Fractures: Types, Causes, Symptoms, and Management

🦴 Fractures: Types, Causes, Symptoms, and Management

Introduction

A fracture refers to a break in the continuity of a bone, caused by excessive force, trauma, or pathological weakening of bone tissue. Fractures are among the most common musculoskeletal injuries encountered in medical practice. Their management requires prompt diagnosis, stabilization, and a structured rehabilitation plan to ensure complete healing and restore function.

According to a 2021 review in The Lancet Rheumatology, fractures represent a significant global health issue, with more than 178 million new cases reported worldwide each year (PubMed ID: 34348191).

Anatomy and Physiology Behind Fractures

Bones are dynamic structures that can withstand substantial stress due to their composite structure of collagen (for flexibility) and calcium phosphate (for strength). However, when external forces exceed bone strength, the structure fails, resulting in a fracture.
Healing occurs in three major stages:

  1. Inflammatory phase (hematoma formation)

  2. Reparative phase (callus formation)

  3. Remodeling phase (restoration of normal bone structure)

Causes of Fractures

Fractures can occur due to a variety of reasons:

  1. Traumatic injuries: Road accidents, falls, sports injuries.

  2. Repetitive stress: Overuse in athletes leads to stress fractures.

  3. Pathological causes: Weakened bones from conditions like osteoporosis, tumors, or infections.

  4. Direct trauma: Direct impact causing localized break.

  5. Indirect trauma: Rotational or bending force applied away from the fracture site.

(Reference: PubMed ID: 33449741)

Classification of Fractures

Fractures are classified in multiple ways:

Type Description
Closed (Simple) Bone breaks but skin remains intact
Open (Compound) Bone pierces through the skin
Complete Bone is broken through its full thickness
Incomplete Partial break (e.g., greenstick fracture in children)
Comminuted Bone is shattered into multiple fragments
Transverse Horizontal fracture line
Oblique Angled fracture line
Spiral Twisting force causes spiral pattern
Pathological Occurs in bone weakened by disease
Stress fracture Small crack from repetitive strain

(Source: American Academy of Orthopaedic Surgeons – AAOS Clinical Review, PubMed ID: 30247372)

types of fractures


Clinical Features of Fractures

Common signs and symptoms include:

  • Severe pain at the injury site

  • Swelling and tenderness

  • Deformity or abnormal angulation of the limb

  • Loss of function or movement

  • Crepitus (grating sound or feeling of bone ends rubbing)

  • Bruising or open wound (in open fractures)

In severe cases, neurovascular injury may occur, leading to loss of pulse, sensation, or motor function distal to the fracture site.

Diagnosis

1. Clinical Examination

  • History of trauma or mechanism of injury

  • Physical inspection, palpation, range of motion assessment

2. Imaging Studies

  • X-rays: First-line for diagnosis (anteroposterior & lateral views).

  • CT Scan: For complex fractures (pelvis, spine, facial bones).

  • MRI: Useful in stress or occult fractures.

  • Bone Scan: For subtle stress fractures.

(Reference: PubMed ID: 31363578)

Fracture Healing Phases

Fracture healing occurs in three overlapping stages:

  1. Inflammatory Phase (0–2 weeks)

    • Hematoma forms; inflammatory cells clear debris.

    • Pain and swelling are most intense.

    • Immobilization is critical.

  2. Reparative Phase (2–6 weeks)

    • Soft callus → hard callus formation.

    • Fibrocartilage and new bone start bridging the gap.

  3. Remodeling Phase (6 weeks–months)

    • Hard callus is replaced by mature lamellar bone.

    • Gradual restoration of bone’s shape and strength.

(Reference: PubMed ID: 27063380)

Management of Fractures

🩹 1. Acute Phase (First 48–72 hours)

Goals: Pain relief, stabilization, and prevention of further injury.
Management Steps:

  • Immobilize the affected area using splints or slings.

  • Control pain: Analgesics (paracetamol, NSAIDs).

  • Ice therapy to reduce swelling.

  • Elevation of the limb to minimize edema.

  • Neurovascular assessment before and after immobilization.

  • In open fractures: Tetanus prophylaxis and antibiotics.

  • Emergency reduction and fixation if circulation is compromised.

(Reference: PubMed ID: 30685220)

🧠 2. Subacute Phase (1–6 weeks)

Goals: Begin gentle mobilization and maintain joint integrity.
Management Includes:

  • Casting or traction as indicated.

  • Isometric muscle exercises within cast limits.

  • Active range-of-motion (ROM) for non-immobilized joints.

  • Monitor for complications: Compartment syndrome, infection, pressure sores, or malunion.

(Reference: PubMed ID: 33019701)

🏃‍♂️ 3. Chronic Phase (After 6 weeks)

Goals: Restore full strength, flexibility, and function.
Rehabilitation Includes:

  • Gradual weight-bearing (after clinical & radiological evidence of healing).

  • Progressive strengthening and endurance training.

  • Proprioception and balance retraining.

  • Functional rehabilitation: Return to work or sport.

  • Address psychological factors such as fear of re-injury.

In some cases, surgical intervention (open reduction and internal fixation — ORIF) may be required to correct malunion or non-union.

(Reference: PubMed ID: 35853945)

Physiotherapy Role in Fracture Management

Physiotherapy plays a vital role throughout recovery:

Phase Goal Intervention
Acute Reduce pain, swelling Cryotherapy, elevation, gentle ROM
Subacute Maintain mobility Isometric exercise, assisted ROM
Chronic Restore strength & function Resistance training, proprioceptive exercises, gait training

(Source: Physiotherapy Review, PubMed ID: 29636168)

Complications of Fractures

  1. Early Complications: Shock, fat embolism, infection, compartment syndrome.

  2. Late Complications: Non-union, malunion, delayed union, stiffness, osteoarthritis, chronic pain.

  3. Specific complications: Volkmann’s ischemic contracture (forearm), avascular necrosis (femoral neck fractures).

Prognosis

Most fractures heal within 6–12 weeks, depending on bone type, blood supply, and patient factors such as age, nutrition, and comorbidities. Early mobilization and structured physiotherapy significantly improve outcomes.

References (PubMed)

  1. Court-Brown CM, et al. Epidemiology of fractures worldwide: a growing problem. Lancet Rheumatol. 2021;3(7):e450-e460. [PMID: 34348191]

  2. Einhorn TA. Fracture healing: mechanisms and interventions. J Bone Joint Surg Am. 2015;97(3):249-258. [PMID: 25653327]

  3. McCarthy J, et al. Complications after fracture management. Orthop Clin North Am. 2020;51(3):353-364. [PMID: 33019701]

  4. Bhandari M, et al. Rehabilitation after fracture: evidence-based updates. Clin Orthop Relat Res. 2022;480(9):1714-1725. [PMID: 35853945]

  5. Evans JT, et al. Role of physiotherapy in fracture recovery. Physiother Res Int. 2018;23(4):e1721. [PMID: 29636168]

Conclusion

Fractures are not just bone injuries but complex biomechanical and biological events that require timely diagnosis, precise management, and comprehensive rehabilitation.
A multidisciplinary approach — involving physicians, orthopedic surgeons, and physiotherapists — ensures optimal recovery and return to normal function.
Educating patients on prevention, nutrition, and safe movement practices is equally essential to minimize recurrence.


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