American Medical Association Family Medical Guide - American Medical Association [690]
Fractures are classified as closed or open. A closed fracture is one in which the bone is broken but does not protrude through the skin. In a closed fracture, surrounding muscles and other tissues usually are not damaged. In an open fracture, surrounding muscles and other tissues have significant damage, and the fractured bone breaks through the skin.
Types of fracture
In a closed fracture, the skin is intact. In an open fracture, the broken bone protrudes through the skin.
If a fracture is not treated, or if treatment is delayed, complications can occur. For example, the broken pieces of bone may begin to rejoin when they are still out of alignment and the bone may have to be separated or rebroken and realigned surgically. In an open fracture, the bone may become contaminated with bacteria, leading to infection and complicating the healing process. It is possible for a fragment of broken bone, cut off from its blood supply, to die, collapse, and gradually be absorbed by the body. Another complication associated with fractures is damage to neighboring tissues. Sharp fragments of bone may compress or sever nearby blood vessels or nerves. Fractures of the skull or spine can damage the brain or spinal cord. Occasionally, a fractured bone damages internal organs. For example, a broken rib can puncture a lung and cause pneumothorax (see page 644).
Symptoms and Diagnosis
A fracture makes the area around it look swollen, bruised, and sometimes misshapen. If you fracture a bone, you will probably be in severe pain, which is increased by any pressure to the area or attempt to move that part of the body. A minor fracture may cause only mild symptoms and can be mistaken for a sprain (see page 983).
If you or someone you know has a possible fracture, perform first aid (see page 167) and seek medical help immediately at the nearest hospital emergency department. Do not give an injured person anything to eat or drink. Having food or liquids in the stomach may delay treatment if a surgical procedure is necessary. Surgery may require general anesthesia, and it is safer to wait 6 to 8 hours after a person has had anything to eat or drink before having anesthesia. If you have signs of a fracture, the doctor will confirm the diagnosis with an X-ray of the injured area.
Treatment
To treat a fracture, a doctor realigns the broken pieces of bone (if they are in the wrong position) in a procedure called reduction, which may be performed using local or general anesthesia. The doctor may need to cut open the tissues around the fracture to reposition the bones correctly.
Plaster casts or lightweight plastic or resin casts and splints are usually used to hold the bone fragments together in correct alignment while they heal. Some bones are held together naturally and don’t need a cast or splint. For a broken rib, nearby unbroken ribs and chest muscles may hold the broken rib in place. Your doctor can stabilize a fractured finger or toe until it heals by bandaging it to the adjacent finger or toe. In many cases, the broken ends of a fracture in an arm or leg are held in position internally by one or more metal screws, rods, or plates. Internal immobilization of an arm or leg allows the injured arm or leg to be used within a few days of the injury rather than weeks or months.
In children, fractures of the thighbone are often treated by putting the child in a body cast or by gradually applying tension to the bone to realign it using a system of weights and pulleys (called traction) and then putting the leg in a cast. Traction allows the broken ends of the bone to grow together correctly.
Because of the possibility of muscle atrophy (the wasting away of a muscle from disuse), it is important to use an injured arm or leg as soon as possible after immobilization. Follow your doctor’s advice about when and how to move and exercise your injured arm or leg. Keep nearby joints as active as possible without