The following information does not replace a physician’s diagnosis and advice under any circumstances whatsoever.
Bone fracture: What’s that?
Our skeleton consists of approx. 206 bones which have developed in different forms1, depending on their functional requirements:
- Long bones (tubular bones)
Can be found in the arms and legs (extremities) The tubular bones include, for example, the thigh bone, the shin or ulna and radius. Their major function is to ensure stability.
- Short bones
These include, for example, carpal and tarsal bones. They stabilise and support moderate movement.
- Flat bones
Such as, for example, the iliac bone or shoulder blade protect the inner organs, provide stability and are responsible for the formation of blood.
- Uneven bones
These include, for example, all vertebrae of the spine. In this case, they protect the spinal marrow and, as also all other bones, provide stability. So, uneven bones mostly have a protective function in the body.
- Air-filled bones
These can mostly be found in the cranial region, such as the paranasal sinuses. Air-filled bones reduce weight burdens. They are important as sound resonance for the voice in the cranial region.
- Sesamoid bones
Such as, for example the kneecap, improve strength transmission and support the motion sequence.
During the course of our life, our skeleton is reconstructed several times. One cycle lasts approx. 10 years and it is then fully renewed. The bones remain performant and any micro injuries are corrected.
If the bone tissue is blocked, normally by external mechanical forces, this is described as a broken bone or a fracture.
If a bone is injured, the body’s self-healing powers are primarily activated. Here, a multi-stage process2 creates new bone material:
Directly following the fracture, the tissue injury causes bruising (a haematoma).
During the first weeks after the acute inflammation phase, soft bone tissue is grafted in the affected region. This tissue is referred to as “soft callus”.
After approx. one month, the callus hardening phase begins. The soft bone substance is mineralised during this phase.
During this phase, which can take up to several months, the bone is transformed back to its normal rigidity.
The bones do not always break in an identical manner. Depending on the type of trauma, different fracture types develop3:
The most frequently incurred bone fractures include4:
Bone fractures do not always heal uncomplicatedly of their own accord. Often, an operation and immobilisation of the body region affected is necessary in order to achieve an optimum healing process during therapy.
Causes of a bone fracture
The most common causes of a bone fracture include:
- Direct or indirect trauma
- Hormone-related changes or diseases
Bone fractures arising from direct or indirect trauma are mostly incurred during sports. The risk sports here include skiing or snowboarding and ball sports. But why is that? In particular, tubular bones are highly stable in the vertical load line as these bones have become accustomed to the body weight force during the course of growth. On the other hand, they display less stability against horizontal burdens because this load direction is only incurred seldom during bone growth.
Hormone-related fractures are often facilitated by the metabolic disorder osteoporosis. The ailment of osteoporosis is based on reduced release of the hormone oestrogen which supports the intake of calcium in bone material. Reduction of the intake of calcium for the bones can cause increased tendency for fractures.
Further causes may include fatigue fractures which arise from continuous overburdening of the osseous structures.
Bone fracture symptoms
- Swelling (haematoma)
- Abnormal joint position
- Grating noise
One of the major symptoms of a bone fracture is pain. The pain trigger arises from the irritation or destruction of the sensitive periosteum. Generally, a swelling can be felt in the body region concerned. The fracture injures blood and lymph vessels and haematomas and bleeding result. The osteotomy may also lead to abnormal joint movement or positioning or movement restrictions. A grating noise during movement can also be observed. A fatigue or stress fracture (e.g. in case of osteoporosis) does not always demonstrate typical fracture symptoms.
Bone fracture diagnosis
In addition to the case history (e.g. questioning regarding the course of the accident), inspection and physical examination of the affected region play an extremely critical role. These are distinguished between certain and uncertain fracture indications.
CERTAIN FRACTURE INDICATIONS
- Axis malposition
- Visible bone fragments
- Abnormal movement
- Grinding noise from friction of the bone fragments (crepitation)
UNCERTAIN FRACTURE INDICATIONS
- Restricted movement
- Reddening/Temperature rise
Uncertain fracture indications may also arise in case of different diseases or injuries.
An X-ray of the region concerned is normally made in order to confirm a suspected bone fracture. It enables the recognition of the precise localisation of the fracture. Furthermore, it can be recognised whether the bone is completely broken or only in-part.
Bone fracture therapy
The therapy depends on the extent and type of the injury. Also the body region and the person’s age play a role. Bone fractures can be treated conservatively (without an operation) or operated.
Initially, we recommend general emergency measures such as cooling and immobilisation. As the risk of infection exists in case of open fractures, it makes sense to cover them with sterile wound dressings. Finally, the person concerned should be presented in a clinic (emergency unit) or to a physician. They decide regarding the further therapeutic measures.
If the physician decides in favour of conservative treatment, the region affected is normally immobilised. Immobilisation of the region of the body affected can be achieved with a brace, e.g. the BORT Stabilo® Lumbar Back Brace, BORT Thumb/Hand Brace or the BORT X-Walker.
Before immobilisation, the treating physician returns the fracture to the physiological initial position (reduces it) without an operation in order to support optimum healing.
In case of particularly complex or serious fractures, the treating physician will normally propose operational therapy. Here, depending on the operation method applied, the bone fragments are anatomically repositioned and stabilised. This process is described as osteosynthesis.
In order to secure therapeutic success, additional rehabilitation measures such as physiotherapy can be prescribed, both as a follow-up for conservative and for operative therapy.
If fractures are not diagnosed in good time and treated professionally, complications such as pseudoarthrosis (false joint) may arise. This is understood as an unnatural (pathological) movement of the bone. It normally arises if the fracture gap doesn’t close properly.
How can bone fractures be prevented (fracture prophylaxis)?
As most bone fractures arise from unpredicted traumas, it is very difficult to avoid them. However, the risk can be reduced in certain cases.
Regular exercise and targeted training support the stabilisation of the bone structure. Also, a healthy and balanced diet can contribute to better mineralisation of the bone.
For example, older persons with an uncertain gait can wear a special protector for the hip/femoral neck which reduces the trauma in case of a fall. Accompanying this, all stumbling blocks should be removed and stairs be well secured. For additional security, hand-grips can be attached, for example in the bathroom. These measures can also be taken for osteoporosis patients.
BORT Generation Hip Protector
- Hip protection beltwith a shock absorbing effect
- Protectors made of soft visco-elastic foam can be removed
- Strap with an anatomically designed cut can be fully opened
- Easy to put on/remove thanks to Velcro fastening
- Wide frontal grip straps
- Safe handling and comfortable to wear
- Suitable for temporary use during phases of activity
- Attractive, functional design
- Protector Set (REF 201 120)
BORT StabiloHip Hip Protector
- Hip protection pants with shock absorbing effect
- Protectors made of soft visco-elastic foam can be removed
- Highly elastic waistband and leg edge
- Protectors can be easily removed
- High-quality functional pants made of cotton and Lycra
- Protector Set (REF 201 120)
- Pants (REF 201 200)
In case of considerable overweightness, it can be helpful to reduce one’s weight. As a result, the bones are literally “burdened less”.
1 Reference: Allgemeine Anatomie und Bewegungssysteme, Prometheus Lernatlas der Anatomie. Georg Thieme Verlag. 4. überarbeitete und erweiterte Auflage. Seite 40
2 Reference: Auszug Bohndorf, Imhof, Fischer, Radiologische DIagnostik der Knochen und Gelenke. Frakturheilung. https://www.minerva-kg.de/libraryonline/upload/files/file_3201.pdf
3 Reference: MDS Manual. Überblick über Frakturen. https://www.msdmanuals.com/de-de/profi/verletzungen,-vergiftungen/frakturen/%C3%BCberblick-%C3%BCber-frakturen
4 Reference: Das DEUTSCHE ÄRZTEBLATT. Inzidenz von Frakturen in der Erwachsenenpopulation in Deutschland. Eine Analyse von 2009 bis 2019. https://www.aerzteblatt.de/archiv/221388/Inzidenz-von-Frakturen-in-der-Erwachsenenpopulation-in-Deutschland