Fracture - Causes

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What causes a bone fracture?

When outside forces such as a direct blows or falls are applied to bone it has the potential to fail. Fractures occur when bone cannot withstand those outside forces. Fracture, break, or crack all mean the same thing. One term does not imply a more or less severe injury. The integrity of the bone has been damaged, which causes the bone structure to fail, which results in a fracture or broken bone.

Broken bones are painful for a variety of reasons:

  • The nerve endings that surround bones contain pain fiber. These fibers may become irritated when the bone is broken or bruised.
  • Broken bones bleed, and the blood and associated swelling (edema) causes pain.
  • Muscles that surround the injured area may go into spasm when they try to hold the broken bone fragments in place, and these spasms may cause further pain.

Often a fracture is easy to detect because there is obvious deformity. However, at times it is not easily diagnosed. It is important for the physician to take a history of the injury to decide what potential problems might exist. Moreover, fractures don't always occur in isolation, and there may be associated injuries that need to be addressed.

Fractures can occur because of direct blows, twisting injuries, or falls. The type of forces or trauma applied to the bone may determine what type of injury that occurs. Some fractures occur without any obvious trauma due to osteoporosis, the loss of calcium in bone (for example a compression fracture of the vertebrae of the back) or a congenital bone cysts that has been present since birth, which causes a weak area in the bone.

Descriptions of fractures can be confusing. They are based on:

  • Where in the bone the break has occurred
  • How the bone fragments are aligned
  • Whether any complications exist
  • Whether the skin is intact

The first step in describing a fracture is to decide if it is open or closed. The skin protects the inside of the body, including bones, from the outside world. If the skin over the break is disrupted, then an open fracture exists. The skin can be cut, torn, or abraded (scraped), but if the skin's integrity is damaged, the potential for an infection from the outside world to get into the bone exists. Since the fracture site in the bone communicates with the outside world, these injuries often need to be cleaned out aggressively and many times require anesthesia in the operating room to do the job effectively. Compound fracture was the previous term used to describe an open fracture.

Next, there needs to be a description of the fracture line. Does the fracture line go across the bone (transverse), at an angle (oblique) or does it spiral? Is the fracture in two pieces or is it comminuted, in multiple pieces?

A greenstick fracture describes the situation when the bone partially breaks. This often occurs in infants and children where the bone hasn't completely calcified and has the potential to bend instead of breaking completely through. It is similar to trying to break off a young branch or shoot from a tree (a green stick). Other fracture terms include torus or buckle fracture, again when only part of a bone breaks, but this may occur in adults as well.

Finally, the fracture's alignment is described as to whether the fracture fragments are displaced or in their normal anatomic position. If the bones fragments aren't in the right place, they need to be reduced or "set" and placed back into normal alignment.

Return to Bone Fracture (Broken Bone)

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