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Symptoms and Signs of Bone Fracture (Broken Bone)

Doctor's Notes on Bone Fracture
(Broken Bone)

The term bone fracture and/or broken bone means that a bone is damaged enough to consider it not to be intact. Signs and symptoms of a bone fracture are usually pain, swelling and inflammation especially at the site where the bone is broken. Sometimes the pain from a bone fracture may be referred (for example, hip fractures may cause knee pain. Some patients develop numbness and tingling. Additional signs and symptoms may occur depending upon which bone is fractured and what type of fracture has occurred. There are many examples; compression fractures, open fractures (broken bone protrudes through the skin), greenstick (partial) fractures, skull fractures, rib fractures, and many others. Growth plate fractures (Salter-Harris fractures) in children can result in misalignment during healing. Usually, signs and symptoms of bone fractures relate to not only the bone fracture itself, but to nerves, blood vessels, muscles and internal organs adjacent to or involved with whatever caused the fracture.

Fractures occur because the bone cannot withstand an outside force placed on it by such common forces encountered in accidental trauma like falls, or intentional trauma like being hit with a bat. Other causes are due to compression or twisting forces. Gunshot and/or shrapnel can cause bone loss in the fracture. Contributing factors that can cause or increase risk for bone fractures include bone cancers, bone cysts, bone infections, heredity and metabolic conditions that influence calcium levels.

Medical Author:
Medically Reviewed on 3/11/2019

Bone Fracture
(Broken Bone) Symptoms

  • As people age, there is a potential for the bones to develop osteoporosis, a condition where bones lose their calcium content. This makes bone more susceptible to breaking. One such type of injury is a compression fracture to the spine, most often the thoracic or lumbar spine. Since we are an upright animal, if the bones of the back cannot withstand the force of gravity these bones can crumple. Pain is the major complaint, especially with movement and often there is an acute event where the pain is felt. There may or not be a fall or injury associated with the pain as compression fractures may occur spontaneously.
  • Compression injuries of the back may or may not be associated with nerve or spinal cord injury. An X-ray of the back can reveal the bone injury, however, sometimes a CT scan or MRI will be used to ensure that no damage is done to the spinal cord. However, if there is a loss of bowel control or the inability to urinate (urinary retention), the symptoms of cauda equina syndrome, requires an emergent MRI to assure that the spinal cord is not at risk of permanent damage.
  • Treatment includes pain medication and often a back brace. Some compression fractures can also be treated with vertebroplasty. Vertebroplasty involves inserting a glue-like material into the center of the collapsed spinal vertebra in order to stabilize and strengthen the crushed bone. The glue (methyl methacrylate) is inserted with a needle and syringe through the anesthetized skin into the midportion of the vertebra under the guidance of specialized X-ray equipment. Once inserted, the glue soon hardens, forming a cast-like structure within the compressed vertebra. However, there are studies and controversy whether this procedure is effective and beneficial.
  • The ribs are especially vulnerable to injury and are prone to breaking due to a direct blow. Rib X-rays are rarely taken since it doesn't matter if the rib is broken or just bruised. A chest X-ray often ordered to make certain there is no collapse or bruising of the lung.
  • As we breathe, our ribs and lungs expand like a bellows. When we breathe, the ribs swing out and the diaphragm, the muscle that separates the chest wall and abdomen pushes down and the air is sucked into the lungs. When a person has a rib injury, the pain associated with that injury, be it a fracture or contusion (bruise), makes breathing difficult and the person has a tendency to not take deep breaths. If the lung underlying the injury does not expand, it is at risk for infection. The person is then susceptible to pneumonia (lung infection), which is characterized by fever, cough, and shortness of breath.
  • As opposed to other parts of the body that can rest when they are injured, it is very important to take deep breaths to prevent pneumonia when rib fractures are present. The treatment for bruised and broken ribs is the same: ice to the chest wall, ibuprofen as an anti-inflammatory, deep breaths, and pain medication. Even if all goes well, there will be significant pain for four to six weeks. Ribs are no longer wrapped because this prevents the victim from breathing deeply, which may lead to the complication of pneumonia.
  • With lower rib fractures, there may be concern about organs in the abdomen that the ribs protect. The liver is located under the ribs on the right side of the chest, and the spleen under the ribs on the left side of the chest. Many times your doctor may be more worried about the abdominal injury than about the broken rib itself. Ultrasound or CT scan may help diagnosis intra-abdominal injuries.
  • When bones break, they cause pain, swelling, and inflammation. The ability to move the joint above or below an injury does not guarantee that the bone is not broken. Instead, it means that the muscles and tendons that move the joint still work.
  • Unless there is a previous underlying condition that prevents the patient from feeling pain (such as a spinal cord injury or diabetic neuropathy) all broken bones hurt. The pain may or may not be felt at the site of the break but can be referred elsewhere. For example, hip injuries, especially in children, can have knee pain.
  • Other structures can be damaged when a bone breaks. Numbness and tingling can result if there is nerve inflammation or injury. A limb may be cool and without pulse, if the artery at the fracture site is torn, kinked or clots off, preventing blood from circulating.
  • When bones break, they cause pain, swelling, and inflammation. The ability to move the joint above or below an injury does not guarantee that the bone is not broken. Instead, it means that the muscles and tendons that move the joint still work.
  • Unless there is a previous underlying condition that prevents the patient from feeling pain (such as a spinal cord injury or diabetic neuropathy) all broken bones hurt. The pain may or may not be felt at the site of the break but can be referred elsewhere. For example, hip injuries, especially in children, can have knee pain.
  • Other structures can be damaged when a bone breaks. Numbness and tingling can result if there is nerve inflammation or injury. A limb may be cool and without pulse, if the artery at the fracture site is torn, kinked or clots off, preventing blood from circulating.
  • Open fractures (compound fractures) are injuries where the skin over the broken bone is compromised, either cut or scraped. This allows the potential for infection to invade the bone causing osteomyelitis (bone infection).
  • Depending upon the bone involved, the type of injury, and how much contamination is in and around the wound. The patient may require surgery to clean the wound area.
  • Surgical realignment of the bone may be postponed once the risk of infection has decreased.
  • Open fractures (compound fractures) are injuries where the skin over the broken bone is compromised, either cut or scraped. This allows the potential for infection to invade the bone causing osteomyelitis (bone infection).
  • Depending upon the bone involved, the type of injury, and how much contamination is in and around the wound. The patient may require surgery to clean the wound area.
  • Surgical realignment of the bone may be postponed once the risk of infection has decreased.
  • A stress fracture is an overuse injury. Because of repeated micro-trauma, the bone becomes weakened and is unable to absorb the added shock placed on it. Often it is seen in the lower leg, the shin bone (tibia), or foot. Athletes at risk include tennis players, basketball players, jumpers, and gymnasts because they have repeated footfalls on hard surfaces. A "march fracture" is the name given to a stress fracture of the metatarsal or long bones of the foot. It is named so because it often occurs in soldiers who are required to march long distances.)
  • Diagnosis usually is made by history and physical exam. Bone scan, CT scan, or MRI may be ordered to confirm the diagnosis.
  • Treatment is conservative (no surgery is required). Rest, decreased weight bearing, ice, and anti-inflammatory medication such as ibuprofen (Advil) often are all the treatment required. These fractures can take six to eight weeks to heal. Trying to return too quickly may cause re-injury, and may also allow the stress fracture to extend through the entire bone and displace, which may turn a stress fracture into a "real" fracture that requires casting or surgery. Surgery is not commonly performed for routine stress fractures.
  • Shin splints may have very similar symptoms as a stress fracture of the tibia but they are due to inflammation of the covering of the bone, called the periosteum. Shin splints are caused by overuse, especially in runners, walkers, dancers, including those who do aerobics. Muscles that run through the periosteum and the bone itself may also become inflamed.
  • Treatment is similar to a stress fracture, and physical therapy can be helpful.
  • A stress fracture is an overuse injury. Because of repeated micro-trauma, the bone becomes weakened and is unable to absorb the added shock placed on it. Often it is seen in the lower leg, the shin bone (tibia), or foot. Athletes at risk include tennis players, basketball players, jumpers, and gymnasts because they have repeated footfalls on hard surfaces. A "march fracture" is the name given to a stress fracture of the metatarsal or long bones of the foot. It is named so because it often occurs in soldiers who are required to march long distances.)
  • Diagnosis usually is made by history and physical exam. Bone scan, CT scan, or MRI may be ordered to confirm the diagnosis.
  • Treatment is conservative (no surgery is required). Rest, decreased weight bearing, ice, and anti-inflammatory medication such as ibuprofen (Advil) often are all the treatment required. These fractures can take six to eight weeks to heal. Trying to return too quickly may cause re-injury, and may also allow the stress fracture to extend through the entire bone and displace, which may turn a stress fracture into a "real" fracture that requires casting or surgery. Surgery is not commonly performed for routine stress fractures.
  • Shin splints may have very similar symptoms as a stress fracture of the tibia but they are due to inflammation of the covering of the bone, called the periosteum. Shin splints are caused by overuse, especially in runners, walkers, dancers, including those who do aerobics. Muscles that run through the periosteum and the bone itself may also become inflamed.
  • Treatment is similar to a stress fracture, and physical therapy can be helpful.
  • Wrist fractures are the most common fracture of people under the age of 75.
  • Common causes of wrist fractures include falling on an outstretched hand causing one or more of the bones that make up the wrist to buckle. In this situation, a Colles' fracture, is often the result.
  • In a Colles' fracture, a broken distal radius bone is displaced. Displaced fractures need to be aligned and kept in position while they heal so that the end result is not only cosmetically normal but also functionally normal.
  • This is especially true if the fracture enters a joint. The joint surface needs to align perfectly, otherwise, over time, arthritis may develop limiting function and causing pain.
  • Wrist fractures are the most common fracture of people under the age of 75.
  • Common causes of wrist fractures include falling on an outstretched hand causing one or more of the bones that make up the wrist to buckle. In this situation, a Colles' fracture, is often the result.
  • In a Colles' fracture, a broken distal radius bone is displaced. Displaced fractures need to be aligned and kept in position while they heal so that the end result is not only cosmetically normal but also functionally normal.
  • This is especially true if the fracture enters a joint. The joint surface needs to align perfectly, otherwise, over time, arthritis may develop limiting function and causing pain.
  • Shoulder fractures are often treated without surgery.
  • Fractures of the humerus, elbow, forearm, and wrist have different treatment plans compared to similar bones in the leg because they are not weight-bearing bones.
  • Shoulder fractures are often treated without surgery.
  • Fractures of the humerus, elbow, forearm, and wrist have different treatment plans compared to similar bones in the leg because they are not weight-bearing bones.
  • Hands and fingers often are involved in crush injuries.
  • In addition to the bone injury, the focus of the hand exam is on the tendons, arteries and nerves, again looking at the function in addition to anatomy.
  • Bones in the hands and finger need to align properly to make certain that the power, range of motion and sensation are maintained optimally.
  • Hands and fingers often are involved in crush injuries.
  • In addition to the bone injury, the focus of the hand exam is on the tendons, arteries and nerves, again looking at the function in addition to anatomy.
  • Bones in the hands and finger need to align properly to make certain that the power, range of motion and sensation are maintained optimally.

With the wide availability of CT scans, skull X-rays are rarely taken to diagnose head injury. If a head injury exists, the doctor will feel or palpate the scalp and skull to determine if there may be a skull fracture present. A nervous system exam may be done assessing brain function. Fractures of the base of the skull may cause hemotympanum (blood behind the eardrum), Battle's sign (bruising behind the ear), or raccoon eyes (bruising around the eye sockets).

The skull is a flat, compact bone and it takes significant force to break it. If a skull fracture exists, there is an increased likelihood of bleeding in the brain, especially in children. There are guidelines that are available to decide whether a CT scan is indicated (needed).

A concussion is a head injury, either a direct blow, or being shaken or jarred where there is a temporary change in mental function, but the victim returns to normal status within 2 hours. With the minor head injury, the following risk groups are considered when evaluating the need for CT brain scan:

High risk for the potential neurosurgical operation

  • Abnormal neurologic exam within two hours after injury
  • Suspected open or depressed skull fracture
  • Any sign of basal skull fracture (blood behind the eardrum, blackened eyes, clear fluid running from the ears, or bruising behind the ear)
  • Vomiting - two episodes
  • 65 years of age or older

Medium risk (for brain injury on CT)

  • Amnesia before impact - more than 30 minutes
  • Dangerous mechanism (pedestrian struck by motor vehicle, occupant ejected from motor vehicle, fall from a height greater than three feet or five stairs)

With the wide availability of CT scans, skull X-rays are rarely taken to diagnose head injury. If a head injury exists, the doctor will feel or palpate the scalp and skull to determine if there may be a skull fracture present. A nervous system exam may be done assessing brain function. Fractures of the base of the skull may cause hemotympanum (blood behind the eardrum), Battle's sign (bruising behind the ear), or raccoon eyes (bruising around the eye sockets).

The skull is a flat, compact bone and it takes significant force to break it. If a skull fracture exists, there is an increased likelihood of bleeding in the brain, especially in children. There are guidelines that are available to decide whether a CT scan is indicated (needed).

A concussion is a head injury, either a direct blow, or being shaken or jarred where there is a temporary change in mental function, but the victim returns to normal status within 2 hours. With the minor head injury, the following risk groups are considered when evaluating the need for CT brain scan:

High risk for the potential neurosurgical operation

  • Abnormal neurologic exam within two hours after injury
  • Suspected open or depressed skull fracture
  • Any sign of basal skull fracture (blood behind the eardrum, blackened eyes, clear fluid running from the ears, or bruising behind the ear)
  • Vomiting - two episodes
  • 65 years of age or older

Medium risk (for brain injury on CT)

  • Amnesia before impact - more than 30 minutes
  • Dangerous mechanism (pedestrian struck by motor vehicle, occupant ejected from motor vehicle, fall from a height greater than three feet or five stairs)

Lower extremity fractures may involve the femur (thigh bone), the knee, the tibia and/or fibula, the ankle and the bones of the foot. Each has their own relatively common symptoms, signs, and treatment plan. The severity depends upon the location of the fracture, whether the bones are in alignment or displaced, and if the type of fracture is unstable.

Some leg fractures are unstable and require surgery, while others are relatively stable and can be observed.

Lower extremity fractures may involve the femur (thigh bone), the knee, the tibia and/or fibula, the ankle and the bones of the foot. Each has their own relatively common symptoms, signs, and treatment plan. The severity depends upon the location of the fracture, whether the bones are in alignment or displaced, and if the type of fracture is unstable.

Some leg fractures are unstable and require surgery, while others are relatively stable and can be observed.

Hip fractures are the most common fracture of people over the age of 75. Causes of a broken hip vary from falls or osteoporosis.

Not all hip fractures are the same and the specific treatment, while almost always surgical, depends upon where the femur bone is broken. Common locations include subcapital, femoral neck, intertrochanteric and subtrochanteric. Each of these terms describes a location in the femur (thigh bone) where a break can commonly occur.

Hip fractures are the most common fracture of people over the age of 75. Causes of a broken hip vary from falls or osteoporosis.

Not all hip fractures are the same and the specific treatment, while almost always surgical, depends upon where the femur bone is broken. Common locations include subcapital, femoral neck, intertrochanteric and subtrochanteric. Each of these terms describes a location in the femur (thigh bone) where a break can commonly occur.

Bone Fracture
(Broken Bone) Causes

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, causing 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, 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 determine what type of injury that occurs. Some fractures occur without any obvious trauma due to osteoporosis, defined as the loss of bone mass or a congenital bone cyst 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 of the bone exists. Because the fracture site in the bone is exposed to the outside world, these injuries often need to be cleaned out aggressively and often require anesthesia in the operating room to do the job effectively. Compound fracture was another 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, which may occur in adults as well.

Bone Fractures Illustration - Fracture of Bone
Bone Fractures Illustration - Fracture of Bone

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.

Osteoporosis Super-Foods for Strong Bones With Pictures Slideshow

Osteoporosis Super-Foods for Strong Bones With Pictures Slideshow

Nothing beats calcium for your bones. Sure, you can get it from dairy, but it’s also found in lots of vegetables. Why not do both? One great choice: dark leafy greens such as bok choy, Chinese cabbage, kale, collard greens, and turnip greens. One cup of cooked turnip greens has about 200 milligrams of calcium (20% of your daily goal). On top of that, dark greens also have vitamin K, which can reduce your risk for osteoporosis.

REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

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