Bone fractures


In bone fractures (also called fractures), there is a break in the continuity of the bone. The cause is often a strong impact or pre-damaged bone tissue. With proper treatment, fractures usually heal without consequence. Complications may occur in complicated cases. Typical complaints can then be persistent pain or limited mobility.

Overview: What are bone fractures?

Bones give the human body support and protect important organs such as the brain or the heart. They are not only stable, but also deformable to a certain degree. This is because they have to withstand various forces such as tension, compression, slight bending or rotation. Together with the muscles, joints, ligaments and vision, the bones form the skeleton. Another task of the bones is to form blood cells.

Bone fractures can occur in different ways, for example due to external force or due to certain pre-existing conditions. This results in a break in the continuity of the bone. In this case, physicians also speak of a fracture (from the Latin “fractura” = break): Two or more fracture pieces are formed, which are sometimes also displaced against each other. Bone fractures are usually very painful and require quick, medical treatment. Normally, bone fractures heal without consequences with the right therapy. Only in some cases, such as complicated fractures or when the soft tissue mantle has also been injured, can the healing process be impaired.

  • Closed fracture: In a closed fracture, the skin is intact and the fracture is sometimes not visible from the outside.
  • Open fracture: In a so-called open fracture, skin and other soft tissue (e.g. muscles) are affected by the injury in addition to the bones. Sometimes bone fragments are visible and the wound bleeds. With an open fracture, the risk for infection and impaired bone healing is very high. Therefore, the wound should be covered with a sterile dressing until surgical or conservative care by a physician is available and a trauma surgeon should be consulted quickly.
  • Joint fracture: Sometimes the joints are involved in the injury. Here, for example, there is the joint fracture in which the joint surfaces are affected by the fracture (e.g. malleolar fracture).
  • Shaft fracture: If the long tubular bones are fractured, these are referred to as shaft fractures (e.g. femoral shaft fracture).
  • Dislocation fractures: In so-called dislocation fractures, on the other hand, in addition to the bone fracture, the joint surfaces have shifted against each other.
  • Comminuted fracture: In addition to the simpler fractures, there are also complicated cases. These include, for example, comminuted fracture with multiple bone fragments and fractures in which bone ends or fragments have been displaced by the injury(fracture dislocation). Muscles, tendons and ligaments can also be injured in the process. The greater the extent of the damage, the more protracted and difficult the treatment.
  • Greenstick fractures: Greenstick fractures in children are a special case. Here, the periosteum surrounding the bone remains uninjured and holds the bone together. This is because children’s bones are not yet fully mineralized and the periosteum is very elastic. As a rule, greenwood fractures heal quickly and well. However, if the growth plates of the bones are affected, problems with bone growth may occur later on.

Age and frequency (ankle fractures)

Bone fractures can occur at any age. However, children and adults over the age of 60 are most commonly affected. The reason: children occasionally injure themselves while playing and romping. In older people, on the other hand, the risk of falling is increased. In addition, bone tissue changes with increasing age. It becomes softer, more porous and thus more brittle.

Of the total 206 bones that an adult has, theoretically any one can break. Particularly frequently affected, however, are for example

  • The vertebral bodies
  • the neck of the femur,
  • the forearm bones,
  • the ribs,
  • the humerus or
  • the ankle joint.

Bone fractures: causes and risk factors

There are several causes that can lead to bone fractures. Generally, there are three triggers.

  • External force: This can occur directly, for example through a blow or impact, and leads directly to a fracture at the point of impact. Mechanical influences such as compression or twisting, on the other hand, act indirectly, so that the bone breaks at a location other than the site of the force.
  • Disease: In this case, the bone tissue is pre-damaged due to a disease (e.g. osteoporosis) and is correspondingly sensitive. The bone breaks under normal stress and for no apparent reason. Doctors then also speak of a “pathological fracture”.
  • Overload: In this case, bone fractures occur as a result of prolonged, recurrent mechanical stress, for example when marching or running (fatigue fracture).

These are the risk factors (fractures)

While the bones of children and young adults are still growing and becoming more stable, there is a slow increase in the loss of bone substance from around the age of 30. From about 50 years of age, this process accelerates more and more. Women are particularly affected by this. Normally, the female sex hormone estrogen protects the bones from too rapid a loss of bone substance. With menopause, estrogen levels drop and the protective effect of the hormone decreases. The result: an excessive amount of bone mass is lost and so-called osteoporosis develops. Also known as “bone loss,” the disease makes bones porous, making them particularly susceptible to fractures.

In addition, certain sports are associated with an increased risk of bone fractures. These include, for example, skiing, snowboarding, mountain biking or football.

Symptoms: Broken bone or other injury?

Bone fractures can cause various symptoms. Some of these may indicate other injuries, such as strains or contusions, among others. Experts therefore divide the signs of a bone fracture into so-called sure and uncertain fracture signs.

Uncertain fracture sign

Symptoms that may also be caused by other injuries include, for example.

  • Pain,
  • Swelling,
  • Adopting a gentle posture,
  • Bruises as well as
  • the restricted mobility of the affected body part.

Secure fracture characters

Sure signs of a bone fracture include the following symptoms:

  • visible bones or bone particles (in a so-called open fracture, where the skin and other soft tissues such as muscles or connective tissue are also injured),
  • Crepitations (the rubbing of bone fragments against each other),
  • Malpositions of limbs and
  • abnormal mobility of the affected body part.

Bone fractures: diagnosis with us

We often recognize bone fractures at first glance when bone fragments, malpositions or unnatural mobility can be seen. Nevertheless, we will ask you some questions to collect your medical history (anamnesis). Important information is for example:

  • Are you in pain? Where are they strongest?
  • How did the injury occur (e.g., accident, sport, fall)?
  • How great was the impact of the force?
  • When was the accident?
  • Are there any pre-existing conditions?

After the questions about the medical history, we will carefully examine the affected part of the body. To do this, we palpate the area and check for swelling. The surrounding musculature is also included in the examination. Sometimes bone fractures are not immediately visible. Therefore, only imaging techniques can often provide a reliable diagnosis.

Imaging methods for confirming the diagnosis

We usually perform a two-plane X-ray to confirm a suspected fracture. Computed tomography (CT ) is used primarily for pelvic or vertebral fractures. This procedure provides more accurate images and additional information that cannot be captured by a simple X-ray. If there is a suspicion that the soft tissue is injured, the so-called magnetic resonance imaging (MRI) is sometimes used. With the help of sonography (ultrasound examination), for example, injuries to certain tendons that are present at the same time can be detected. SPECT/CT can also be used to visualize occult (hidden) fractures and assess healing of complicated fractures.

Fractures: prevention, early detection, prognosis

Many bone fractures can usually be recognized by the fact that they cause severe pain or that the affected limb assumes an abnormal position. Sometimes, however, a fracture remains undetected. This is the case, for example, with fatigue fractures or when a toe bone breaks. However, without proper treatment, the bone may not grow back together properly. Permanent pain or restrictions in mobility can then be the result. Therefore, if in doubt, always have an injury evaluated by a medical professional. Especially if complaints such as pain increase, this could be an indication of a bone fracture.

How to prevent bone fractures

Accidents, which often cause bone fractures, can only be avoided to a limited extent. However, there are still things you can do to strengthen your bones and thus reduce your risk of fracture. Women in particular should pay attention to their bone health. This is because the risk of developing osteoporosis increases with age and due to hormonal changes during menopause. The disease, also known as bone loss, makes bones porous and prone to fractures. Various measures can reduce the risk of osteoporosis:

  • Lack of exercise promotes the breakdown of bone substance. So be sure to get regular, physical activity to keep your bones healthy. But don’t overdo it. Because excessive exercise does more harm than good.
  • Calcium deficiency weakens the bones. A varied diet with sufficient calcium intake through dairy products can counteract this.
  • If possible, give up cigarettes completely. You should also only consume alcohol in moderation.
  • If you are underweight, you should try to reach your normal weight. Underweight women with a body mass index of less than 20 are more likely to develop osteoporosis.

Course and prognosis (bone fractures)

Simple fractures with smooth fracture edges and few bone fragments usually heal without secondary damage with the right treatment. The injured bone is then as stable as before the fracture. In general, children’s bones grow back together more quickly (sometimes within three weeks). In adults, healing can take up to twelve weeks.

However, the more complicated a fracture is, the more difficult the therapy is. Accordingly, the healing process can also take a long time. Complications are also possible, such as infections or bones that have not grown together correctly.

  • Pseudoarthrosis: In this case, the fracture has not healed after six months and a false joint has formed at the ends of the fracture. This often happens when the fracture has not been sufficiently immobilized.
  • Thrombosis: Blood clots can form as a result of prolonged immobilization Sometimes this clogs vessels and leads to a stroke or pulmonary embolism. We therefore prescribe blood-thinning medication to prevent this.
  • Inflammation of bone marrow or bone tissue by bacteria
  • Compartment syndrome: This involves tissue swelling, which leads to a disturbance of blood flow and, in the worst case, to tissue death. Also known as muscle compression syndrome, it is a medical emergency that must be treated as soon as possible.
  • Complex regional pain syndrome (CRPS): This complication is manifested by persistent pain as well as motor problems, sensory disturbances, and autonomic nervous system disorders. In the past, CRPS was also referred to as “Sudeck’s disease”. Medication and early exercise training can alleviate symptoms.

Bone fractures: treatment depending on the extent of the injury

Since bone fractures often occur in accidents, first aid measures are necessary in many cases.

Bone fractures could be treated conservatively, by means of immobilization (splint or cast), or surgically. Operatively, we usually know open (by means of surgical skin incision) or closed (by means of traction) reduction as well as internal stabilization. For this purpose, as a rule, use screws, plates and intramedullary nails. For more details, ask your doctor.