Fractures & Sprains

Posted: May 1, 2005

A bone fracture is a break in a bone. The soft tissue surrounding the break also may be injured. Most bone fractures are the result of injuries from falls or vehicle crashes, but fractures also can be caused by certain diseases.

Causes of bone fractures

• Injuries from falls, sports or vehicle crashes
• Osteoporosis — weakening of the bones associated with aging
• Tumors that grow on or near bones
• Prolonged walking or running — sometimes called stress fractures

Descriptions of bone fractures

• Simple — the bone is broken in one place
• Comminuted — the bone is broken in several places with at least three bone fragments
• Open — the skin is injured exposing the broken bone (also called "compound")
• Closed — the skin is intact over the broken bone
• Undisplaced — the broken bone pieces are aligned
• Displaced — the broken bone pieces are not aligned

Treating bone fractures
If you think you have broken a bone, seek emergency medical care immediately.

A medical examination and X-rays can help determine if and where a bone is broken.
The broken pieces may need to be put back in place and then immobilized until the bones can heal as new bone forms around the break.

The type of treatment will depend on the kind of fracture and the specific bones involved.
Fractured bones usually need at least four weeks to heal although casts may be removed before that to prevent stiffness (particularly for fractures involving the elbow or hand). Physical therapy may be required after the bone has healed.

The different treatments include:

• Casting — after the broken bones have been manipulated back into their proper positions, a plaster or fiberglass cast is applied to keep the bones from moving while they heal
• External fixation — pins or wires are set into the bone through the skin above and below the fracture. These are connected to a ring or a bar outside the skin that holds the pins in place. After the bones have healed, the pins are removed.
• Internal fixation — in a surgical procedure, metal rods, wires or screws are inserted in the bone fragments to keep them together

Sprains
A sprain is a stretch and/or tear of a ligament (a band of fibrous tissue that connects two or more bones at a joint). One or more ligaments can be injured at the same time. The severity of the injury will depend on the extent of injury (whether a tear is partial or complete) and the number of ligaments involved.

A strain is an injury to either a muscle or a tendon (fibrous cords of tissue that connect muscle to bone). Depending on the severity of the injury, a strain may be a simple overstretch of the muscle or tendon, or it can result from a partial or complete tear.

Although sprains can occur in both the upper and lower parts of the body, the most common site is the ankle. Sprains also frequently occur at the wrist, typically when people fall and land on an outstretched hand. A sprain to the thumb is common in skiing and other sports.

What causes a sprain?
A sprain can result from a fall, a sudden twist, or a blow to the body that forces a joint out of its normal position and stretches or tears the ligament supporting that joint. Typically, sprains occur when people fall and land on an outstretched arm, slide into a baseball base, land on the side of their foot, or twist a knee with the foot planted firmly on the ground.

The usual signs and symptoms include pain, swelling, bruising, instability, and loss of the ability to move and use the joint (called functional ability). However, these signs and symptoms can vary in intensity, depending on the severity of the sprain. Sometimes people feel a pop or tear when the injury happens.

When to see a doctor for a sprain

• You have severe pain and cannot put any weight on the injured joint.
• The injured area looks crooked or has lumps and bumps (other than swelling) that you do not see on the uninjured joint.
• You cannot move the injured joint.
• Your limb buckles or gives way when you try to use the joint.
• You have numbness in any part of the injured area.
• You see redness or red streaks spreading out from the injury.
• You injure an area that has been injured several times before.
• You have pain, swelling, or redness over a bony part of your foot.
• You are in doubt about the seriousness of the injury or how to care for it.

Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center

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