Bone Fractures and Dislocations

Fractures

A fracture is the medical term for a broken bone. There are 206 bones in an adult's body, more than half of which reside in the hands and feet. Most people will fracture a bone once or twice in a lifetime. A fracture occurs when too much force is exerted on a bone, usually from an accident or fall. Because our bones get brittle as we age, there is a higher incidence of fractures among the elderly. Children also experience more fractures, but because their bones are suppler, these breaks are usually less complicated and heal relatively quickly.

Fractures are characterized as either displaced or non-displaced and as either closed or open. A displaced fracture occurs when the bone breaks into two or more parts. A non-displaced fracture occurs when the bone cracks, but maintains its proper position and alignment. A closed fracture means that there is no puncture or open wound on the skin whereas an open fracture refers to a bone that breaks through the surface of the skin.

There are several different types of fractures. The most common include:

• Simple fracture: where the bone breaks into two pieces.
• Stress fracture: a hairline break that is usually caused by repetitive motion or overuse, like running.
• Comminuted fracture: where the bone breaks into multiple pieces.
• Compound fracture: also known as an open fracture, where the bone protrudes through the skin.
• Complete fracture: where the bone breaks cleanly into two or more pieces.
• Incomplete fracture: also known as a closed fracture, where the bone cracks but doesn’t break.

The seriousness of a fracture depends upon the person’s age and the location and nature of the fracture. In many cases, the break does damage to the surrounding soft tissue as well as the bone. It is critical to get the bone back into its proper alignment as quickly as possible, so you should always seek immediate medical attention if you suspect you have a fracture.

When a fracture first occurs, the broken bone should be immobilized from an area above to an area below the break, if needed using a splint or sling. Apply ice to limit pain and swelling and seek immediate medical attention. X-rays will be used to help diagnose the fracture and determine the best treatment for your specific condition.

Treatment for a fracture usually entails a period of immobilization via a splint or cast. In severe cases, surgery may be needed to realign the bone. In these cases, it is common for pins, rods, screws or plates to be used to help keep the bone in its proper position.

Rehabilitation through physical therapy is an important part of healing from a fracture. Depending on the location and severity of the break, a short period of rest and immobilization is followed by a period of light movement and exercise using the surrounding muscle and tissue to strengthen the bone and prevent stiffness. The physical therapy treatment plan will likely include at-home exercises to ensure that the individual can conduct activities of daily living and to keep all body parts fully functioning. Over time, the exercises are escalated to include more strengthening and resistance exercises to regain range of motion and rebuild muscle strength.

In cases of stress fractures, the combination of rest and rehabilitation are coupled with education to teach the person basic body mechanics and ways to prevent future injury.

Dislocation

A dislocation, also known as luxation, can be difficult to distinguish from a fracture because the initial symptoms appear to be the same. With dislocations, instead of a bone breaking, the bones in a joint separate, moving out of their natural position. A dislocation often impacts the surrounding ligaments, tendons and muscles. They can be very painful and are frequently seen in people who play contact sports.

Dislocations are predominantly caused by a trauma, fall or blow. In some cases, they can be caused by disease, such as rheumatoid arthritis. They most commonly occur in the shoulder or hands, but also happen in the hip, knee, elbow, ankle, fingers and toes. Symptoms includes intense pain, swelling and bruising, limited movement and a joint that is visibly out of place.

It is important to seek immediate medical attention for a joint dislocation. It is also important not to move the joint from its dislocated position. The joint should be immobilized with a splint or sling and ice can be applied to reduce swelling. Do not under any circumstances attempt to move the joint back into its proper position.

At the medical facility, a physician will perform some maneuvers to move the joint back into its proper position. In some cases, the dislocation damages the surrounding ligaments, blood vessels or nerves and may require surgery.

Rehabilitation is longer for dislocations than for fracture. Generally, the first several weeks the joint is immobilized. Then rehabilitation begins to restore range of motion and rebuild joint strength and stability. The physical therapist will slowly progress to more resistance exercises to regain normal joint strength.