How can you tell if you “broke” or “fractured” a bone? And what the heck is the difference?
Did one doctor tell you that you broke your bone, while the other doctor told you that you fractured it? If so, there is a simple explanation – you did both!
“Broke” and “fractured” are synonymous terms.
Like “heart attack” and “myocardial infarction.”
They are two different words describing the exact same thing.
Most medical professionals prefer to use “fracture” when describing a bone injury to one another, but commonly use “break” or “crack” when describing the injury to patients.
A broken bone and a fractured bone are the exact same thing!
But just because break and fracture mean the same thing, that doesn’t mean that all types of breaks/fractures are the same.
Like most medical conditions there is a spectrum with some breaks/fractures being more complicated than others. For ease, from here on out, let’s call it a fracture.
Complicated fractures cause more severe symptoms, longer recoveries, and more complex treatments than simple fractures.
Simple fractures cause minimal symptoms and often need little to no treatment.
Now that we have partially clarified the confusion, let’s learn more about fractures and broken bones. In this article we’ll answer some common questions:
- What are the different types of fractures?
- Why do bones fracture?
- How do you know if you fractured a bone?
- How does a doctor tell if you fractured a bone?
- What complications can occur after a bone is fractured?
- How does a fractured bone heal?
- How do you treat fractures?
- What are surgical treatments for fractures?
- 3 Easy tips to help prevent fractures?
What Are the Different Types of Fractures?
As experts, doctors love to classify!
Fractures can be classified by distance between bone fragments, number of fractured pieces, angle of break, presence or absence of a tears in skin, health of bone, age of patient, and the list goes on.
But instead of boring you with words, let’s let the pictures do the talking.
Displaced Fracture – A bone that has broken into two or more pieces and the pieces have moved far enough that the ends are not lined up straight.
Non-Displaced Fracture – A bone that has broken into two or more pieces but the pieces have not moved far enough to throw off its proper alignment.
Comminuted Fracture – A bone that has broken into more than two pieces.
Stress Fracture – A bone that has cracked due to repeated use and strains. This is a partial fracture of the bone and is sometimes unnoticeable on X-ray.
Pathologic Fracture – A bone that has broken because it is very weak due to disease, such as cancer or osteoporosis <link to osteoporosis blog>.
Greenstick Fracture – A bone that has broken in a child. Children’s bones or relatively flexible and can bend in the extreme without breaking. Sometimes when they bend too much they partial break, often on one side only.
Now that we’ve identified the main types of fractures classified by breakage, let’s look at another classification of fractures – whether or not the skin around the bone is torn.
This is very important because torn skin close to a fracture increases the risk of infection.
An open fracture, sometimes called a compound fracture, indicates the skin was torn, while a closed fracture indicates the skin was not torn.
Why Do Bones Fracture?
The reason a bone fractures is simple physics.
If the force acting on a bone is stronger than the internal strength of the bone, then the bone breaks.
It’s just like taking a sledge hammer to an egg.
The force of the sledge hammer striking the egg is much stronger than the intrinsic strength of the egg shell.
So just as the egg shell shatters, so does bone.
This mismatch in strength usually occurs in 3 types of situations:
- Excessive Force, High Energy and StrongBones – The energy transfer to the bone is really high and strong, causing the bone to fracture.
- Weak Force, Low energy, and Weak Bones – The energy transfer to the bone is low, but the bone is weak and it fractures.
- Repetitive or Prolonged Stress – The bone is exposed to repetitive injury and it fatigues causing it to fracture.
Let us take a closer look:
Excessive Force, High Energy, and Strong Bones
In this scenario the amount of energy being absorbed by normal, strong bone is way beyond its strength and capacity, so the bone fractures.
Common examples include breaks that occur because of gunshot wounds, car accidents and falls from significant heights.
Weak Force, Low energy, and Weak Bones
Some bones are fractured not because of high energy or too much stress, but because the bone itself is weak.
Most of the time this is caused by an underlying medical condition.
As we noted above, experts refer to these types of breaks as pathologic fractures.
Common medical conditions that weaken bone include osteoporosis <link to osteoporosis blog>, tumors, and infections.
Repetitive or Prolonged Stress
Also noted above, fractured due to repetitive or prolonged stress on the bone are known as stress fractures.
They occur because of repeated stress or force applied to the bone causing it to fatigue and break.
Competitive athletes and military recruits are at high risk for this type of fracture.
How Do You Know If You Fractured a Bone?
Signs and symptoms of a fracture vary depending on the severity of the injury, the bone involved, your age and your overall health condition.
However, most types often include some of the following:
- Bruising or skin discoloration
- Numbness or abnormal sensation
- Inability to carry out normal activities
- Inability to move the affected area
- Bleeding, if it is an open fracture
How Does a Doctor Tell If You Fractured a Bone or Broke it?
Doctors can identify most types of bone fractures by examining the injured area for physical signs such as deformity, swelling, tenderness, bruising, and inability to bear weight.
A definitive diagnosis is usually made using imaging techniques like an X-ray.
However, there are times that an X-ray will not show a bone fracture.
This is very common in stress fractures and hairline fractures.
In these cases, your doctor may request other tests like CT scan, MRI or bone scan to confirm the diagnosis.
These tests can also be helpful in determining other injuries in the muscles, ligaments, tendons and joints.
If your doctor suspects a skull fracture, he or she may skip the X-ray and proceed immediately with a CT scan to catch early signs of brain bleeding and possible secondary injuries in the skull.
Occasionally, even after the diagnosis has been established, you may still be required to take additional tests like an Angiogram (an X-ray of the blood vessels) to check if the blood vessels surrounding the bone have been damaged.
What Complications Can Occur After a Bone is Fractured?
Damage resulting from a bone fracture may range from minor to severe, depending on the impact and involvement of other body parts.
Possible complications that may occur include:
- Open Wound
- Osteomyelitis (An infection of the bone)
- Nerve Damage
- Muscle Damage
- Organ Damage
- Non-Union (Bones do not heal after an injury)
- Delayed Union (Bone takes longer to heal)
- Mal-Union (The fractured bone heals in the wrong position)
- Subluxation (Bones become partly out of their normal position within the joint).
- Dislocation (Bones in joint become grossly separated)
- Disruption of Bone Growth (Possible in fractures in children near the bone growth plate)
- Avascular Necrosis or Bone Death (Without a proper blood supply, bones may die)
How Does a Fractured Bone Heal?
A fractured bone normally heals in 3 unique and consecutive stages – Inflammation, Repair, and Remodeling.
During this initial stage, the body forms a huge blood clot around the area of injury.
Immune cells migrate to the injured area and start getting rid of the damaged bone fragments and other injured tissues.
This stage causes the most swelling, bruising, and pain.
It usually lasts 7 to 10.
The repair stage is broken up into 2 sub parts: early and late.
In the early repair process, stem cells start forming scar tissue.
This scar tissue is being generated to knit the damaged parts back together and results in soft bone.
This newly formed soft bone, called soft callus, is still fragile and may easily be damaged if exposed to new injury.
In the late repair process, new bone cells start adding minerals such as calcium and magnesium to the soft bone to add strength and stiffness.
This new callus is called a hard callus and is very close to normal bone.
The repair process starts around the 2 week mark and lasts for months.
In this stage, bones gradually morph back to their normal shape, density, strength, and function.
This enables bone to sustain normal activities with little chance of re-injury.
The remodeling process can last for years, but bone usually has sufficient strength after a few months of healing.
Factors that influence healing
Many factors influence the healing of fractured bones. These include your age, which bone was affected, the type of fracture, your overall health and your lifestyle.
Healing becomes more complicated with age.
Kidney disease, malnutrition, and poorly controlled diabetes dramatically disrupt the bone healing process.
Smoking and/or alcohol use are straight up bone killers, making healing very difficult.
How Do You Treat Fractures?
Fractured bones can be treated with or without surgery
Non-surgical treatment usually involves some form of immobilization.
Immobilization should be done as soon as possible to protect the bone and to help keep it aligned as it heals.
The best way to immobilize a fractured bone varies based on the bone involved.
In most cases, the following are ways to immobilize a fractured bone:
Casts or Splints
These are used to prevent the bone from moving.
Casts and splints are commonly made of plaster or fiberglass.
The bone will be set before casts or splints are used. In some cases, if the bone is not aligned in the right position, it has to be reset.
This process is called fracture reduction.
Anesthesia is given so that the doctor can manipulate and reposition the bone properly.
Functional braces work exactly the same as cast or splints, but they are made of plastic and can be taken on and off.
They help hold the bone in position until it has completely healed.
With traction, weights are attached to the fractured bone to help align it by a gentle, steady pulling action.
After a sufficient period of immobilization, usually around 4 to 6 weeks, fractured bones becomes sticky and strong enough to start physical therapy, an essential part of healing.
Physical therapy helps restore muscle function, strength, and mobility.
What Are Surgical Treatments for Fractures?
In cases where non-surgical treatment is not sufficient to ensure a good outcome, surgery may be required.
Surgical repair of bone fractures is usually performed by an orthopedic surgeon (we rock!)
The main goal of surgery is to properly straighten bones and keep them in the right position.
This allows for early range of motion, weight bearing and increases the likelihood a full recovery.
Most of the time, surgeons do one of the following procedures:
Open Reduction and Internal Fixation
This is the most common type of fracture surgery.
During this surgery, bone fragments are first repositioned in their proper location and alignment.
They are then held together with a combination of metal screws and plates.
The screws and plates attach to the outer surface of the bone.
In fractures involving long bones, such as your leg bone, the fragments can likewise be held together by inserting rods down through the marrow space in the center of the bone.
This kind of surgery is commonly performed as a temporary fix with open reduction and internal fixation planned for a later date.
Sometimes the soft tissue and skin surrounding the bone is too injured or the patient is too sick to perform an immediate open reduction and internal fixation.
External fixation offers a safe intermediate option until the patient and the soft issues heal enough to allow for open reduction and internal fixation.
External fixators are made of metal and carbon fiber.
Pins of the external fixator are placed into the bone above and below the fractured area.
The metal pins inside the bone are connected to a metal bar outside the surface of the skin.
They act like scaffolding outside the body, stabilizing the bones so they don’t move.
External fixators, while a fantastic temporary measure, are rarely kept on for more than a few weeks.
3 Easy Tips to Help Prevent Broken Bones
Get Plenty of Calcium, Magnesium, Boron, and Vitamin D in your diet.
Providing proper nutrition for your bones is of the utmost importance to make your bones strong.
You must get enough calcium, magnesium, boron, and vitamin D to maintain optimal bone health.
Green leafy vegetables, cheese, milk, and yogurt are excellent sources of calcium.
While pumpkin seeds, soy beans, sesame seeds, and black beans are rich sources of magnesium.
Healthy sources of boron are dates, raisins, peanuts, and avocados.
Direct exposure to sunlight is the undisputed champion of vitamin D synthesis, but dietary sources include oily fish and eggs.
Both men and women age 40 and above must take at least 1,200 mg of calcium, 420 mg of magnesium, 4 mg of Boron, and 1,000 IU of vitamin D daily.
After menopause, women are especially at risk for weak bones and must consume optimal amounts of bone nutrients to compensate for the hormonal changes that decrease bone strength.
Do Plenty of Weight Bearing Physical Activity
Regardless of age, weight-bearing exercises like walking, running, weight lifting, yoga, tai chi, and dancing are excellent for bone health.
The more exercises you do, the stronger your bones will be.
Bones naturally weaken as you age, but that weakening is accelerated with little or no physical activity.
Get moving to help avoid nasty bone breaks.
As you age, falls become a major risk factor for fractured bones.
Take the following measures to help void falls:
- Wear comfortable and sensible shoes
- Keep your house clutter free
- Tidy up things that can cause tripping, such as exposed cords and wires
- Use good lighting, especially at night and in the bathroom
- Add rugs with no-slip pads
- Use a walker or cane if necessary
You probably learned more than you ever wanted to know about a fracture!
- A break and a fracture are the exact same thing.
- There are many different types of breaks and fractures.
- Why breaks occur and how doctors diagnose them.
- The bone healing process and how fractured bones are treated.
- Straight forward ways to prevent future fractures.
So while there is no sugar coating that a fractured bone sucks, if you happen to suffer from a fractured bone, you’ll be in the know.
There’s fun to be had, even in the most difficult situations. If you have a broken bone, ask your doctor for a copy of your x-ray and play “identify that fracture.” Or maybe that is just a fun game to us Orthopedic Surgeons?
Or maybe post your x-rays to your Instagram account and show off how cool you hardware looks!
But most important make sure you adhere to your doctor’s treatment guidelines and take the necessary steps to heal a break properly and to prevent future injury!