Bone fracture

Bone fracture: What’s that?

Our skeleton consists of approx. 206 bones which have developed in different forms¹, depending on their functional requirements:

• Long bones (tubular bones)
  Can be found in the arms and legs (extremities) The tubular bones include, for example, the thigh bone, the shin or ulna and radius. Their major function is to ensure stability.
• Short bones
  These include, for example, carpal and tarsal bones. They stabilise and support moderate movement.
• Flat bones
  Such as, for example, the iliac bone or shoulder blade protect the inner organs, provide stability and are responsible for the formation of blood.
• Uneven bones
  These include, for example, all vertebrae of the spine. In this case, they protect the spinal marrow and, as also all other bones, provide stability. So, uneven bones mostly have a protective function in the body.
• Air-filled bones
  These can mostly be found in the cranial region, such as the paranasal sinuses. Air-filled bones reduce weight burdens. They are important as sound resonance for the voice in the cranial region.
• Sesamoid bones
  Such as, for example the kneecap, improve strength transmission and support the motion sequence.

During the course of our life, our skeleton is reconstructed several times. One cycle lasts approx. 10 years and it is then fully renewed. The bones remain performant and any micro injuries are corrected.

If the bone tissue is blocked, normally by external mechanical forces, this is described as a broken bone or a fracture.

If a bone is injured, the body’s self-healing powers are primarily activated. Here, a multi-stage process² creates new bone material:

The bones do not always break in an identical manner. Depending on the type of trauma, different fracture types develop³:

The most frequently incurred bone fractures include⁴:

• Fracture of the femoral neck
• Lower arm fractures (such as distal radius fracture)
• Upper arm fractures
• Lumbar vertebrae fractures

Bone fractures do not always heal uncomplicatedly of their own accord. Often, an operation and immobilisation of the body region affected is necessary in order to achieve an optimum healing process during therapy.

Causes of a bone fracture

The most common causes of a bone fracture include:

1. Direct or indirect trauma
2. Hormone-related changes or diseases

Bone fractures arising from direct or indirect trauma are mostly incurred during sports. The risk sports here include skiing or snowboarding and ball sports. But why is that? In particular, tubular bones are highly stable in the vertical load line as these bones have become accustomed to the body weight force during the course of growth. On the other hand, they display less stability against horizontal burdens because this load direction is only incurred seldom during bone growth.

Bone fracture symptoms

• Pain
• Swelling (haematoma)
• Abnormal joint position
• Grating noise

One of the major symptoms of a bone fracture is pain. The pain trigger arises from the irritation or destruction of the sensitive periosteum. Generally, a swelling can be felt in the body region concerned. The fracture injures blood and lymph vessels and haematomas and bleeding result. The osteotomy may also lead to abnormal joint movement or positioning or movement restrictions. A grating noise during movement can also be observed. A fatigue or stress fracture (e.g. in case of osteoporosis) does not always demonstrate typical fracture symptoms.

Bone fracture diagnosis

In addition to the case history (e.g. questioning regarding the course of the accident), inspection and physical examination of the affected region play an extremely critical role. These are distinguished between certain and uncertain fracture indications.

Uncertain fracture indications may also arise in case of different diseases or injuries.

An X-ray of the region concerned is normally made in order to confirm a suspected bone fracture. It enables the recognition of the precise localisation of the fracture. Furthermore, it can be recognised whether the bone is completely broken or only in-part.

Bone fracture therapy

The therapy depends on the extent and type of the injury. Also the body region and the person’s age play a role. Bone fractures can be treated conservatively (without an operation) or operated.

Initially, we recommend general emergency measures such as cooling and immobilisation. As the risk of infection exists in case of open fractures, it makes sense to cover them with sterile wound dressings. Finally, the person concerned should be presented in a clinic (emergency unit) or to a physician. They decide regarding the further therapeutic measures.
If the physician decides in favour of conservative treatment, the region affected is normally immobilised. Immobilisation of the region of the body affected can be achieved with a brace, e.g. the BORT Stabilo® Lumbar Back Brace, BORT Thumb/Hand Brace or the BORT X-Walker.

Before immobilisation, the treating physician returns the fracture to the physiological initial position (reduces it) without an operation in order to support optimum healing.

In case of particularly complex or serious fractures, the treating physician will normally propose operational therapy. Here, depending on the operation method applied, the bone fragments are anatomically repositioned and stabilised. This process is described as osteosynthesis.

In order to secure therapeutic success, additional rehabilitation measures such as physiotherapy can be prescribed, both as a follow-up for conservative and for operative therapy.
If fractures are not diagnosed in good time and treated professionally, complications such as pseudoarthrosis (false joint) may arise. This is understood as an unnatural (pathological) movement of the bone. It normally arises if the fracture gap doesn’t close properly.

How can bone fractures be prevented (fracture prophylaxis)?

As most bone fractures arise from unpredicted traumas, it is very difficult to avoid them. However, the risk can be reduced in certain cases.

Regular exercise and targeted training support the stabilisation of the bone structure. Also, a healthy and balanced diet can contribute to better mineralisation of the bone.

For example, older persons with an uncertain gait can wear a special protector for the hip/femoral neck which reduces the trauma in case of a fall. Accompanying this, all stumbling blocks should be removed and stairs be well secured. For additional security, hand-grips can be attached, for example in the bathroom. These measures can also be taken for osteoporosis patients.

In case of considerable overweightness, it can be helpful to reduce one’s weight. As a result, the bones are literally “burdened less”.