Fractures: Types, Pictures and Treatment

Defining a fracture

It is an injury to a bone that results in its complete or partial rupture. Fractures usually involve bones in the extremities. They can also occur in other parts of the body (for example, the spine, pelvis, or shoulder).^[4] The disruption of the integrity of the bone can take many forms – the types of fracture vary depending on where and how the bone broke. ^[5]

Fractures occur most often in falls, injuries and accidents. Osteoporosis, a disease in which bones thin, can also be a cause. ^[6] Older age and an unhealthy lifestyle contribute to fractures. ^[7]

Fractures are divided into several groups according to what the fracture site looks like. Where parts of the bone are displaced or whether the bone penetrates through the skin.

• Closed
  The bone stays under the skin and does not come out of the wound.
• Open fracture
  The bone penetrates the skin.
• Dislocated fracture
  Parts of the bone may shift in some fractures – for example, sideways or lengthways.
• Stess fracture
  It occurs, for example, due to long-term or unilateral stress. Athletes are typical patients with a fatigue fracture.^[8]

Fractures can have different fracture lines. The bone may fracture transversely, obliquely or in a spiral. A splinter fracture can also occur.^[9]

Osteoporosis (thinning of the bones) is a risk factor for fractures. It mainly affects people over 50 and women in the menopause.

• Osteoporosis makes bones brittle and more prone to fractures.
• Regular checking of bone density by densitometry will show the level of risk. Depending on the results of the examination, the doctor can recommend appropriate treatment. ^[10]

Diagnosis begins with a physical examination, during which the doctor examines and palpates the affected area.

• An X-ray will provide an accurate picture of the fracture.
• In some cases, magnetic resonance imaging (MRI) or computed tomography (CT) is also used.
• With these examinations, the doctor gets a detailed overview of the condition of the bone and surrounding tissues. ^[11]

A broken leg or arm cannot go without treatment. The key is to fixate the fracture to provide rest for healing. Rest and elevated positioning also help to reduce swelling. In some cases, it is necessary to first set the broken bone in the correct position – either by manipulating the limb in the doctor’s office or surgically in the operating room.

• A plaster cast, splint or brace is used for basic fixation of the fracture.
• Various metallic materials are used in the surgical immobilisation of the fracture. It is reinforced either externally or internally using screws, wires and other metal devices. ^[16]

Each fracture has its own specific procedures for treatment. They also have different healing times.

• Broken ankle usually requires 6 to 8 weeks of treatment.
• Fracture of the femoral neck usually cannot be treated without hospital stay and surgery. Treatment can extend for up to several months. ^[18]
• Fracture of the clavicle is a common injury and in many cases is treated only with a sling on the arm. More complicated cases requires surgery. ^[19]
• Broken ribs usually heal spontaneously within 6 weeks. Patients must observe a resting regime and take care to breathe properly. Analgesics help.^[20]
• Distal radius fracture is very common, especially in the elderly. This is a type of fracture of the bone that is located in the lower part of the forearm and attaches to the bone of the wrist. It can occur as a result of an injury such as a fall on the wrist. Its healing time can generally take 4-6 weeks. If it requires surgical treatment, the healing time is considerably longer.^21]
• Less common fractures include pelvic fractures. Uncomplicated fractures heal without surgery within a few weeks, while serious pelvic fractures are a reason for urgent surgery. ^[22]

Broken Ankle  – What is Weber Classification?

Patients often ask about Weber classification if they want to better understand their injury. This is used to assess the severity of the ankle fracture and how much the ankle has moved from its original location. It focuses on exactly where it is in relation to the syndesmosis – which is the articulation between two bones in the lower limb.

Ankle fractures according to the Weber classification are divided into three categories, depending on where they are located:
Type A: located below the syndesmosis.
Type B: passes through the syndesmosis.
Type C: located above the syndesmosis.

These three types of fractures can have different consequences and require different treatments. For example, a type C fracture may be the most severe because it may be associated with joint injury and require surgery.[^23]

Treatment of the fracture is usually followed by physiotherapy. Properly selected exercises will ensure that the weakened muscles in the affected area become strong again.

The goal of rehabilitation is to fully restore mobility and movement. Specific exercises and type of physical therapy will be recommended by the physiotherapist. The length of rehabilitation depends on the type of fracture and the age of the patient. ^[26]