What are fractures?

Orthopaedic trauma is a phrase used to describe the impact on bones, joints and nerves when someone experiences a traumatic event like a fall, a car accident or a gunshot wound. Orthopaedic trauma can also be used to describe the damage caused by severe osteoporosis and bone cancer that weakens bones to the point where they cannot sustain pressure.

Fractures

A fracture is a broken bone that occurs when pressure exerted on the bone is more than it can withstand. Fractures can occur on any bone in the body. Northwestern Medicine treats fractures to the:

• Arms and legs
• Hands and feet, including fingers and toes
• Pelvis
• Ribs
• Hips
• Skull

Fractures to bones may be closed (simple) fractures where the bone does not break through the skin, or open (compound) fractures where the fracture causes internal or external wounds. The type of treatment depends on the type of fracture and how easily the bones can be fit back together to heal. Fractures are treated with immobilization or surgery:

• Immobilization: Bone fragments are restored to their natural positions and kept in place using plaster or fiberglass casts and splints to immobilize the joints above and below the fracture. Bone healing occurs naturally in patients who are not compromised by nutritional deficiencies or bone health problems such as osteoporosis.
• Surgery: Surgery is usually done when conservative treatment has failed, or if prolonged immobilization would raise the risk of pressure sores, deep vein thrombosis (DVT) and pulmonary embolism. Surgical treatment involves reinforcing the bones with metal rods and screws to hold them in place. Surgery is more often performed on hip and pelvis fractures than on limb fractures because of potential damage to internal organs and difficulty immobilizing the fracture.

Trauma specialists also take into account the type of separation, direction the fracture occurs on the bone, and how many fragments the bone has broken into:

• Complete: The bone fragments separate completely.
• Incomplete: The bone fragments are partially joined, and the fracture may not go all the way through the bone.
• Linear: The bone is fractured along the long axis.
• Transverse: The bone is broken along the short axis, parallel to the ground.
• Oblique: A diagonal fracture.
• Spiral: Part of the bone is twisted.
• Comminuted: The bone has broken into several pieces.
• Impacted: Bone fragments are driven into each other.
• Avulsion: A tendon or ligament breaks away, along with the bone it is attached to.