A bone fracture (abbreviated FRX or Fx, F_x, or #) is a medical condition in which there is a partial or complete break in the continuity of any

bone A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, an ...

in the body. In more severe cases, the bone may be broken into several fragments, known as a ''comminuted fracture''. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, osteopenia, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture.

Signs and symptoms

Although bone tissue contains no pain receptors, a bone fracture is painful for several reasons: * Breaking in the continuity of the

periosteum The periosteum is a membrane that covers the outer surface of all bones, except at the articular surfaces (i.e. the parts within a joint space) of long bones. Endosteum lines the inner surface of the medullary cavity of all long bones. Struc ...

, with or without similar discontinuity in endosteum, as both contain multiple pain receptors. *

Edema Edema, also spelled oedema, and also known as fluid retention, dropsy, hydropsy and swelling, is the build-up of fluid in the body's tissue. Most commonly, the legs or arms are affected. Symptoms may include skin which feels tight, the area ma ...

and

hematoma A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillaries. A hematoma is ...

of nearby soft tissues caused by ruptured

bone marrow Bone marrow is a semi-solid tissue found within the spongy (also known as cancellous) portions of bones. In birds and mammals, bone marrow is the primary site of new blood cell production (or haematopoiesis). It is composed of hematopoieti ...

evokes pressure pain. * Involuntary

muscle spasms A spasm is a sudden involuntary contraction of a muscle, a group of muscles, or a hollow organ such as the bladder. A spasmodic muscle contraction may be caused by many medical conditions, including dystonia. Most commonly, it is a muscl ...

trying to hold bone fragments in place. Damage to adjacent structures such as nerves, muscles or blood vessels, spinal cord, and nerve roots (for spine fractures), or cranial contents (for skull fractures) may cause other specific signs and symptoms.

Complications

Some fractures may lead to serious complications including a condition known as

compartment syndrome Compartment syndrome is a condition in which increased pressure within one of the body's anatomical compartments results in insufficient blood supply to tissue within that space. There are two main types: acute and chronic. Compartments of th ...

. If not treated, eventually, compartment syndrome may require

amputation Amputation is the removal of a limb by trauma, medical illness, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on ind ...

of the affected limb. Other complications may include non-union, where the fractured bone fails to heal or mal-union, where the fractured bone heals in a deformed manner. One form of malunion is the malrotation of a bone, which is especially common after femoral and tibial fractures. Complications of fractures may be classified into three broad groups, depending upon their time of occurrence. These are as follows – # ''Immediate'' complications – occurs at the time of the fracture. # ''Early'' complications – occurring in the initial few days after the fracture. # ''Late'' complications – occurring a long time after the fracture.

Pathophysiology

The natural process of healing a fracture starts when the injured bone and surrounding tissues bleed, forming a fracture

. The blood coagulates to form a blood

clot A thrombus (plural thrombi), colloquially called a blood clot, is the final product of the blood coagulation step in hemostasis. There are two components to a thrombus: aggregated platelets and red blood cells that form a plug, and a mesh of c ...

situated between the broken fragments. Within a few days, blood vessels grow into the jelly-like matrix of the blood clot. The new blood vessels bring

phagocyte Phagocytes are cells that protect the body by ingesting harmful foreign particles, bacteria, and dead or dying cells. Their name comes from the Greek ', "to eat" or "devour", and "-cyte", the suffix in biology denoting "cell", from the Greek ...

s to the area, which gradually removes the non-viable material. The blood vessels also bring

fibroblast A fibroblast is a type of biological cell that synthesizes the extracellular matrix and collagen, produces the structural framework ( stroma) for animal tissues, and plays a critical role in wound healing. Fibroblasts are the most common cells of ...

s in the walls of the vessels and these multiply and produce collagen fibres. In this way, the blood clot is replaced by a matrix of collagen. Collagen's rubbery consistency allows bone fragments to move only a small amount unless severe or persistent force is applied. At this stage, some of the fibroblasts begin to lay down bone matrix in the form of collagen monomers. These monomers spontaneously assemble to form the bone matrix, for which bone crystals ( calcium hydroxyapatite) are deposited in amongst, in the form of insoluble

crystal A crystal or crystalline solid is a solid material whose constituents (such as atoms, molecules, or ions) are arranged in a highly ordered microscopic structure, forming a crystal lattice that extends in all directions. In addition, macr ...

s. This mineralization of the collagen matrix stiffens it and transforms it into bone. In fact, bone ''is'' a mineralized collagen matrix; if the mineral is dissolved out of bone, it becomes rubbery. Healing bone

callus A callus is an area of thickened and sometimes hardened skin that forms as a response to repeated friction, pressure, or other irritation. Since repeated contact is required, calluses are most often found on the feet and hands, but they may o ...

on average is sufficiently mineralized to show up on

X-ray X-rays (or rarely, ''X-radiation'') are a form of high-energy electromagnetic radiation. In many languages, it is referred to as Röntgen radiation, after the German scientist Wilhelm Conrad Röntgen, who discovered it in 1895 and named it ' ...

within 6 weeks in adults and less in children. This initial "woven" bone does not have the strong mechanical properties of mature bone. By a process of remodelling, the woven bone is replaced by mature "lamellar" bone. The whole process may take up to 18 months, but in adults, the strength of the healing bone is usually 80% of normal by 3 months after the injury. Several factors may help or hinder the bone healing process. For example,

tobacco Tobacco is the common name of several plants in the genus '' Nicotiana'' of the family Solanaceae, and the general term for any product prepared from the cured leaves of these plants. More than 70 species of tobacco are known, but the ch ...

smoking hinders the process of bone healing, and adequate nutrition (including

calcium Calcium is a chemical element with the symbol Ca and atomic number 20. As an alkaline earth metal, calcium is a reactive metal that forms a dark oxide-nitride layer when exposed to air. Its physical and chemical properties are most similar t ...

intake) will help the bone healing process. Weight-bearing stress on bone, after the bone has healed sufficiently to bear the weight, also builds bone strength. Although there are theoretical concerns about NSAIDs slowing the rate of healing, there is not enough evidence to warrant withholding the use of this type analgesic in simple fractures.

Effects of smoking

Smokers generally have lower bone density than non-smokers, so they have a much higher risk of fractures. There is also evidence that smoking delays bone healing.

Diagnosis

A bone fracture may be diagnosed based on the history given and the physical examination performed. Radiographic imaging often is performed to confirm the diagnosis. Under certain circumstances, radiographic examination of the nearby joints is indicated in order to exclude dislocations and fracture-dislocations. In situations where projectional radiography alone is insufficient, Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) may be indicated.

Classification

orthopedic Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeleta ...

medicine Medicine is the science and Praxis (process), practice of caring for a patient, managing the diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care, palliation of their injury or disease, and Health promotion ...

, fractures are classified in various ways. Historically they are named after the physician who first described the fracture conditions, however, there are more systematic classifications as well. They may be divided into stable versus unstable depending on the likelihood that they may shift further.

Mechanism

* Traumatic fracture – a fracture due to sustained trauma. e.g., fractures caused by a fall, road traffic accident, fight, etc. * Pathologic fracture – a fracture through a bone that has been made weak by some underlying disease is called pathological fracture. e.g., a fracture through a bone weakened by metastasis. Osteoporosis is the most common cause of pathological fracture. * Periprosthetic fracture – a fracture at the point of mechanical weakness at the end of an

implant Implant can refer to: Medicine *Implant (medicine), or specifically: ** Brain implant ** Breast implant **Buttock implant **Cochlear implant **Contraceptive implant **Dental implant ** Fetal tissue implant **Implantable cardioverter-defibrillator ...

Soft-tissue involvement

* Closed/simple fractures are those in which the overlying skin is intact * Open/compound fractures involve wounds that communicate with the fracture, or where fracture hematoma is exposed, and may thus expose bone to

contamination Contamination is the presence of a constituent, impurity, or some other undesirable element that spoils, corrupts, infects, makes unfit, or makes inferior a material, physical body, natural environment, workplace, etc. Types of contamination ...

. Open injuries carry a higher risk of

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable d ...

. Reports indicate an incidence of infection after internal fixation of closed fracture of 1-2%, rising to 30% in open fractures. ** Clean fracture ** Contaminated fracture

Displacement

* Non-displaced * Displaced ** Translated, or ''ad latus'', with sideways displacement. ** Angulated ** Rotated ** Shortened, a reduction in overall bone length when displaced fracture fragments overlap

Fracture pattern

* Linear fracture – a fracture that is parallel to the bone's long axis * Transverse fracture – a fracture that is at a right angle to the bone's long axis * Oblique fracture – a fracture that is diagonal to a bone's long axis (more than 30°) * Spiral fracture – a fracture where at least one part of the bone has been twisted * Compression fracture/

wedge fracture A compression fracture is a collapse of a vertebra. It may be due to trauma or due to a weakening of the vertebra (compare with burst fracture). This weakening is seen in patients with osteoporosis or osteogenesis imperfecta, lytic lesions from m ...

– usually occurs in the vertebrae, for example when the front portion of a

vertebra The spinal column, a defining synapomorphy shared by nearly all vertebrates, Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characterist ...

in the spine collapses due to osteoporosis (a medical condition which causes bones to become brittle and susceptible to fracture, with or without trauma) * Impacted fracture – a fracture caused when bone fragments are driven into each other * Avulsion fracture – a fracture where a fragment of bone is separated from the main mass

Fragments

* Incomplete fracture – a fracture in which the bone fragments are still partially joined, in such cases, there is a crack in the osseous tissue that does not completely traverse the width of the bone. * Complete fracture – a fracture in which bone fragments separate completely. * Comminuted fracture – a fracture in which the bone has broken into several pieces.

Anatomical location

An anatomical classification may begin with specifying the involved body part, such as the head or arm, followed by more specific localization. Fractures that have additional definition criteria than merely localization often may be classified as subtypes of fractures, such as a Holstein-Lewis fracture being a subtype of a

humerus fracture A humerus fracture is a break of the humerus bone in the upper arm. Symptoms may include pain, swelling, and bruising. There may be a decreased ability to move the arm and the person may present holding their elbow. Complications may include injur ...

. Most typical examples in an orthopaedic classification given in the previous section cannot be classified appropriately into any specific part of an anatomical classification, however, as they may apply to multiple anatomical fracture sites. * Skull fracture ** Basilar skull fracture **

Blowout fracture An orbital blowout fracture is a traumatic deformity of the orbital floor or medial wall that typically results from the impact of a blunt object larger than the orbital aperture, or eye socket. Most commonly, the inferior orbital wall, or the flo ...

– a fracture of the walls or floor of the

orbit In celestial mechanics, an orbit is the curved trajectory of an object such as the trajectory of a planet around a star, or of a natural satellite around a planet, or of an artificial satellite around an object or position in space such a ...

** Mandibular fracture ** Nasal fracture **

Le Fort fracture of skull A Le Fort fracture of the skull is a classic transfacial fracture of the midface, involving the maxillary bone and surrounding structures in either a horizontal, pyramidal or transverse direction. The hallmark of Lefort fractures is traumatic ''p ...

– facial fractures involving the maxillary bone and surrounding structures in a usually bilateral and either horizontal, pyramidal, or transverse way. * Spinal fracture ** Cervical fracture *** Fracture of '' C1'', including Jefferson fracture *** Fracture of '' C2'', including

Hangman's fracture Hangman's fracture is the colloquial name given to a fracture of both pedicles, or '' partes interarticulares'', of the ''axis vertebra'' ( C2). Causes The injury mainly occurs from falls, usually in elderly adults, and motor accidents mainly d ...

***

Flexion teardrop fracture A flexion teardrop fracture is a bone fracture, fracture of the anteroinferior aspect of a cervical vertebral body due to flexion of the spine along with vertical axial compression. The fracture continues sagittally through the vertebral body, and ...

– a fracture of the anteroinferior aspect of a cervical vertebral ** Clay-shoveler fracture – fracture through the

spinous process The spinal column, a defining synapomorphy shared by nearly all vertebrates, Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristic ...

of a

occurring at any of the lower cervical or upper thoracic vertebrae ** Burst fracture – in which a vertebra breaks from a high-energy axial load ** Compression fracture – a collapse of a vertebra, often in the form of

s due to larger compression anteriorly ** Chance fracture – compression injury to the anterior portion of a vertebral body with concomitant distraction injury to posterior elements ** Holdsworth fracture – an unstable fracture

dislocation In materials science, a dislocation or Taylor's dislocation is a linear crystallographic defect or irregularity within a crystal structure that contains an abrupt change in the arrangement of atoms. The movement of dislocations allow atoms to ...

of the thoraco lumbar junction of the spine * Rib fracture * Sternal fracture *

Shoulder fracture The human shoulder is made up of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone) as well as associated muscles, ligaments and tendons. The articulations between the bones of the shoulder mak ...

** Clavicle fracture ** Scapular fracture *

Arm fracture In human anatomy, the arm refers to the upper limb in common usage, although academically the term specifically means the upper arm between the glenohumeral joint (shoulder joint) and the elbow joint. The distal part of the upper limb between the ...

Humerus fracture A humerus fracture is a break of the humerus bone in the upper arm. Symptoms may include pain, swelling, and bruising. There may be a decreased ability to move the arm and the person may present holding their elbow. Complications may include injur ...

(fracture of upper arm) *** Supracondylar fracture *** Holstein-Lewis fracture – a fracture of the distal third of the humerus resulting in

entrapment Entrapment is a practice in which a law enforcement agent or agent of the state induces a person to commit a "crime" that the person would have otherwise been unlikely or unwilling to commit.''Sloane'' (1990) 49 A Crim R 270. See also agent prov ...

of the

radial nerve The radial nerve is a nerve in the human body that supplies the posterior portion of the upper limb. It innervates the medial and lateral heads of the triceps brachii muscle of the arm, as well as all 12 muscles in the posterior osteofascial comp ...

** Forearm fracture *** Ulnar fracture **** Monteggia fracture – a fracture of the proximal third of the ulna with the dislocation of the head of the radius **** Hume fracture – a fracture of the olecranon with an associated

anterior Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position prov ...

of the radial head *** Radius fracture **** Essex-Lopresti fracture – a fracture of the radial head with concomitant dislocation of the distal radio-ulnar joint with disruption of the

interosseous membrane An interosseous membrane is a thick dense fibrous sheet of connective tissue that spans the space between two bones, forming a type of syndesmosis joint. Interosseous membranes in the human body: * Interosseous membrane of forearm The interosse ...

Essex Lopresti fracture
at Wheeless' Textbook of Orthopaedics online **** Distal radius fracture ***** Galeazzi fracture – a fracture of the radius with dislocation of the distal radioulnar joint *****

Colles' fracture A Colles' fracture is a type of fracture of the distal forearm in which the broken end of the radius is bent backwards. Symptoms may include pain, swelling, deformity, and bruising. Complications may include damage to the median nerve. It typi ...

– a distal fracture of the radius with dorsal (posterior) displacement of the wrist and hand ***** Smith's fracture – a distal fracture of the radius with volar (ventral) displacement of the wrist and hand ***** Barton's fracture – an intra-articular fracture of the distal radius with dislocation of the radiocarpal joint * Hand fracture ** Scaphoid fracture ** Rolando fracture – a

comminuted Comminuted may refer to: *Comminution, the process in which solid materials are reduced in size, by crushing, grinding and other processes *Bone fracture, as in a crushed or splintered bone *Comminuted skull fracture A skull fracture is a break ...

intra-articular fracture through the base of the first

metacarpal In human anatomy, the metacarpal bones or metacarpus form the intermediate part of the skeletal hand located between the phalanges of the fingers and the carpal bones of the wrist, which forms the connection to the forearm. The metacarpal bones ...

bone ** Bennett's fracture – a fracture of the base of the first metacarpal bone which extends into the

carpometacarpal The carpometacarpal (CMC) joints are five joints in the wrist that articulate the distal row of carpal bones and the proximal bases of the five metacarpal bones. The CMC joint of the thumb or the first CMC joint, also known as the trapeziometacar ...

(CMC) joint ** Boxer's fracture – a fracture at the neck of a

* Broken finger – a fracture of the carpal phalanges * Pelvic fracture ** Fracture of the hip bone ** Duverney fracture – an isolated pelvic fracture involving only the iliac wing *

Femoral fracture A femoral fracture is a bone fracture that involves the femur. They are typically sustained in high-impact trauma, such as car crashes, due to the large amount of force needed to break the bone. Fractures of the diaphysis, or middle of the fe ...

Hip fracture A hip fracture is a break that occurs in the upper part of the femur (thigh bone). Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Usually the person cannot walk. They most often occur as a re ...

(anatomically a fracture of the

femur The femur (; ), or thigh bone, is the proximal bone of the hindlimb in tetrapod vertebrates. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates wit ...

bone and not the hip bone) * Patella fracture * Crus fracture ** Tibia fracture ***

Pilon fracture A pilon fracture, is a fracture of the distal part of the tibia, involving its articular surface at the ankle joint. Pilon fractures are caused by rotational or axial forces, mostly as a result of falls from a height or motor vehicle accident ...

*** Tibial plateau fracture *** Bumper fracture – a fracture of the

lateral Lateral is a geometric term of location which may refer to: Healthcare *Lateral (anatomy), an anatomical direction * Lateral cricoarytenoid muscle * Lateral release (surgery), a surgical procedure on the side of a kneecap Phonetics *Lateral co ...

tibia The tibia (; ), also known as the shinbone or shankbone, is the larger, stronger, and anterior (frontal) of the two bones in the leg below the knee in vertebrates (the other being the fibula, behind and to the outside of the tibia); it connects ...

l plateau caused by a forced valgus applied to the

knee In humans and other primates, the knee joins the thigh with the human leg, leg and consists of two joints: one between the femur and tibia (tibiofemoral joint), and one between the femur and patella (patellofemoral joint). It is the largest join ...

*** Segond fracture – an avulsion fracture of the

lateral tibial condyle The lateral condyle is the lateral portion of the upper extremity of tibia. It serves as the insertion for the biceps femoris muscle (small slip). Most of the tendon of the biceps femoris inserts on the fibula. See also * Gerdy's tubercle * Medi ...

*** Gosselin fracture – a fractures of the tibial plafond into anterior and posterior fragments *** Toddler's fracture – an undisplaced and spiral fracture of the distal third to distal half of the tibia **

Fibular fracture A crus fracture is a bone fracture, fracture of the Crus (lower leg), lower legs bones meaning either or both of the tibia and fibula. Tibia fractures * Pilon fracture * Tibial plateau fracture * Tibia shaft fracture * Bumper fracture - a fractu ...

*** Maisonneuve fracture – a spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane *** Le Fort fracture of ankle – a vertical fracture of the antero-

medial Medial may refer to: Mathematics * Medial magma, a mathematical identity in algebra Geometry * Medial axis, in geometry the set of all points having more than one closest point on an object's boundary * Medial graph, another graph that re ...

part of the distal

fibula The fibula or calf bone is a human leg, leg bone on the Lateral (anatomy), lateral side of the tibia, to which it is connected above and below. It is the smaller of the two bones and, in proportion to its length, the most slender of all the long ...

with avulsion of the anterior tibiofibular ligament *** Bosworth fracture – a fracture with an associated fixed posterior

of the distal fibular fragment that becomes trapped behind the posterior tibial tubercle; the injury is caused by severe external rotation of the ankle **

Combined tibia and fibula fracture The human leg, in the general word sense, is the entire lower limb (anatomy), limb of the human body, including the foot, thigh or sometimes even the hip or Gluteal muscles, gluteal region. However, the definition in human anatomy refers only to ...

***

Trimalleolar fracture A trimalleolar fracture is a fracture of the ankle that involves the lateral malleolus, the medial malleolus, and the distal posterior aspect of the tibia, which can be termed the posterior malleolus. The trauma is sometimes accompanied by li ...

– involving the

lateral malleolus A malleolus is the bony prominence on each side of the human ankle. Each leg is supported by two bones, the tibia on the inner side (medial) of the leg and the fibula on the outer side (lateral) of the leg. The medial malleolus is the promi ...

medial malleolus A malleolus is the bony prominence on each side of the human ankle. Each leg is supported by two bones, the tibia on the inner side (medial) of the leg and the fibula on the outer side (lateral) of the leg. The medial malleolus is the promi ...

, and the distal posterior aspect of the tibia ***

Bimalleolar fracture A bimalleolar fracture is a fracture of the ankle that involves the lateral malleolus and the medial malleolus. Studies have shown that bimalleolar fractures are more common in women, people over 60 years of age, and patients with existing comorbi ...

– involving the lateral malleolus and the medial malleolus ***

Pott's fracture Pott's fracture, also known as Pott's syndrome I and Dupuytren fracture, is an archaic term loosely applied to a variety of bimalleolar ankle fractures. The injury is caused by a combined abduction external rotation from an eversion force. This ...

* Foot fracture ** Lisfranc fracture – in which one or all of the metatarsals are displaced from the tarsus ** Jones fracture – a fracture of the proximal end of the fifth metatarsal ** March fracture – a fracture of the distal third of one of the metatarsals occurring because of recurrent stress **Cuneiform fracture – a fracture of one of the three cuneiform bones typically due to direct blow, axial load, or avulsion ** Calcaneal fracture – a fracture of the calcaneus (heel bone) * Broken toe – a fracture of the pedal phalanges

OTA/AO classification

The Orthopaedic Trauma Association Committee for Coding and Classification published its classification system in 1996, adopting a similar system to the 1987 AO Foundation system. In 2007, they extended their system, unifying the two systems regarding wrist, hand, foot, and ankle fractures.

Classifications named after people

A number of classifications are named after the person (

eponymous An eponym is a person, a place, or a thing after whom or which someone or something is, or is believed to be, named. The adjectives which are derived from the word eponym include ''eponymous'' and ''eponymic''. Usage of the word The term ''epon ...

) who developed it. * "Denis classification" for spinal fractures * " Frykman classification" for forearm fractures (fractures of radius and ulna) * "

Gustilo open fracture classification The Gustilo open fracture classification system is the most commonly used classification system for open fractures. It was created by Ramón Gustilo and Anderson, and then further expanded by Gustilo, Mendoza, and Williams. This system uses the am ...

" * "Letournel and Judet Classification" for Acetabular fractures * "Neer classification" for

s *

Seinsheimer classification The Seinsheimer classification is a system of categorizing subtrochanteric hip fractures based on the fracture pattern of the proximal femoral shaft. The classification was developed by Frank Seinsheimer III in 1978. In the published work, fifty ...

, Evans-Jensen classification, Pipkin classification, and Garden classification for

hip fracture A hip fracture is a break that occurs in the upper part of the femur (thigh bone). Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Usually the person cannot walk. They most often occur as a re ...

Prevention

Both high- and low-force trauma can cause bone fracture injuries. Preventive efforts to reduce motor vehicle crashes, the most common cause of high-force trauma, include reducing distractions while driving. Common distractions are driving under the influence and texting or calling while driving, both of which lead to an approximate 6-fold increase in crashes. Wearing a seatbelt can also reduce the likelihood of injury in a collision. 30 km/h or 20 mph

speed limit Speed limits on road traffic, as used in most countries, set the legal maximum speed at which vehicles may travel on a given stretch of road. Speed limits are generally indicated on a traffic sign reflecting the maximum permitted speed - expre ...

s (as opposed to the more common intracity 50 km/h / 30 mph) also drastically reduce the risk of accident, serious injury and even death in crashes between motor vehicles and humans. Vision Zero aims to reduce traffic deaths to zero through better traffic design and other measures and to drastically reduce traffic injuries which would prevent many bone fractures. A common cause of low-force trauma is an at-home fall. When considering preventative efforts, the

National Institute of Health The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late ...

(NIH) examines ways to reduce the likelihood of falling, the force of the fall, and bone fragility. To prevent at-home falls they suggest keeping cords out of high-traffic areas where someone could trip, installing handrails and keeping stairways well-lit, and installing an assistive bar near the bathtub in the washroom for support. To reduce the impact of a fall the NIH recommends to try falling straight down on your buttocks or onto your hands. Some sports have a relatively high risk of bone fractures as a common

sports injury Sports injuries are injuries that occur during sport, athletic activities, or exercising. In the United States, there are approximately 30 million teenagers and children who participate in some form of organized sport. Of those, about three mi ...

. Preventive measures depend to some extent on the specific sport, but learning proper technique, wearing protective gear and having a realistic estimation of one's own capabilities and limitations can all help reduce the risk of bone fracture. In contact sports rules have been put in place to protect athlete health, such as the prohibition of unnecessary roughness in

American football American football (referred to simply as football in the United States and Canada), also known as gridiron, is a team sport played by two teams of eleven players on a rectangular field with goalposts at each end. The offense, the team wit ...

. Taking calcium and vitamin D supplements can help strengthen your bones. Vitamin D supplements combined with additional calcium marginally reduces the risk of hip fractures and other types of fracture in older adults; however, vitamin D supplementation alone did not reduce the risk of fractures.

Patterns

Treatment

Treatment of bone fractures are broadly classified as surgical or conservative, the latter basically referring to any non-surgical procedure, such as pain management, immobilization or other non-surgical stabilization. A similar classification is ''open'' versus ''closed treatment'', in which ''open treatment'' refers to any treatment in which the fracture site is opened surgically, regardless of whether the fracture is an

open Open or OPEN may refer to: Music * Open (band), Australian pop/rock band * The Open (band), English indie rock band * ''Open'' (Blues Image album), 1969 * ''Open'' (Gotthard album), 1999 * ''Open'' (Cowboy Junkies album), 2001 * ''Open'' (Y ...

closed fracture A bone fracture (abbreviated FRX or Fx, Fx, or #) is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a '' ...

Pain management

In arm fractures in children,

ibuprofen Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is used for treating pain, fever, and inflammation. This includes painful menstrual periods, migraines, and rheumatoid arthritis. It may also be used to close a patent ductus ...

has been found to be as effective as a combination of

paracetamol Paracetamol, also known as acetaminophen, is a medication used to treat fever and mild to moderate pain. Common brand names include Tylenol and Panadol. At a standard dose, paracetamol only slightly decreases body temperature; it is inferi ...

and

codeine Codeine is an opiate and prodrug of morphine mainly used to treat pain, coughing, and diarrhea. It is also commonly used as a recreational drug. It is found naturally in the sap of the opium poppy, ''Papaver somniferum''. It is typically use ...

. In the ems setting it might be applicable to administer 1mg/kg of iv

ketamine Ketamine is a dissociative anesthetic used medically for induction and maintenance of anesthesia. It is also used as a recreational drug. It is one of the safest anesthetics, as, in contrast with opiates, ether, and propofol, it suppresses ...

to achieve a dissociated state.

Immobilization

Since bone healing is a natural process that will occur most often, fracture treatment aims to ensure the best possible ''function'' of the injured part after healing. Bone fractures typically are treated by restoring the fractured pieces of bone to their natural positions (if necessary), and maintaining those positions while the bone heals. Often, aligning the bone, called reduction, in a good position and verifying the improved alignment with an X-ray is all that is needed. This process is extremely painful without

anaesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), am ...

, about as painful as breaking the bone itself. To this end, a fractured limb usually is immobilized with a

plaster Plaster is a building material used for the protective or decorative coating of walls and ceilings and for moulding and casting decorative elements. In English, "plaster" usually means a material used for the interiors of buildings, while "r ...

fibreglass Fiberglass (American English) or fibreglass (Commonwealth English) is a common type of fiber-reinforced plastic using glass fiber. The fibers may be randomly arranged, flattened into a sheet called a chopped strand mat, or woven into glass clot ...

cast Cast may refer to: Music * Cast (band), an English alternative rock band * Cast (Mexican band), a progressive Mexican rock band * The Cast, a Scottish musical duo: Mairi Campbell and Dave Francis * ''Cast'', a 2012 album by Trespassers William ...

or splint that holds the bones in position and immobilizes the joints above and below the fracture. When the initial post-fracture oedema or swelling goes down, the fracture may be placed in a removable brace or

orthosis Orthotics ( el, Ορθός, translit=ortho, lit=to straighten, to align) is a medical specialty that focuses on the design and application of orthoses, or braces. An is "an externally applied device used to influence the structural and functi ...

. If being treated with surgery, surgical nails, screws, plates, and wires are used to hold the fractured bone together more directly. Alternatively, fractured bones may be treated by the Ilizarov method which is a form of an external fixator. Occasionally smaller bones, such as phalanges of the toes and

finger A finger is a limb of the body and a type of digit, an organ of manipulation and sensation found in the hands of most of the Tetrapods, so also with humans and other primates. Most land vertebrates have five fingers (Pentadactyly). Chambers 1 ...

s, may be treated without the cast, by buddy wrapping them, which serves a similar function to making a cast. A device called a Suzuki frame may be used in cases of deep, complex intra-articular digit fractures. By allowing only limited movement, immobilization helps preserve anatomical alignment while enabling

formation, toward the target of achieving union. Splinting results in the same outcome as casting in children who have a distal radius fracture with little shifting.

Surgery

Surgical Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pa ...

methods of treating fractures have their own risks and benefits, but usually, surgery is performed only if conservative treatment has failed, is very likely to fail, or is likely to result in a poor functional outcome. With some fractures such as

s (usually caused by osteoporosis), surgery is offered routinely because non-operative treatment results in prolonged immobilisation, which commonly results in complications including chest infections, pressure sores, deconditioning,

deep vein thrombosis Deep vein thrombosis (DVT) is a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. A minority of DVTs occur in the arms. Symptoms can include pain, swelling, redness, and e ...

(DVT), and

pulmonary embolism Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism). Symptoms of a PE may include shortness of breath, chest pain particularly upon breathing ...

, which are more dangerous than surgery. When a joint surface is damaged by a fracture, surgery is also commonly recommended to make an accurate anatomical reduction and restore the smoothness of the joint.

Infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable d ...

is especially dangerous in bones, due to the recrudescent nature of bone infections. Bone tissue is predominantly

extracellular matrix In biology, the extracellular matrix (ECM), also called intercellular matrix, is a three-dimensional network consisting of extracellular macromolecules and minerals, such as collagen, enzymes, glycoproteins and hydroxyapatite that provide struc ...

, rather than living cells, and the few

blood vessels Blood vessels are the structures of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away fro ...

needed to support this low metabolism are only able to bring a limited number of immune cells to an injury to fight infection. For this reason, open fractures and osteotomies call for very careful

antiseptic An antiseptic (from Greek ἀντί ''anti'', "against" and σηπτικός ''sēptikos'', "putrefactive") is an antimicrobial substance or compound that is applied to living tissue/skin to reduce the possibility of infection, sepsis, or putre ...

procedures and prophylactic use of antibiotics. Occasionally, bone grafting is used to treat a fracture. Sometimes bones are reinforced with metal. These

s must be designed and installed with care. ''

Stress shielding Stress shielding is the reduction in bone density (osteopenia) as a result of removal of typical stress from the bone by an implant (for instance, the femoral component of a hip prosthesis). This is because by Wolff's law Wolff's law, developed ...

'' occurs when plates or screws carry too large of a portion of the bone's load, causing

atrophy Atrophy is the partial or complete wasting away of a part of the body. Causes of atrophy include mutations (which can destroy the gene to build up the organ), poor nourishment, poor circulation, loss of hormonal support, loss of nerve supply ...

. This problem is reduced, but not eliminated, by the use of low- modulus materials, including

titanium Titanium is a chemical element with the Symbol (chemistry), symbol Ti and atomic number 22. Found in nature only as an oxide, it can be reduced to produce a lustrous transition metal with a silver color, low density, and high strength, resista ...

and its alloys. The heat generated by the friction of installing hardware can accumulate easily and damage bone tissue, reducing the strength of the connections. If dissimilar metals are installed in contact with one another (i.e., a titanium plate with

cobalt Cobalt is a chemical element with the symbol Co and atomic number 27. As with nickel, cobalt is found in the Earth's crust only in a chemically combined form, save for small deposits found in alloys of natural meteoric iron. The free element, ...

chromium Chromium is a chemical element with the symbol Cr and atomic number 24. It is the first element in group 6. It is a steely-grey, lustrous, hard, and brittle transition metal. Chromium metal is valued for its high corrosion resistance and h ...

alloy or stainless steel screws), galvanic

corrosion Corrosion is a natural process that converts a refined metal into a more chemically stable oxide. It is the gradual deterioration of materials (usually a metal) by chemical or electrochemical reaction with their environment. Corrosion engi ...

will result. The metal ions produced can damage the

locally and may cause systemic effects as well.

Other

Cochrane review Cochrane (previously known as the Cochrane Collaboration) is a British international charitable organisation formed to organise medical research findings to facilitate evidence-based choices about health interventions involving health profes ...

low-intensity pulsed ultrasound Low-intensity pulsed ultrasound (LIPUS) is a technology that can be used for therapeutic purposes. It exploits low intensity and pulsed mechanical waves in order to induce regenerative and anti-inflammatory effects on biological tissues, such as ...

to speed healing in newly broken bones found insufficient evidence to justify routine use. Other reviews have found tentative evidence of benefit. It may be an alternative to surgery for established nonunions.

Children

In children, whose bones are still developing, there are risks of either a growth plate injury or a greenstick fracture. * A greenstick fracture occurs due to mechanical failure on the tension side. That is since the bone is not so brittle as it would be in an adult, it does not completely fracture, but rather exhibits bowing without complete disruption of the bone's cortex in the surface opposite the applied force. * Growth plate injuries, as in Salter-Harris fractures, require careful treatment and accurate reduction to make sure that the bone continues to grow normally. *

Plastic deformation In engineering, deformation refers to the change in size or shape of an object. ''Displacements'' are the ''absolute'' change in position of a point on the object. Deflection is the relative change in external displacements on an object. Strai ...

of the bone, in which the bone permanently bends, but does not break, also is possible in children. These injuries may require an osteotomy (bone cut) to realign the bone if it is fixed and cannot be realigned by closed methods. * Certain fractures mainly occur in children, including fracture of the

clavicle The clavicle, or collarbone, is a slender, S-shaped long bone approximately 6 inches (15 cm) long that serves as a strut between the shoulder blade and the sternum (breastbone). There are two clavicles, one on the left and one on the rig ...

and supracondylar fracture of the humerus.

References

External links

Authoritative information in orthopaedic surgery
American Association of Orthopedic Surgeons (AAOS)
Radiographic Atlas of Fracture
{{Authority control Acute pain