Fracture

Reliable statistics on the number and distribution of bone fractures are not available, at least partly because such conditions are not routinely reported to national agencies, such as the Centers for Disease Control and Prevention (CDC). Some experts estimate that 10 to 20 million bone fractures occur each year in the United States. They calculate that the average person has two bone fractures during his or her lifetime. Bone fractures tend to be somewhat more common among the young and the elderly. The young are at risk for bone fractures because they tend to be very active, engaged in the types of physical activities that lead to bone fractures. In addition, their bones may not be fully formed and lacking in their adult-level strength, making them more likely to experience a fracture. Bone fractures are also more common among the elderly partly because they tend to be less active and, therefore, somewhat less healthy, and partly because their bones begin to lose calcium, becoming more brittle and more susceptible to breaks. Prior to the age of 50, men are at greater risk for fracture than are women because they tend to be more physically active. After the age of 50, women tend to be at greater risk for fractures because they tend to suffer loss of bone mass at a greater rate than do men.

The three most common causes of bone fracture are osteoporosis, sports injuries, and accidents. Osteoporosis is a condition in which bones begin to lose their protein and mineral content, especially the mineral calcium. As this process occurs, bones become more fragile and more likely to break. A person with osteoporosis can easily break a hip, knee, or other bone simply as the result of a fall, an event that would be much less likely in the absence of osteoporosis. In the United States, an estimated 10 million people have osteoporosis, 80% of whom are women. On average, one out of every two American women will eventually develop osteoporosis as will one out of every four men. Experts estimate that osteoporosis is responsible for about 1.5 million cases of bone fractures every year, about half of which are vertebral fractures, 20% are hip fractures, and 15%, wrist fractures.

The most common immediate symptom of a fracture is pain at the affected site. The pain tends to grow more severe over time, and is generally accompanied by swelling at the site of injury. A lump or other obvious deformity along with a pale skin may also be present. In the case of a compound fracture, a portion of the broken bone can actually be seen protruding from the skin. Loss of feeling and a tingling sensation in the region of the fracture may also be noticeable. Depending on the location of the break, a person may find it difficult to stand or walk or to maintain one's balance. Bleeding, nausea, and vomiting may also accompany a fracture. Loss of consciousness, the appearance of a compound fracture, profuse bleeding, and loss of vision are all symptoms of a serious fracture that requires immediate medical attention.

Bone fractures are often easy to diagnosis when a medical professional knows from a patient's history why she or he has sought medical advice. That is, a person who has fallen off a ten-foot ladder and begins to feel severe pain in an arm may suspect a fracture. An initial diagnosis of a fracture, or suspicion of a fracture, is confirmed with one or more x rays to determine the location and type of fracture. More than one x-ray may be necessary because fractures are difficult to see and must be viewed from more than one angle. In some cases, a computed tomography (CT) scan or magnetic resonance imaging (MRI) may be necessary to confirm an initial diagnosis of fracture. Some fractures are difficult or impossible to detect with imaging techniques soon after they have occurred, and follow-up studies may be necessary to confirm the existence of a fracture.

First aid for a bone fracture involves immobilization of the affected area to prevent further damage. Immobilization can be achieved by the simplest of methods, such as placing two boards around the fracture to prevent further movement of the bones and muscles in the region. The fracture should also be elevated to reduce blood flow to the area, and ice should be applied to reduce swelling. Once under the care of a medical professional, the next step is to immobilize the affected area more efficiently with splints made of wood or plastic. Splints do not completely encircle an arm, leg, finger, or other broken bone because swelling may still be occurring in the area. The splints are left in place until no more swelling occurs, after which they can be replaced by a plaster of paris or plastic cast that completely encircles and immobilizes the damaged area. The cast is left in place until the broken bone has completely healed.

Most fractures heal completely in 6 to 12 weeks, with younger patients seeing significant improvement in a shorter period compared to adults or the elderly. Some factors that affect the rate of healing are the type and extent of bone damage, the presence of infection at the fracture site, quality of blood flood to the damaged area, and the presence of other disorders or diseases in the patient.

One complication that sometimes occurs with fracture healing is non-union, the process by which two broken parts of a bone do not grow back together after a period when healing should have been completed. Nonunion can be caused by a number of factors, including poor nutrition, smoking, excessive alcoholic consumption, and use of certain types of drugs like steroids. Age is also an important cause of nonunion since bone growth in the elderly may be so slow as to prevent complete closure of damaged bones. In such cases, the fractured bones may eventually form a stable configuration in which motion is decreased or prevented, but the injury is regarded as having been resolved. With other causes of nonunion, the condition may be resolved by surgical techniques in which bone parts are forced into an aligned connection and then held in place by immobilization techniques.

Many fractures can be prevented by understanding and following common sense safety rules, such as not using chairs to climb on, not climbing higher on a ladder than the distance for which it is intended, using nonskid bath mats, avoiding slippery throw rugs, and using hand rails when going up and down stairs. In particular, parents can help children understand circumstances that increase one's risk for fractures. Making use of safety equipment is also an important step in preventing fractures. All sports activities now have equipment designed to prevent a whole range of accidents, including fractures, such as helmets, body padding, special shoes, and face guards. Passengers in motor vehicles should also take advantage of restraint devices, such as seat belts. Individuals at risk for osteoporosis can make sure that they have adequate amounts of calcium and vitamin D in their diets, and that they participate in levels of exercise that are appropriate for their age group. Individuals of all ages can also decrease their risk of fractures by maintaining good nutritional and exercise practice that keep their bodies strong and their balance in good order. Seniors in particular can benefit from good balance to avoid falls and subsequent fractures.

David E. Newton, A.B., M.A. Ed.D.