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Fractures

Injuries Causing Fractures

Fractures, broken bones--it means the same thing--are among the most common orthopedic problems, about 6.8 million come to medical attention each year in the United States. The average citizen in a developed country can expect to sustain two fractures over the course of their lifetime. Despite what you may have heard, a broken bone is not worse than a fracture, they both mean the same thing.

Fractures happen because an area of bone is not able to support the energy placed on it (quite obvious, but it becomes more complicated). Therefore, there are two critical factors in determining why a fracture occurs:

• the energy of the event
• the strength of the bone

The energy can being acute, high-energy (e.g. car crash), or chronic, low-energy (e.g. stress fracture). The bone strength can either be normal or decreased (e.g. osteoporosis). A very simple problem, the broken bone, just became a whole lot more complicated!

Statistics

Orthopedic surgeons treat fractures throughout the skeletal frame, except for the skull (neurosurgeon) and face (ENT, or ear, nose, and throat, surgeon). Extremity fractures are most common, and usually occur in men younger than age 45, and then become more common in women over age 45. The reason for the difference is when women go through menopause, and stop producing estrogen, the rate of bone loss increases. This is why women are particularly susceptible to osteoporosis and subsequent fractures. The most common fracture prior to age 75 is a wrist fracture. In those over age 75, hip fractures become the most common broken bone.

Treatment of Broken Bones

Fracture Treatment

Bone is constantly in a state of change, even when not damaged or injured. We continually absorb and replace the cells that make up our bones. Because of this natural turnover, the process of healing bone also comes about quite naturally. However, in order for a fracture to heal as well as possible, a good reduction, or placement, of the bones must be attained.

• When doctors talk about reduction or a fracture, or reducing the broken bone, they are talking about improving the alignment of the broken ends of the bone.

In most cases reducing a fracture involves placing the broken bone in a cast, often after a little pulling and tugging to achieve improved alignment. If the reduction cannot be satisfactorily achieved (meaning the alignment is either not adequate or not sufficiently stable), then a further procedure may be necessary.

• This usually means surgery with fixation of the bone with pins, plates, screws or rods.

One potential complication of fracture treatment is either a mal-union or non-union of bone. This problem is more common in elderly individuals and in people who sustain more severe fractures. In the case of some fractures (e.g. hip fracture in elderly) the rate of non-union is high enough that instead of trying to heal the bone, the damaged segment of bone is replaced (e.g. hip replacement).

The treatment of a specific fracture is too complicated to be discussed in a general overview of broken bones, but depends on factors such as:

• Location of the fracture
• Severity of deformity
• Potential for healing
• Other injuries
• Age and activity level of the patient
• And many more factors....

In order to understand your treatment, and the options you may have for treatment, you need to discuss your fracture with your doctor. Because treatments are individualized based on the patient, the x-ray appearance of the fracture, and the other factors mentioned, each case must be treated individually.

Underlying Problems

The most common cause of fractures is due to trauma. However, especially in the elderly, broken bones often occur where the bone has been weakened by an underlying process. This is called a "pathologic fracture," which means that there is some pathology, or disease process, that caused the bone to be weak and highly susceptible to fracture. Common diseases that lead to pathologic fracture include osteoporosis and tumors. The mere fact that one is more susceptible to broken bones does not mean one has any less right to recover for the injury if it was the result of another’s negligence.

What is a hand fracture?

A hand fracture occurs when one of the small bones of the hand is broken. There are several small bones that together make up the supporting framework of the hand.
How does a hand fracture occur?
Most hand fractures occur as a result of direct trauma to the hand. Commonly an object either falls on the hand or the hand strikes an object. When he hand fracture occurs common symptoms include:

• Pain
• Swelling
• A palpable deformity
• Difficulty moving the fingers

What tests are needed to diagnose a hand fracture?

If a hand fracture is suspected, your doctor will obtain x-ray studies to determine if the bone is broken. If a fracture is seen in one of the bones of the hand a decision will be made to determine appropriate treatment for the injury.
What treatments are used for hand fractures?

Possible treatments of hand fractures include those listed below.

Cast & Splints

If the fracture is not displaced (meaning it is in proper position) a cast or splint will likely be sufficient for treatment of the fracture. Furthermore, there are some types of hand fractures that do not necessarily need to be in perfect position in order to heal properly. These fractures may also be casted or splinted and allowed to heal.

Pins

Small metal pins may be inserted through this skin in order to hold the bones in a better position. This procedure is usually done with the patient under general anesthesia, but may also be done with a local anesthesia block. The metal pins remain in place for several weeks while the fracture heals, and then the pins can usually be removed in the office.

Metal Plates & Screws

In some unusual types of hand fractures further treatment may be necessary. In knees cases, metal screws with either a plate or an external fixator can be used to help maintain proper alignment of the bones.

Most hand fractures will heal uneventfully. The two most common problems patients who sustain a hand fracture will face are stiffness of the fingers any noticeable bump. The bump is usually a result of extra bone the body forms as part of the healing process. While the bump does diminish in size over time it may never completely go away. Finger stiffness is prevented by beginning motion as soon as possible. It is sometimes necessary to work with a specialized hand therapist in order to help regain finger motion.

Common Wrist Injury

A fall on an outstretched arm often results in a fracture of the scaphoid (navicular) bone in the wrist. This small bone is one of 8 carpal bones in the wrist. The scaphoid sits below the thumb, and is shaped like a kidney bean. This complex bone has a unique and limited blood supply that can be easily disrupted by a fracture. The scaphoid’s blood flow comes from a small vessel that enters the most distant part of the bone and flows back through the bone to give nutrition to the bone cells. Because there is only this one, small blood supply, a fracture in the center of the bone can actually sever blood flow to the proximal portion of the bone. For this reason, scaphoid fractures need immediate diagnosis and treatment. Scaphoid fractures may heal very slowly or may not heal at all.

Diagnosis

If you have pain or deep aching on the thumb-side of the wrist, typically after a fall on an outstretched arm, you may have a scaphoid fracture. Other symptoms include swelling in the wrist, difficulty gripping objects, and tenderness or pain in the anatomical snuff box (a sunken space between tendons of the wrist). Many patients are diagnosed with a wrist sprain, when they actually have a fracture. Diagnosis is difficult because the fracture often doesn't appear on x-rays until weeks later, after healing has begun. Because of this, it is common for physicians to treat a wrist injury as though it were a scaphoid fracture initially, and then repeat x-rays within two weeks.

Treatment

If it is a simple, nondisplaced fracture, orthopedists usually treat the injury with cast immobilization to see if the fracture heals in a timely manner. Repeat x-rays are taken over several weeks or months, and the physician can watch for appropriate healing, which can take 10 to 12 weeks. If it does not heal, surgery can be considered.

If the scaphoid fracture is displaced, the risk of nonunion is higher, and your physician may recommend initial surgery to reposition the bones. Also, if the fracture does not heal with cast treatment (immobilization), surgery will be recommended. This type of surgery involves pinning the bone in place with screws. Sometimes a bone graft may also be used. A cast is used to immobilize the scaphoid bone after surgery.

Rehab

Rehabilitation is an important part of healing due to the long immobilization time needed to treat most scaphoid fractures. Range-of-motion exercises for the wrist can be started after immobilization, followed by strengthening exercises for the wrist flexors and extensors. Supination, pronation, and grip exercises should also be added.

Prevention

The best way to avoid a scaphoid fracture is to use proper protective gear whenever possible. Wrist guards are particularly useful during sports such as rollerblading, snowboarding and many contact sports.

What is a broken collarbone?

The collarbone, also called the clavicle, is the bone over the top of your chest, between your breastbone (sternum) and shoulder blade (scapula). It is easy to feel the clavicle, because unlike other bones which are covered with muscle, only skin covers a large part of the bone.

Clavicle fractures are extremely common. Broken collarbones occur in babies (usually during birth), children and adolescents (because the clavicle does not completely ossify, or develop, until the late teens), athletes (because of the risks of being hit or falling), or during many types of accidents and falls.

How does a collarbone fracture occur?

Clavicle fractures are common injuries, and they can occur different ways. Some patients fall on an outstretched hand, others fall and hit the outside of their shoulder. Broken collarbones can also occur from a direct hit to the clavicle. In babies, clavicle fractures occur at birth during passage through the birth canal.

What are the symptoms of a broken collarbone?

Most often, patients have shoulder pain, and difficulty moving their arm. Swelling and bruising around the broken bone are also quite common. After the swelling has subsided, the fracture is often easily felt through the skin.
At the doctor's office or in the emergency room, an x-ray will show the fracture. Your doctor will also perform an examination to ensure the nerves and blood vessels surrounding the clavicle are in tact. The nerves and vessels are rarely injured because of a broken collarbone.

What is the treatment for a clavicle fractures?

Treatment of clavicle fractures most commonly involves resting the affected extremity. There are several types of slings available; one commonly used is called a"figure-of-8" splint. This is a brace that wraps around the shoulders to keep them back--like a soldier standing at attention.

It is unusual for a clavicle fracture to require surgery, and most often an attempt at treatment in a sling is made. Surgery is required in some situations when either the skin is broken or if the fracture is severely displaced or shortened.
How long does it take to recover from a collarbone fracture?

Clavicle fractures should heal completely within 12 weeks, but the pain usually subsides within a few weeks. Often patients are back to full activities before 12 weeks has passed, especially with younger patients.

As a general guide to return to activities, nothing should cause worsening pain. If not wearing a sling causes pain, wear a sling. If driving hurts the fracture site, don't drive. If throwing a ball hurts, don't throw. Once an activity doesn't cause significant pain, a gradual return can be attempted.

Recovery is usually complete, with a full return expected. Patients may notice a persistent bump where the fracture was (often for months or longer), but this should not be bothersome.

Where is the broken bone in a proximal humerus fracture?

A proximal humerus fracture is a common injury to the shoulder. Especially common in elderly individuals due to osteoporosis, proximal humerus fractures are among the most common broken bones. A proximal humerus fracture occurs when the ball, of the ball-and-socket shoulder joint, is broken. The fracture is actually at the top of the arm bone.

What is the treatment of a proximal humerus fracture?

Most often, proximal humerus fractures are not badly displaced, and will head with simple management in sling. It is not possible to cast proximal humerus fractures.

In more severe or badly displaced fractures, surgery may be necessary. In surgery, either the fracture pieces are put back together and held in position, or the broken bones are removed and a shoulder replacement is performed. If the fragments of bone can be fixed, either spins, crews, wires, large sutures, or a plate will be used to hold the bones in place. The determination of performing a shoulder replacement depends on how many pieces of the bone are fractures.

Why do some proximal humerus fractures require surgery?

The proximal humerus is part of the shoulder joint, and it also is the attachment of the important rotator cuff muscles. These muscles help with movement of the shoulder, and injury to the proximal humerus can affect the function of these muscles.

Also Known As: shoulder fracture, broken shoulder

Information about fractures of the forearm bones

A forearm fracture occurs when there is a fracture of one or both of the bones of the forearm. The two bones of the forearm are the radius and the ulna. Both bones are important for proper motion of the elbow and wrist joints, and both bones serve as important attachments to muscles of the upper extremity.

How do forearm fractures occur?

The most common types of fractures occur due to a fall onto the hand, or a direct blow to the forearm (commonly seen in altercations, sports injuries, and car accidents). Symptoms of a forearm fracture include pain, swelling, and deformity of the forearm. Diagnosis of a forearm fracture can be made with a proper physical examination and x-ray studies.

Radial Shaft Fractures

An isolated fracture of the radial shaft is an unusual injury. More commonly, fractures of the radial shaft are associated with injury to the ulna (see 'both bones forearm fracture' below) or injury to one of the joints around the wrist (Galeazzi fracture).
When an isolated radial shaft fracture occurs, it commonly requires surgery unless the fracture is non-displaced. If the fracture is out of position, then forearm rotation could be limited unless the fracture is realigned. For this reason, most radial shaft fractures are treated with surgery to realign and hold the bones in proper position.

Both Bones Forearm Fracture

A both bones fracture is an injury that almost always requires surgery in an adult patient. Without surgery, the forearm is generally unstable and there is no ability to cast this type of fracture in a proper orientation.

How is surgery done in the treatment of a both bones forearm fracture?

Both bones forearm fractures are most commonly treated by placing a metal plate and screws on both the radius and ulna bones. These bones must each be approached through a separate incision, therefore you will have two incisions on your forearm. Some surgeons will use a rod within the bone to maintain the position of the bone, but this cannot be done in fractures where rotational stability is an issue. Therefore, most both bones forearm fractures are treated with a plate and screws.

What are the complications associated with a both bones forearm fracture?

The most common complications of these fractures include:

Decreased Motion

Limited motion is common after the treatment of forearm fractures. Motion can be limited in the elbow and wrist joints, but is most commonly noticed as a limitation of forearm rotation (i.e. opening a jar or turning a door handle).

Non-Healing Fracture

The bones of the forearm can have inadequate healing leading to persistent pain. This is especially true with forearm fractures where bone is lost because of the type of fracture (i.e. many small pieces) or open fractures. Repeat surgery for bone grafting may be necessary in these cases.

Infection

Infection can occur after any surgical procedure. When an infection occurs after fixation of a forearm fracture, the metal plate and screws may require removal in order to cure the infection.

Painful Hardware

The metal implants used during surgery may be felt under the skin, and they may be painful. If they do cause discomfort they can be removed, usually at least a year after surgery.

What is an ulna fracture?

The ulna is one of two bones of the forearm. The two bones of the forearm, the radius and the ulna, both span the distance from the elbow to the wrist joints.

How does an ulna fracture occur?

An isolated ulna fracture most commonly occurs by the forearm being struck by an object (or an the forearm striking an object). The common eponym for an isolated ulna fracture is a "nightstick fracture," although there are many other common mechanisms of this injury including falls, car accidents, and others.

What are the symptoms of an ulna fracture?

By far the most common symptom of an ulna fracture is pain. Other common symptoms include swelling and deformity of the forearm. When you suspect a forearm fracture, you should be seen by a physician and obtain x-rays to determine if there is an ulna fracture present, and if there are any associated injuries.

What is the treatment of an ulna fracture?

Isolated ulna fractures can most often be treated with a cast or fracture brace. Usually a period of immobilization will allow the bone to heal adequately.

If there is a significant amount of displacement of the ulna fracture, the fracture is considered 'unstable.' In these cases, the patient may benefit from surgical stabilization of the fracture. The usual treatment is to use a plate and screws to secure the fractured bone.

What are the complications of surgical treatment of ulna fractures?

The most common complications include:

Painful Implants

Occasionally, the metal plate and screws can be tender and painful and require removal. This is usually done at least a year after surgery. Refracture of the bone is possible after plate removal.

Infection

Infection is an unusual complication, but possible after any surgical procedure. If infection is a problem, the metal implant will likely have to be removed.

Non-Healing Fracture

Non-healing, called a nonunion, occurs in about 5% of patients with ulna fractures. These patients may require another surgical procedure for bone grafting to obtain healing of the ulna fracture.

Information About A Broken Hip

What is a hip fracture?

A broken hip is a common injury, especially in elderly individuals. In the United States, hip fractures are the most common broken bone that requires hospitalization; about 300,000 Americans are hospitalized for a hip fracture every year.

• A "broken hip" and a "hip fracture" mean the same thing!

How do hip fractures happen?

Hip fractures in the elderly are most often caused by a fall, usually a seemingly insignificant fall. In younger patients with stronger bones, more common causes of a broken hip include high-energy injuries such as car accidents. Hip fractures can also be caused by bone weakened from tumor or infection, a problem called a pathologic fracture. A broken hip in the elderly can be explained primarily by weak bones and osteoporosis. Elderly patients with osteoporosis are at much higher risk of developing a hip fracture than someone without osteoporosis. Other risk factors associated with hip fracture are female sex, Caucasian race, slightly built individuals, and limited physical activity.

Are all hip fractures the same?

No. Hip fractures are generally separated into two types of fractures:

Femoral Neck Fractures

A femoral neck fracture occurs when the ball of the ball-and-socket hip joint is fractured off the femur. Treatment of a femoral neck fracture depends on the age of the patient and the amount of displcament of the fracture.

Intertrochanteric Hip Fractures

An intertrochanteric hip fracture occurs just below the femoral neck. These fractures are amenable to repair more often than femoral neck fractures. The usual surgical treatment involves placement of a plate and screws to stabilize the fractures.
Treatment of a hip fracture almost always requires surgery. In some cases, such as some stress fractures of the hip, or in patients who have severe medical problems that prevent surgical treatment, non-operative treatment may be recommended. However, most all hip fractures are treated with surgery. The type of surgery that is preferred depends on the type of fracture.

What is a femoral neck fracture?

A femoral neck fracture occurs just below the ball of the ball-and-socket hip joint; this region is called the femoral neck. When a femoral neck fracture occurs, the ball is disconnected from the rest of the thigh bone (the femur).

The important issue with femoral neck fractures is that the blood supply to the fractured portion of bone is often disrupted at the time of injury. Because blood flow is diminished, these fractures are at high risk of not healing, especially when the fracture is badly displaced. Due to the problem blood supply with femoral neck fractures, many will be treated by a partial hip replacement.

What is the treatment of a femoral neck fracture?

Treatment of a femoral neck fracture depends on several factors. The most important criteria to consider are:

• The amount of displacement of the fracture
• The age of the patient

In younger patients, those under 60 to 65 years old, every effort will be made to avoid a partial hip replacement. Hip replacements work very well for less active patients, but they tend to wear out in younger, more active patients. Therefore, in young patients, a chance may be taken to avoid hip replacement even if there is a high risk of a non healing fracture.

For most femoral neck fractures the treatment will be one of the following:

Hip Pinning

A hip pinning is a procedure done to place several screws across the fractured bone. Hip pinning is generally only done in patients with a femoral neck fracture that is well aligned and minimally displaced. In young patients, as described above, hip pinning may be attempted even if the bones are not properly aligned. However, even in this setting, a partial hip replacement may be necessary.

When a hip pinning is performed, a patient is usually under general or spinal anesthesia. A small incision is made on the outside of the thigh. Using x-ray to guide your surgeon, several screws are passed across the fracture in order to stabilize the broken bones.
Patients can generally place as much weight on the hip as is tolerated, but this will vary in some cases--check with your surgeon before initiating any therapy or exercise. As the bones heal, the pain will generally subside. The primary concern with femoral neck fractures is that the damaged blood supply to the bone will lead to non healing or bone death (hip osteonecrosis) of the femoral head. In these cases, patients may require a hip replacement surgery down the road.

Hip Hemiarthroplasty

A hip hemiarthroplasty is the word used to describe a half of a hip replacement. In this procedure, the ball of the ball-and-socket joint is removed, and a metal prosthesis is implanted into the joint. Hip hemiarthroplasty is favored in patients with displaced fractures because of the complications described above with trying to rapir these fractures.
A hip hemiarthroplasty is performed under general anesthesia or spinal anesthesia. An incision is made over the outside of the hip.

The fractured femoral head is removed, and replaced with a metal implant. In a normal hip replacement surgery, the socket of the pelvis would also be replaced. This can be done in patients with pre-existing arthritis of the hip, but in most cases of femoral neck fractures the socket is left alone. The prosthetic stem can be cemented into the bone in patients with thinner, more osteoporotic bone, or press-fit into patients with better bone quality.

Rehabilitation is initiated immediately and patients can usually walk with their full weight on the implant. Patients tend to feel much better after the surgery, and usually return to walking quite quickly.

Tibia Fracture

The tibia is the major bone of the lower leg, commonly referred to as the shin bone. Tibia fractures can occur from many types of injuries. Tibia fractures come in different shapes and sizes, and each fracture must be treated with individual factors taken into account. When determining treatment of a tibia fracture, the following factors must be considered:

• Location of the fracture,
• Displacement of the fracture,
• Alignment of the fracture,
• Associated injuries,
• Soft-tissue condition around the fracture, and
• Patient general health.

In general, tibia fractures can be separated into three categories based on the location of the fracture. Specific issues concerning these fractures are discussed on the following pages. It should be noted that open, or compound, fractures must be treated specially.

Open fractures occur when the fractured bone is open through the skin. These fractures are at especially high-risk of developing an infection, and generally require surgical treatment in all cases.

Tibial Shaft Fractures

Tibial shaft fractures are the most common type of tibia fracture and occur between the knee and ankle joints. Most tibial shaft fractures can be treated in a long leg cast. However, some fractures have too much displacement or angulation and may require surgery to realign and secure the bones.

Tibial Plateau Fractures

Tibial plateau fractures occur just below the knee joint. These fractures require consideration of the knee joint and its cartilage surface. Tibial plateau fractures can lead to a chance of developing knee arthritis.

Tibial Plafond Fractures

Tibial plafond fractures occur at the bottom of the shin bone around the ankle joint. These fractures also require special consideration because of the ankle cartilage surface. Tibial plafond fractures are also concerning because of potential damage to surrounding soft-tissues.

Tibial Shaft Fractures

Tibial shaft fractures are common injuries that can occur after falls, car accidents, sports injuries, and other activities. A tibial shaft fracture can be treated by several methods depending on the type of fracture and alignment of the bone. The most common treatments include:

Casting

A cast is appropriate for tibial shaft fractures that are not badly displaced and are well aligned. Patients need to be in a cast that goes above the knee and below the ankle (a long leg cast). The advantage of casting is that these fractures tend to heal well and casting avoids the potential risks of surgery such as infection. Patients with casts must be monitored to ensure adequate healing of the tibia and to ensure the bones maintain their alignment.

Intrameduallary (IM) Rodding

Intrameduallary rodding is a procedure to place a medal rod down the center of the tibia to hold the alignment of the bone. A tibial rodding is a surgical procedure that lasts about an hour and half and is usually done under general anesthesia. Patients will have an incision over the knee joint, and small incisions below the knee and above the ankle. In addition, some fractures may require an incision near the fracture to realign the bones.

IM rods are secured within the bone by screws both above and below the fracture. The metal screws and the rod can be removed if they cause problems, but can also be left in place for life. Tibial rodding provides excellent fixation and alignment of the bones. The most common risk of surgery is knee pain, and the most concerning complication is infection. Infection of the rod may require removal of the rod in order to cure the infection.

Plates and Screws

Plates and screws are less commonly used, but are helpful in some fracture types, especially those closer to the knee or ankle joints (see information on tibial plateau and tibial plafond fractures). Most surgeons choose an IM rod for tibial shaft fractures unless the fracture is too close to the joint to allow for placement of the IM rod. In these fractures close to the joint surface, a plate and screws may be the ideal method of fixation.

External Fixator

An external fixator may also be helpful in some particular fracture types. External fixators tend to be used in more severe fractures, especially open fractures with associated lacerations and soft-tissue damage. In these cases, the placement of IM rods or plates may not be possible because of soft-tissue injury. When there is significant soft-tissue injury, the external fixator may provide excellent immobilization while allowing monitoring and treatment of the surrounding soft-tissues.

If you have suffered fractured bones as a result of another’s negligence, contact the experienced attorneys at Herrick & Hart.

If you suffered a fractured bone as a result of someone else’s negligent or wrongful conduct in a car accident, workplace accident, farm accident, or from the use of an unsafe product, you need a compassionate yet aggressive law firm with experienced lawyers working on your behalf to obtain the compensation that you are entitled to for your financial compensation losses. Contact our office to speak to an Eau Claire burn injury lawyer with experience and proven results.

At Herrick & Hart, our attorneys have obtained very successful results for injured adults and children throughtout northwestern Wisconsin (please see service areas listed below for a list of the courts and jurisdictions most frequently represented).

Two of our Eau Claire personal injury lawyers are board-certified in trial advocacy, a mark of legal proficiency that fewer than two percent of Wisconsin attorneys have achieved. Through the dedicated efforts of our experienced attorneys, our firm has been able to recover significant financial compensation for past clients with injuries.

Call us at 715-832-3491, email us (mike@eauclairelaw.com), or provide us with the facts about your case (submit your case online ) for a free initial consultation and expert advice. We are prepared to take your case to court.

For more information about the issues faced by an injured person, please refer our Personal Injury Practice Center, or to our online library of personal injury information. You may also be interested in these articles.

You & Your Personal Injury Claim
Answering Questions About Accident-related Injuries
At The Accident Scene, What Should I Do?
How Much Is My Injury Claim Worth?
Product Liability Claims

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