Broken Bones and Fractures
Most people were introduced to the orthopedic surgeon at a young age when they were brought to the emergency room with their first broken bone. For me the memory of the event is now faint (something about a bicycle and pavement), but the cast that I was able to tote around the classroom is fondly recalled as one of my moments of youthful pride.
Introduction to Fractures
Fractures, broken bones–you can call it what you wish, it means the same thing–are among the most common orthopedic problems, about 6.8 million come to medical attention each year in the United States. The average citizen in a developed country can expect to sustain two fractures over the course of their lifetime.
Is it a Fracture or a Break?
Despite what you may have heard, a broken bone is not worse than a fracture, they both mean the same thing. In fact, the word fracture, according to the Oxford English Dictionary is defined as “the act of being broken.” There are different types of fractures and broken bones, but these words mean the same thing!.
Fractures happen because an area of bone is not able to support the energy placed on it (quite obvious, but it becomes more complicated). Therefore, there are two critical factors in determining why a fracture occurs:
- the energy of the event
- the strength of the bone
The energy can being acute, high-energy (e.g. car crash), or chronic, low-energy (e.g. stress fracture). The bone strength can either be normal or decreased (e.g. osteoporosis). A very simple problem, the broken bone, just became a whole lot more complicated!
Orthopedic surgeons treat fractures throughout the skeletal frame, except for the skull (neurosurgeon) and face (ENT, or ear, nose, and throat, surgeon). Extremity fractures are most common, and usually occur in men younger than age 45, and then become more common in women over age 45. The reason for the difference is when women go through menopause, and stop producing estrogen, the rate of bone loss increases. This is why women are particularly susceptible to osteoporosis and subsequent fractures. The most common fracture prior to age 75 is a wrist fracture. In those over age 75, hip fractures become the most common broken bone.
Bone is constantly in a state of turnover, even when not damaged or injured. We continually absorb and replace the cells that make up our bones. Because of this natural turnover, the process of healing bone also comes about quite naturally.However, in order for a fracture to heal as well as possible, a good reduction, or placement, of the bones must be attained.
- When doctors talk about reduction or a fracture, or reducing the broken bone, they are talking about improving the alignment of the broken ends of the bone.
In most cases reducing a fracture involves placing the broken bone in a cast, often after a little pulling and tugging to achieve improved alignment. If the reduction cannot be satisfactorily achieved (meaning the alignment is either not adequate or not sufficiently stable), then a further procedure may be necessary. This usually means surgery with fixation of the bone with pins, plates, screws or rods.One potential complication of fracture treatment is either a mal-union or non-union of bone. This problem is more common in elderly individuals and in people who sustain more severe fractures. In the case of some fractures (e.g. hip fracture in elderly) the rate of non-union is high enough that instead of trying to heal the bone, the damaged segment of bone is replaced (e.g. hip replacement).
The treatment of a specific fracture is too complicated to be discussed in a general overview of broken bones, but depends on factors such as:
- Location of the fracture
- Severity of angulation or deformity
- Potential for healing
- Other injuries
- Age and activity level of the patient
- And many more factors….
In order to understand your treatment, and the options you may have for treatment, you need to discuss your fracture with your doctor. Because treatments are individualized based on the patient, the x-ray appearance of the fracture, and the other factors mentioned, each case must be treated individually.
The most common cause of fractures is due to trauma. However, especially in the elderly, broken bones often occur where the bone has been weakened by an underlying process. This is called a “pathologic fracture,” which means that there is some pathology, or disease process, that caused the bone to be weak and highly susceptible to fracture. Common diseases that lead to pathologic fracture include osteoporosis and tumors.