibly more than doubling the calorific requirement (Smith, TK. 1987). It is also important to ensure that you have sufficient protein in your diet. Low protein means that the healing time is increased with a greater chance of complications. The amino acids lysine, arginine, proline, glycine, cystine, and glutamine are important and can increase calcium absorption into the bone, enhancing tissue regeneration. Anti-oxidants and vitamins are also beneficial as are basic minerals such as copper, calcium and phosphorus.

 

Don’t wait

While some kinds of bone fractures are obvious and will leave you in no doubt that urgent treatment is required, others, such as a stress fracture, are not always so obvious. If you think that there is any possibility you have a fracture, then you should seek treatment as quickly as possible; delays will only exacerbate the condition and could lead to potentially serious complications.

 

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References

Oryan, A., Monazzah, S., & Bigham-Sadegh, A. (2015). Bone Injury and Fracture Healing Biology. Biomedical and Environmental Sciences, 28(1), 57–71.

Saltaji, H., Raza, H., Kaur, H., & Flores, C. (2016). Effect of Low-Intensity Pulsed Ultrasound on Distraction Osteogenesis Treatment Time. American Institute of Ultrasound in Medicine, 349-358 .

Smith, TK. (1987). Prevention of complications in orthopedic surgery secondary to nutritional depletion, Clin Ortho and Related Research, 222:91-97.