A fracture is more than just a broken bone—it's a medical event that can affect blood vessels, nerves, and nearby organs. Proper understanding and management are critical to avoid complications such as infection, non-union, or even permanent disability. This guide walks you through everything from types of fractures to their classification, complications, and treatment strategies.
What Is a Fracture?
A fracture is a break in the continuity of a bone. It may result from trauma, pathology, or stress. Fractures can be:
- Transverse, oblique, or spiral (based on the direction of the break)
- Comminuted (bone is shattered into multiple pieces)
- Greenstick (common in children; one side of the bone bends)
- Complicated (involving blood vessels, nerves, or organs)
- Compound/Open (skin is broken, exposing bone)
- Pathological (occurs in weakened bones, e.g., from osteoporosis, metastasis)
Common Causes of Fractures
- Trauma: Road accidents, falls, sports injuries
- Osteoporosis: Bones weakened by age or hormonal imbalance
- Overuse: Repetitive stress leads to microfractures (e.g., in runners)
- Tumors: Bone metastases make bones brittle
- Congenital conditions: E.g., osteogenesis imperfecta
Clinical Features of a Fracture
- Severe pain and tenderness
- Swelling and bruising
- Deformity or limb shortening
- Loss of function or range of motion
- Abnormal mobility (crepitus)
- Numbness (nerve involvement)
- Bleeding (if vessels are involved)
Investigations
- X-ray (2 views): Most common and accessible
- CT Scan: For complex or subtle fractures
- MRI: Best for soft tissue involvement
- Bone Scan: If X-rays are inconclusive
Types of Fractures: At a Glance
| Type | Description |
|---|---|
| Simple | Clean break without damage to surrounding |
| Compound | Bone pierces the skin |
| Comminuted | Multiple bone fragments |
| Greenstick | Incomplete break (pediatric) |
| Impacted | Bone fragments driven into each other |
| Spiral | Caused by twisting force |
| Avulsion | Tendon/ligament pulls a fragment of bone |
Complications of Fractures
A. General Complications
- Shock: Hypovolaemic or neurogenic due to severe trauma
- Sepsis: Especially in compound/open fractures
- ARDS (Acute Respiratory Distress Syndrome)
- DIC (Disseminated Intravascular Coagulation)
- Fat embolism: Seen in long bone fractures
- DVT and PE: Immobility and vascular injury
- Crush syndrome: Leads to Acute Renal Failure (ARF) and Myonecrosis
B. Local Bony Complications
- Sepsis of bone: Osteitis, acute/chronic osteomyelitis
- Avascular necrosis: Especially in femoral head fractures
- Joint stiffness and early osteoarthritis
- Non-union or delayed union:
- Causes: Infection, ischaemia, distraction, soft tissue interposition
- Malunion: Improper healing leading to deformity, shortening, or angulation
- Epiphyseal injury: Can affect growth (Salter-Harris classification I-V)
C. Local Other Tissues
Vascular:
- Ischaemic: Tear, spasm, thrombosis
- Non-ischaemic: Aneurysm, AV fistula
Nervous:
- Nerve palsy (permanent)
- Praxia (temporary loss)
Muscle:
- Acute: Haematoma
- Chronic: Myositis ossificans (calcification)
Viscera:
- Organ injury from fracture fragments (e.g., ribs damaging lungs)
D. Compartment Syndrome
A true emergency! Rising pressure in a closed compartment → ischemia.
Features:
- Pain (out of proportion)
- Pulselessness
- Pallor
- Paresthesia
- Paralysis
- Pressure (tense limb)
Causes: Tight casts, crush injury, vascular occlusion
Early vs Late Complications
| Early Complications | Late Complications |
|---|---|
| Shock | Non-union, delayed union |
| Infection (osteomyelitis, tetanus) | Malunion |
| Fat embolism, DVT/PE | Arthritis |
| Crush syndrome → ARF | Myositis ossificans |
| Compartment syndrome | Post-traumatic sympathetic dystrophy |
Key Points to Remember
- Always assess for multiple injuries
- Long bone fractures may involve major blood loss
- Compound fractures = surgical emergency
- Tetanus prophylaxis must be given
- Image the joint above and below the fracture site
Essential Management of Fractures
General
- Follow ABCDE of trauma
- Control bleeding, treat shock
- Assess head, spine, thorax, and pelvis for associated injuries
Immediate Fracture Care
- Pain control: NSAIDs, opiates, nerve blocks
- Splint and immobilize
- IV access + blood grouping
- Start antibiotics and tetanus prophylaxis (if compound fracture)
Definitive Management
| Method | Description |
|---|---|
| Closed Reduction | Manual realignment, usually under anesthesia |
| Open Reduction | Surgical realignment of bone fragments |
| Internal Fixation | Screws, plates, rods placed inside the bone |
| External Fixation | Stabilization using external frames/pins |
| Immobilization | Plaster casts, functional braces |
| Rehabilitation | Physical and occupational therapy |
Fractures in Special Populations
Children
- Greenstick fractures common
- Growth plate injuries → Salter-Harris classification
- Potential for remodeling higher than adults
Elderly
- Often due to osteoporosis
- High risk of hip fractures
- Increased mortality from complications
Preventing Complications
- DVT prophylaxis in immobile patients
- Early mobilization
- Adequate nutrition and hydration
- Meticulous wound care for compound fractures
- Periodic imaging to assess healing progression
FAQs on Fractures
1. How do I know if my bone is fractured or just bruised?
Only an X-ray or scan can confirm. Look for deformity, inability to bear weight, and localized tenderness.
2. What is the danger of an open fracture?
High risk of infection, sepsis, tetanus, and osteomyelitis.
3. How long does a fracture take to heal?
6–8 weeks for simple fractures, longer for complex or osteoporotic bones.
4. What is the first aid for a suspected fracture?
Immobilize the limb, control bleeding, and avoid moving the patient until help arrives.
5. Can fractures cause permanent damage?
Yes, if not treated properly: nerve damage, deformity, or chronic pain may result.
Conclusion
Fractures are more than just broken bones—they're a trauma event that demands attention to both the bone and the surrounding tissues. With prompt diagnosis, appropriate immobilization, and vigilant monitoring for complications like infection, embolism, and compartment syndrome, patients can make a full recovery.
Fractures heal—complications may not. Treat smart. Treat early.
