Fracture versus break
You may have heard people talk about bone fractures and breaks. The terms are actually interchangeable and both refer to a bone that has been shattered, often by excessive force. Your doctor may be more likely to use the term fracture.
Fractures are usually not life-threatening, but they need immediate medical treatment.
Bone injuries are common. In the United States, more than 1 million people a year fracture a bone.
A fracture occurs when a bone is struck by something stronger than the bone itself. This causes it to break. Car accidents, sports injuries, and falls are common causes of fractures.
Repeated wear on a bone, such as from running, can also cause small fractures. These are called stress fractures or hairline fractures.
Sometimes fractures result from an infection or cancer that weakens the bone. Weakened bones in older people, called osteoporosis, are also a frequent cause of fractures.
Fractures can range from minor to severe depending on the force of the impact and whether there is other damage to the body. Some other types of damage that may occur include:
- breaks in the skin
- nerve damage
- muscle damage
- organ damage
The main sign of a fracture is pain. Most fractures will hurt, especially if you try to move or put weight on the injured bone.
Other symptoms at the site of the injury include:
- bruising or change in color
- bone poking through the skin
You should go to the emergency room if you suspect a fracture. Call an ambulance if you, or someone else, has multiple injuries or is unable to walk.
Your doctor will examine you and check the area of the injury for mobility, and for possible damage to blood vessels or joints. Most fractures are diagnosed using an X-ray of the affected bone.
Sometimes other tests besides X-rays may be needed to determine the extent of the fracture and associated damage.
Magnetic resonance imaging (MRI) or a bone scan can show more details if the fracture is small. An MRI can also show the soft tissue area around the bone, and may indicate injuries to surrounding muscles or tendons.
A computed tomography scan (CT or CAT scan) can be used to provide a three-dimensional image in horizontal or vertical slices of the affected area. This will show more of the detail of the fracture. Your doctor may also inject a dye into your arteries and then do a scan. The dye can make it easier for your doctor to identify damage to blood vessels. Finally, if nerve damage is suspected, nerve conduction studies can be used to check for any damaged nerves.
Your doctor will also ask how the injury occurred, when the pain started, and whether the pain has been getting worse. This will help your doctor decide whether to check for additional complications, such as a disruption of blood flow.
The treatment for a fracture depends on the type of injury, the location of the injury, and its severity.
Bones heal themselves by producing new bone tissue to repair the fracture. New bone tissue forms at the edges of the break to “knit” the broken pieces together. The new bone is soft at first, and so it needs to be protected.
Usually a fracture is immobilized to protect the new, soft bone tissue. Your doctor can immobilize the bone using options that include:
These devices can help keep the bone aligned while it heals. They also make it more difficult for you to accidently use the injured bone.
For a small bone like a finger or toe, the fracture can be immobilized by wrapping it with a soft wrap or a splint.
The injured bone may have to be realigned into its natural position before it’s immobilized with a cast or splint. The realignment may be done without surgery, and is called closed reduction. This often requires a local anesthetic and painkillers.
Sometimes surgery will be required to reposition the injured bone. This is called open reduction. The surgeon may also need to insert the following into your bone to help surgically align the bone:
- wire cables
This may require anesthesia and pain medication.
Hip fractures almost always require surgery to promote faster and better healing. Some limb fractures may need traction, a gentle pulling of the muscles and tendons around the broken bone in order to realign the bone. The traction can be created with a system of weights and pulleys that are mounted on a metal frame over your bed.
On average, fractures heal in six to eight weeks. Children usually heal faster than adults.
The healing time depends on the location and severity of the break. Your age and general health will also affect your recovery time. Follow your doctor’s advice for caring for the fracture to improve the healing process.
The pain usually stops before the fracture has fully healed, but it’s important to keep protecting the injured area until it has healed completely. You may have a physical therapy program and exercises designed to build up muscle strength and joint flexibility in the injured area.
Most fractures heal without complications. A fracture doesn’t necessarily increase or reduce your chances for a break in the same area in the future.
Keeping your bones healthy is important at every age. This means getting enough calcium from your diet and doing weight-bearing exercises to keep your bones strong. Weak bones break more easily.
After age 40, everyone begins to lose bone mass. Your genetic makeup determines your peak bone mass, but diet and exercise make a big difference in keeping your bones healthy as you age.
The American Academy of Orthopedic Surgeons recommends that both men and women over the age of 40 have:
- at least 1,000 milligrams of calcium every day
- at least 1,000 international units (IU) of vitamin D every day
If you are a woman and have gone through menopause, you should increase your calcium to 1,200 milligrams a day. This is because hormonal changes decrease bone strength, which can lead to osteoporosis and increased risk for fractures.
At any age, daily weight-bearing exercises, such as walking, are necessary for bone health. Check with your doctor about an appropriate exercise program for you.
There are also some things you can do to prevent falls and reduce your risk for bone fractures:
- Wear sensible shoes.
- Minimize clutter around the house.
- Make sure that wires, cords, and other hazards are out of the way to prevent tripping.
- Have adequate lighting and place nightlights in the bathroom or other rooms you may have to access in the middle of the night.
- Secure rugs with no-slip pads.
- Get physical therapy to help improve your balance. Take a balance training course, chair yoga, or tai chi.
- Use a cane or walker if needed.