Bone fractures

A bone fracture is a break or crack in a bone. It happens when a force pushing against the bone is stronger than the bone can bear. This disturbs the structure and strength of the bone and leads to pain, loss of function, and sometimes bleeding and injury around the site.

The main functions of our skeleton are supporting the body, enabling movement, and protecting our internal organs. Bones are a type of connective tissue, reinforced with calcium and bone cells. They have a softer centre, called bone marrow, where blood cells are made.

There are different types of bone fracture#

Some fractures are more severe than others, depending on the strength and direction of the force, the particular bone involved, and the person’s age and general health.

• Hip fractures occur most often in older people.
• Most broken bones take around 4 to 8 weeks to heal, depending on the age and health of the person and the type of break.

Some health conditions, such as osteoporosis and some types of cancer, can cause bones to fracture more easily, meaning even minor trauma or a fall can become serious.

Fractures are different from other injuries to the skeleton, such as dislocations, although in some cases it can be hard to tell them apart. Sometimes a person may have more than one type of injury. If in doubt, treat the injury as if it is a fracture.

Symptoms of a fracture#

Symptoms depend on the bone involved and the severity of the injury, but may include:

• pain
• swelling
• bruising
• deformity
• inability to use the limb

Common types of fracture#

• Closed (simple) fracture – the broken bone has not pierced the skin.
• Open (compound) fracture – the bone breaks through the skin, so infection and external bleeding are more likely.
• Greenstick fracture – a small, slender crack in the bone. This can occur in children, because their bones are more flexible than an adult’s.
• Hairline (stress) fracture – often occurring in the foot or lower leg as a result of repeated stress from activities such as jogging or running.
• Complicated fracture – structures surrounding the fracture are injured. There may be damage to veins, arteries or nerves, and there may also be injury to the lining of the bone (the periosteum).
• Comminuted fracture – the bone is shattered into small pieces. This type of fracture tends to heal more slowly.
• Avulsion fracture – muscles are anchored to bone with tendons. Powerful muscle contractions can wrench the tendon free and pull out pieces of bone. This is more common in the knee and shoulder joints.
• Compression fracture – occurs when 2 bones are forced against each other. The bones of the spine (vertebrae) can fracture this way. Older people, particularly those with osteoporosis, are at higher risk.

Fractures of the head, chest, spine or pelvis#

Not all fractures involve an arm or leg. Trauma to the head, chest, spine or pelvis can fracture bones such as the skull and ribs. These fractures are complicated by the underlying body structure that the bone normally protects, and some can be very difficult to manage with first aid alone, as they may be life-threatening. Always seek emergency assistance if you suspect this type of fracture.

Other problems caused by a bone fracture can include:

• Blood loss – bones have a rich blood supply, and a bad break can make you lose a large amount of blood.
• Injury to organs or surrounding structures – for example, the brain can be damaged by a skull fracture, and chest organs can be injured if a rib breaks.
• Stunted growth of the bone – if a child’s long bone breaks close to the joint where the growth plates are found.

First aid for fractures#

Good first-aid care matters. Moving broken bones can increase pain and bleeding and can damage tissues around the injury, which may lead to complications in healing later on. First aid for fractures is all about immobilising (limiting movement of) the injured area.

Complicated breaks where a limb is very deformed may need to be realigned before splinting – only paramedics or medical staff should do this. Fractures of the skull, ribs and pelvis are all serious and should be managed by paramedics.

If you suspect a bone fracture:

• Keep the person still. Do not move them unless there is immediate danger, especially if you suspect a fracture of the skull, spine, ribs, pelvis or upper leg.
• Attend to any bleeding wounds first. Stop the bleeding by pressing firmly on the site with a clean dressing. If a bone is protruding, apply pressure around the edges of the wound. Once bleeding is controlled, keep the wound covered with a clean dressing.
• Never try to straighten broken bones. For a limb fracture, provide support and comfort, such as a pillow under the lower leg or forearm, without causing further pain or unnecessary movement.
• Apply a splint to support the limb. Splints do not have to be professionally made – items like wooden boards and folded magazines can work for some fractures. Immobilise the limb above and below the fracture.
• Use a sling to support an arm or collarbone fracture.
• Raise the fractured area if possible and apply a cold pack to reduce swelling and pain.
• Do not give food or drink until the person has been seen by a health professional, in case they need surgery.

In an emergency, call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) for an ambulance.

Diagnosis of bone fractures#

Doctors can diagnose bone fractures with x-rays. They may also use CT (computed tomography) and MRI (magnetic resonance imaging) scans.

Treatment of bone fractures#

Broken bones heal by themselves – the aim of medical treatment is to make sure the pieces of bone are lined up correctly so the bone can recover fully in strength, movement and sensitivity. Depending on where the fracture is and how severe it is, treatment may include:

• pain relief
• a plaster cast – made from a preparation of gypsum that sets hard when water is added – to immobilise a limb
• splints or braces to support the bone
• traction (a less common option)
• surgically inserted metal rods or plates to hold the bone pieces together

Operation procedures#

• Closed (simple) fractures – the 2 ends of the broken bone are lined up and held in place. The limb is thoroughly bandaged and the wet plaster is applied. Sometimes, once the plaster is dry, the cast is split into 2 halves that are re-bandaged on the outside to allow for any swelling.
• Open (compound) fractures – these are thoroughly cleaned in the operating room to remove debris before being set, because a broken bone exposed to the open air may become infected.
• Long bones – long bones such as the thigh bone (femur) are difficult to keep aligned. In adults these are often treated by internal nailing. A child may need traction for a couple of days before the bone is set in a cast. In other cases, pins are inserted above and below the fracture and secured to an external frame, or ‘fixator’. This is done under general anaesthetic.

Immediately after an operation#

After surgery, your doctor will check that you have full feeling in the area. For example, if you have a broken arm in plaster, they may ask you to wiggle your fingers, and they will check your limb for tingling, paleness or coolness. These tests check whether the splint is affecting the limb’s nerve and blood supply. The injured part is kept as still as possible in the first few days, and you will be offered pain-relieving medication.

How fractures heal#

Blood clots that form on the broken ends of bone are the start of the healing process. Over about 5 weeks, the body joins the 2 bone portions together with a combination of fibrous cells and cartilage. This temporary bone (callus) is not as strong as real bone and can break easily until it is slowly replaced with real bone. For this reason, the cast or splint may be removed after a few weeks, but you still need to treat the bone with care for at least one more month. Some bones, such as the collarbone or bones of the toes, are immobilised with a sling or splint rather than plaster, and rested for about 2 months.

Self-care after a bone fracture#

Possible complications include a wrongly fitted plaster cast (too tight or too loose), poor alignment of the limb, and infection. Follow your doctor’s advice. General suggestions include:

• Until the cast has set properly, avoid direct heat such as hot water bottles.
• Rest the limb as much as possible.
• Use the techniques shown to you by nurses to walk or manage day-to-day activities – for example, you risk further injury if you use crutches incorrectly.
• Avoid lifting or driving until the fracture has healed.
• If the skin under the cast is itchy, don’t poke anything between the cast and your limb (such as a coat hanger or pencil). Instead, use a hairdryer to blow cool air into the cast.
• Don’t get your cast wet, as wet plaster becomes soft, does not provide the necessary support, and can irritate your skin. When showering, wrap the cast in a plastic bag and tape it directly to your skin to keep the area watertight.

See your doctor immediately if you have swelling, blueness or loss of movement of the fingers or toes, pins and needles, numbness or increased pain.

Long-term outlook#

In most cases the cast is removed after a few weeks, but you must treat the limb with care for at least the next month or so. Leg fractures can take several months to heal, as the weaker, temporary bone (callus) is still being replaced by real bone and can be easily injured. Your doctor may take more x-rays to check on healing progress.

Unlike skin, broken bones heal without forming scar tissue. However, immobilised muscles tend to weaken and waste, so you may need rehabilitation, including strengthening exercises, for a short time.

Key points#

• The main functions of our skeleton are supporting our body, enabling movement and protecting our internal organs.
• Hip fractures occur most often in older people.
• Greenstick fractures can occur in children, because their bones are more flexible than an adult’s.
• Avulsion fractures are more common in the knee and shoulder joints.
• Older people, particularly those with osteoporosis, are at higher risk of compression fractures.

Where to get help#