DON’T WORRY IT’S JUST FRACTURED……

​So what is the difference between a fracture and a break anyway?

Essentially there is no difference and the terms can be used interchangeably. Both terms mean that there has been a loss of integrity to the bone, varying from a slight crack, to a bone that has been broken into many, many pieces.
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Of course, some bone injuries are more serious than others. The below pictures are 15 examples of different types of fractures/ breaks. Every single upper limb fracture needs to be individually assessed, managed and protected to permit healing including small finger fractures.

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​HOW CAN I TELL IF I HAVE A FRACTURE?

​Common signs of a broken bone are:

• bruising,
  
• swelling, pain,
  
• loss of motion and
  
• tenderness to touch.
  

However, as AMAZING as we are, your doctor or hand therapist does not have XRAY vision! ​It is impossible to know if a fracture is present without doing an Xray, or CT or MRI scan.

Occasionally your fracture may not appear on an initial Xray for a variety of reasons, so if your symptoms persist please follow up again with your health professional for further assessment
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​FRACTURE TREATMENT OF THE UPPER LIMB

​The seriousness of any broken bone and the way your health professional decides to manage it is determined by several factors:

1. the type of fracture you have,
2. whether it is in a good position and
3. whether it is likely to move position

Options for protecting and keeping your fracture still include:

• slings
• off the shelf splints
• custom thermoplastic splints
• plaster or fibreglass casting
• buddy tape
• displaced fractures may require manipulation of the bone position
• unstable fractures may require surgery to hold the broken segments in place with wires, screws or plates.

The length of immobilisation will depend on the bone involved (legs tend to take roughly double the time of arm bones), as well as the type of fracture and the age of the patient.
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Children tend to heal faster, whilst scaphoid fractures (a bone in your hand) can take an especially long time to heal if the bone’s blood flow is affected. Most upperlimb (arm) fractures will be protected / immobilised for about 6 weeks.

​TYPES OF FRACTURES

The above picture gives you some idea of the many types of fractures that can occur. Just to complicate things, sometimes real life fractures can fit more than one of the above categories.
 
Open fracture
An open fracture is when the skin and tissues between the bone and the skin have been damaged and there is a risk of infection. These fractures will require washing out, manipulation back into place, antibiotics and immobilisation with a plaster.
 
Displaced fracture
If the bones have moved out of position you are more likely to need the bone to be manipulated or to require surgery and a plate, screw or wires to keep the bones in position.
 
Comminuted fracture
A comminuted fracture is a more complex break with more than 3 fragments. These can sometimes require surgery but that is not always possible due to the number of bony fragments, and a plaster can still sometimes be the best option.
 
Avulsion fracture
An avulsion fracture is often sustained when a joint is hyperextended or dislocated. When this happens the ligament or tendon is over stretched and instead of breaking, the ligaments detach a small fragment of bone from where it attaches to the bone.
 
Breaks affecting the joint line
Doctors look very closely when a break crosses through the smooth surface of a joint. If the surface of the joint becomes irregular (due to a piece of bone being out of position) people are more likely to have stiffness, pain and longer term risk of joint arthritis.
 
Growth plate fractures
Children’s bones grow from sections called growth plates. These are made of softer cartilage which hardens into bone at around 13-15 years old for girls and 15-17 for boys. It is important to identify growth plate fractures because damage could cause the bone to stop growing early or to grow unevenly
 
Stress fractures
These are tiny cracks in the bone caused by repetitive force and overuse. The most common ones that we hear about are in the feet of long distance runners, but they can also occur in people who have a condition called osteoporosis whose bones are weaker than usual.

Our bones normally adapt to increased load through a process called remodelling. This is a process of continual bone reabsorption and creation but if we increase our training too quickly our bodies cannot keep up and the bones become weakened and develop micro fractures.
 
Greenstick & buckle fractures
A greenstick fracture is when a bone bends and cracks instead of breaking into separate pieces and is most common in the flexible bones of children under 10 years old.

A buckle fracture is an incomplete fracture where the pressure causes a bulging of the bone at the site of injury. This is also very common in younger children who’s bones are more flexible.

Because the children are younger and heal more quickly immobilisation time is often shorter and more like 3 weeks (instead of 6).
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SO WHAT’S MY ADVISE IF YOU SUSPECT A FRACTURE?

1. Get an Xray - we do not have superpowers
2. take all finger, hand and wrist fractures seriously & see a professional who is familiar with managing these injuries such as a hand therapist
3. remember even if your Xray is negative, that only excludes a bone injury.
   

Many soft tissues such as ligaments and tendons can be damaged during trauma. They also require expert care to ensure a full and timely recovery. Your hand therapist can help you achieve the fastest recovery and can frequently diagnose your soft tissue injury without further imaging being required.
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Looking forward to helping you in your recovery 

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