When it comes to bone injuries, patients regularly ask me, “Is my bone fractured or broken?”
To which I reply, it’s actually both. The words fracture and break mean the same thing.
People often confuse a simple fracture with a complex fracture. A simple fracture is a bone that is broken in two pieces while a complex fracture is broken into more than two pieces.
Another source of confusion stems from the difference between a closed fracture and a compound fracture. A closed fracture remains underneath the skin. A compound fracture pierces through the skin.
How can bone injuries be treated?
The bone is quite a unique and fascinating structure due to its ability to heal itself. Our bones are capable of uniting after fragments have been separated. In children, this ability is extremely aggressive. They rarely need surgical assistance to repair a broken bone.
We lose some of that ability as we age. The body tries to heal itself, but adults often need surgery to help properly align a broken bone and bring it back to full function.
Simple fractures can be treated in a variety of ways, and depending on the severity, a fracture may be treated in our outpatient office or the emergency room.
For example, a common finger fracture can easily be treated with a small finger splint. We can treat hairline wrist fractures, or bone contusions, with a wrist brace. We also have larger devices such as boots that can be used for ankle fractures.
In some cases, a fracture may need to be placed in a cast. A casting tape will be wrapped around the injured area and will harden.
If a fracture is not well aligned or is not healing as expected, surgery is the next step. Treating fractures is not too different than going to the hardware store and getting what you need to fix things around your house. We use clamps to hold bones together, screw different sizes and shapes of plates into bones to hold the bones in place, and even use surgical nails. The plates are designed to match specific bones to make installing them easier, while the nails are metal rods that go down the middle of a bone to help keep the bone in the right place as it heals.
Occasionally, when fractures near a joint such as a shoulder or hip cannot heal or do not have a good potential to heal, we will perform a joint replacement. If a shoulder or hip fracture is severe enough that fragments are scattered throughout the joint, we will generally opt for a shoulder or hip replacement.
Frequently asked questions
Is a stress fracture a break?
Yes, a stress fracture is technically considered a break.
The analogy I tell patients is about a sidewalk. A sidewalk may have a crack in it but still be intact. The same can be said for a stress fracture. The bone is in one piece, but it has a crack in it. The bone is not completely broken apart in the way most people think about a broken bone.
I recently fractured my collarbone. Do I need surgery?
It depends on how badly the collarbone is broken.
When I was in training, the standard guideline for most collarbone fractures was to let them heal without surgery. But in the past five to ten years, that school of thought has shifted. Significantly displaced collarbones do need to be fixed surgically because it does affect long-term function.
After a fracture, is physical therapy necessary?
As a surgeon, we have a relatively straightforward and quick process to fix a broken bone. But you as the patient have a longer, harder route to recovery. You have to do an immense amount of physical therapy and rehabilitation to restore all your muscle anatomy and muscle strength around the injury.
Although we physicians might say something looks fully healed, that doesn’t mean you are finished with physical therapy. Therapy isn’t for healing the fracture. It’s used to restore you to your previous level of functioning.
Is PRP therapy used for fractures?
PRP is a type of treatment for other injuries and is not traditionally used for fractures.
For ankle fractures, is a cast better than a boot?
It depends on the fracture. For many ankle fractures, a boot can be used as long as it’s a stable fracture (a hairline fracture or a fracture that does not have a significant shift in bones). If it’s a talus fracture (a fracture of the large bone in the ankle), we will commonly use a cast to completely immobilize the ankle.