Broken Bones (fractures)

Broken bones

A broken bone (fracture) is an abnormal interruption of a bone or the structure of the bone. The cause is direct or indirect external violence. The symptoms depend on the type and location of the fracture.

Therapy for a fracture generally consists of holding the fragments in their normal position until the fracture has healed and restoring the function of the bone. For this, conservative measures (e.g. plaster cast) or an operation can be used.

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• What are the causes of broken bones?
• What types of bone fractures are there?
• What are the symptoms?
• How is the diagnosis made?
• How is bone fracture treated?
• What complications can arise?
• How can you prevent?
• Whom can I ask?
• How are the costs going to be covered?

What are the causes of broken bones?

Bones are among the hardest and most resilient tissues in the body. However, if a bone is stressed beyond its elastic limit, it can break. Whether a fracture occurs depends on:

• the type and extent of violence. Typical causes of broken bones are, for example, a fall, a blow or an impact. Compression, rotation or extreme tensile loads can also lead to bone fractures.
• the structure of the bone. If the bone is changed or weakened, for example due to a previous illness such as osteoporosis or a bone tumor, even a relatively low load can lead to a break. One then speaks of a pathological (diseased) break.

A special form of pathological fracture is the so-called fatigue fracture (also called stress fracture, creeping fracture or stress reaction of the bone): The bone fracture occurs as a result of permanent overloading of a bone. Sport-related fatigue fractures are particularly common in running sports.

What types of bone fractures are there?

A bone fracture caused by an accident is always accompanied by damage to the soft tissues surrounding the bones (vessels, muscles, ligaments, tendons, nerves, skin). The extent of this soft tissue damage has a significant impact on the healing process of the injury. One differentiates:

• Bone fracture with closed soft tissue damage (closed fracture): No bone parts are visible from the outside. The tissue over the bone fracture can be more or less involved; the extent ranges from scarcely significant skin damage to severe compartment syndrome.
• Bone fracture with open soft tissue damage (open fracture): The bone is visible in the area of the wound. There is an increased risk of infection. Depending on how extensive the injury is, there are different degrees of severity. Open fractures tend to be rare in sport and are always the result of considerable violence, such as falling while riding a motorcycle.

In addition, a distinction is made between the following factors for bone fractures:

• Are they two or more fragments? If there are three to five fragments, one speaks of a multi-fragment fracture, and more than five fragments of a comminuted fracture.
• Are the bone parts shifted against each other (dislocated)?
• Are joints involved?

Special features in children

Both the bones themselves and the skin that surrounds the bones (periosteum) are significantly more elastic in children than in adults. If a bone fracture occurs in childhood, the periosteum often remains intact. As a result, the break is held together, supplied with oxygen and nutrients (the periosteum is well supplied with blood) and usually heals much faster than in adults. This type of fracture is known as a greenwood fracture.

In childhood, bones have so-called growth plates (epiphyseal plates): They are located between the ends of the bone and the bone shaft and serve to allow the bone to grow in length. The growth plate consists of cartilage tissue, which is constantly replaced by bone tissue with increasing length. If there is a break in the growth plate area, there is a risk that the growth of the bone will be impaired. Early diagnosis and appropriate treatment are critical.

What are the symptoms?

The symptoms depend on the type and location of the fracture. In the case of a fatigue fracture, they are usually not as acute and pronounced as in a fresh, accident-related fracture. It is not uncommon for a sprain or contusion to be suspected initially. More on the topic: bruises and sprains

Typical signs of a broken bone are pain, deformity, swelling or restricted mobility. Depending on the extent of the soft tissue injury, further complaints may arise (e.g. open skin wound, bleeding).

How is the diagnosis made?

First, the doctor takes the medical history (anamnesis), asks how the accident happened and carries out a physical examination. A distinction is made between so-called unsafe and safe fracture signs:

• Uncertain signs of fracture: swelling, bruising, restricted mobility or function, and pain. However, not every fracture is perceived as painful; conversely, bruises, for example, can also be associated with these symptoms and be very painful.
• Definite signs of fracture: shape deviation and misalignments, abnormal mobility, crunching of the fracture site (bone rubbing, crepitation), pieces of bone protruding from a wound, partial or complete amputation, evidence of the fracture in the X-ray

If a fracture is suspected, an X-ray examination should be performed; in children, an ultrasound examination can be used instead.

If the X-ray does not reveal a broken bone, a computed tomography, magnetic resonance tomography (MRI) or scintigraphy can be arranged depending on the situation.

How is bone fracture treated?

The following rules apply to first aid: immobilization of the fracture, elevation of the affected part of the body, if there are open injuries, apply sterile wound pads, prevent hypothermia, control of breathing and pulse in the severely injured.

More information on the topic: First aid for injuries

In general, the therapy of bone fractures consists in bringing the fragments into their normal position (repositioning), fixing them in place until the fracture has healed, and restoring the function of the bone.

Which treatment is performed depends on the type of fracture, the location, the severity of the injury and the general condition of the injured person. A general distinction is made between a conservative and an operative approach.

Conservative treatment

Bone fractures that are not or only slightly displaced are treated conservatively. Displaced bone parts are first brought into their anatomical position (repositioning); this is done, for example, by slow pulling and counter-pulling or light pressure (if necessary under local anesthesia or brief general anesthesia).

Then the affected bone and the adjacent joints are immobilized with plaster of paris or supporting bandages. How long this is necessary depends on the extent of the break and the location. On average, a fracture gap heals after around six weeks so that the bone can bear normal stress.

Not all fractures require immobilization. In certain cases, the patient is allowed to move the broken area according to the pain and load accordingly, e.g. in the case of stable vertebral fractures or some finger fractures. This is called functional therapy.

Operative therapy (osteosynthesis)

Surgical therapy may be necessary for more complex bone fractures. These include open fractures, closed fractures with extensive accompanying injuries, fractures with joint involvement or fragmentary fractures. Most often, metal implants are used, such as plates, screws, wires or nails made of “surgical steel” (nickel or titanium alloy) to fix the bones in place. Sometimes an operation is also performed to enable faster rehabilitation, as long periods of immobilization also have disadvantages, such as a progressive breakdown of the muscles.

External fixation (external fixator): The screws screwed into the bone protrude from the skin and are connected to the outside via a “frame”. This method is relatively quick and is chosen, for example, for some open fractures, in childhood or for life-threatening injuries.

rehabilitation

As soon as the bone has healed to the point that it can bear normal load, mobilization should begin gradually. This can usually be done faster after surgical therapy than with a conservative approach.

The aim is to restore the original function of the affected region and to prevent further muscle breakdown and joint stiffening. If necessary, physiotherapy can be prescribed.

What complications can arise?

Various complications can occur after bone fractures or during therapy. These include:

• Bleeding with hematoma,
• Infections in the wound area,
• Immobilization-related complications such as deep vein thrombosis or pulmonary embolism. As a preventive measure, heparin prophylaxis (anti-thrombosis injection) is carried out if the patient is bedridden. More on the topic: Deep vein thrombosis
• Increasing muscle wasting, also as a result of immobilization. Early mobilization is therefore crucial.
• Impairment of blood circulation, mobility or sensitivity due to a cast that is too tight. Regular check-ups must be carried out.
• Delayed healing: this is what one speaks of when, after twelve weeks, no clear ossification of the fracture gap is visible in the X-ray. Possible causes are infections, excessive stress or restricted blood flow (smoking, diabetes, etc.). Ultrasound therapy or extracorporeal shock wave therapy, for example, can be used to support the penetration of the fracture. However, the procedures are controversial.
• Pseudarthrosis: one speaks of this if the break has not healed after six months. In these cases, surgical therapy is necessary.

How can you prevent?

The general risk of injury and thus the risk of a broken bone are reduced by being in good general and training condition and acting responsibly. This can be usefully supplemented by sport-specific protectors: e.g. helmet, wrist guards, shin guards, protective bandages (taping the fingers).

Whom can I ask?

If you suspect a broken bone, contact the nearest accident ambulance. In an acute emergency, call the ambulance (144).

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

• Right to treatment
• Visit to the doctor: costs and deductibles
• What does the hospital stay cost?
• Prescription fee: This is how drug costs are covered
• Rehabilitation & cure
• Medical aids & aids
• Health Professions AZ

and via the online guide to reimbursement of social insurance costs.