In patients with a history of trauma, particularly blunt force trauma caused by accidents, a history of falls and impacts can lead to bone fractures. Let's learn more about this condition.
Broken bones are medically known as fractures. This condition occurs when there is a crack or break in bone tissue, which can be caused by many things. Broken bones are often caused by a history of trauma that causes impact and tissue damage. In general, fractures can be classified into two major groups: closed fractures and open fractures.
A closed fracture occurs when the bone breaks inside the body and does not penetrate the skin. An open fracture occurs when the broken bone protrudes through the skin. Based on the shape of the fracture, fractures can be divided into several types:
- Complete fracture: A complete fracture has a fracture line that divides the bone into two or more pieces.
- Incomplete fracture: In an incomplete fracture, the fracture line does not extend to the edge of the bone, thus not dividing it into two parts. In this condition, the bone may crack but not completely separate.
- Hairline fracture: A hairline fracture has a fine, thin crack in the bone, so there is no separation.
- Comminuted fracture: This condition is often called a comminuted fracture because the bone breaks and can split into several small pieces. The type, severity, and type of fracture caused by impact are usually greatly influenced by the force. If the fracture is mild, it usually tends to form an incomplete fracture or hairline fracture. Meanwhile, greater force can cause a complete fracture or comminuted fracture, which results in several fragments or small pieces.
Causes of Fractures
There are several causes of bone fractures. Broadly speaking, these can be categorized as internal and external factors.
Internal factors
Several internal factors can trigger bone fractures, such as age. With age, bone density decreases, as in osteoporosis, increasing the risk of fracture.
Furthermore, a history of osteogenesis imperfecta, a condition that makes bones more brittle, increases the risk of fractures. Bone cancer and metabolic bone diseases affect bone structure, making them more susceptible to fractures.
External factors
The most common cause of bone fractures is physical trauma, whether from a history of accidents, sports injuries, or physical impact such as being hit. This immense pressure can trigger bone fractures. Furthermore, a diet deficient in calcium and vitamin D can also lead to decreased bone strength, making them more brittle and susceptible to fractures.
Symptom
Symptoms of bone fractures can vary widely. They can be completely asymptomatic, meaning they don't interfere with activity, or they can be fatal. For example, hairline fractures rarely cause symptoms. However, a common complaint experienced with fractures is severe pain.
The pain is sharp and throbbing. This pain usually worsens with movement. Furthermore, fractures caused by physical trauma are often accompanied by bruising and swelling. This is due to inflammation in the area. This inflammation is usually accompanied by reddening of the skin, warmth to the touch, and difficulty in moving.
Complete fractures are usually accompanied by deformity, a change in the shape of the fractured area. This can appear as an angle or lump. In some cases, crepitus, or a popping sound, may be present when the area is moved. However, when a fracture occurs, the body part will be very difficult to move due to swelling and intense pain.
Risk Factors
There are several risk factors that can increase a person's likelihood of experiencing a fracture. These risk factors can be classified as modifiable and non-modifiable. Modifiable factors minimize the risk of trauma, whether from accidents, impacts, or overuse. It is crucial to use personal protective equipment (PPE) while working, especially in demanding work environments.
Furthermore, it's crucial to exercise and warm up before exercising, especially if you regularly lift heavy objects. It's crucial to exercise slowly and with proper methods to avoid complications, including preventing fractures. However, there are also modifiable factors that can help reduce the risk of fractures. People whose calcium and vitamin D intake does not meet their daily requirements are at increased risk of fractures.
In older age, the risk of osteoporosis increases, so it's important to maintain daily activities to minimize excessive stress on bones. Furthermore, a history of certain diseases, such as bone metabolism disorders, osteogenesis imperfecta, and bone cancer, can increase the risk of fractures.
Diagnosis
Anamnesis
During the initial examination, the doctor will conduct a medical interview to assess current symptoms and determine if a fracture is suspected. Closed fractures, particularly hairline fractures, usually do not cause significant symptoms. However, the most common complaint in patients with fractures is characteristic pain.
The pain is usually sharp and intense with movement. This pain is usually difficult to improve even with pain relievers. Fractures caused by trauma or impact are usually accompanied by inflammation. Patients may complain of pain accompanied by a burning sensation, swelling, redness of the skin, and difficulty moving.
Physical Examination
During the initial physical examination, vital signs will be checked, including blood pressure, pulse rate, and respiratory rate. In patients presenting with pain, these vital signs typically tend to be elevated. However, in cases of open fractures accompanied by active bleeding, blood pressure is often decreased.
This condition usually occurs when the fracture injures a blood vessel, causing severe bleeding and risking hypotension or shock. In the area of pain, deformity is usually found, indicating a change in shape. A lump or angle may be visible in the affected area. In open fractures, bone protruding through the skin may be visible.
Supporting Examinations
To confirm a fracture diagnosis, a doctor will usually perform imaging tests, such as an X-ray. This method can help determine the type of fracture and the necessary further steps. If necessary, a CT scan may be performed to confirm the diagnosis and rule out other differential diagnoses.
If the treating doctor wishes to further examine the surrounding tissue, a magnetic resonance imaging (MRI) scan may also be performed. In the case of a fracture, laboratory blood tests are often performed to assess for signs of infection.
Therapy
Initial therapy involves addressing the symptoms experienced. Pain relievers or analgesics can be given to relieve pain. Anti-inflammatory medications can be given to help manage inflammation. If signs of infection are found, antibiotics may be considered. Fracture therapy or management is greatly influenced by the cause, type, location, and severity. Here are some possible actions.
Immobilization
This procedure is performed to reduce movement in the fractured area to reduce the risk of worsening the fracture and damaging surrounding tissue. A frequently performed procedure is the application of a cast. This procedure helps maintain the bone's position, speeding the healing process and preventing deformity.
Splinting is also frequently used and can be combined with a cast to help support and stabilize the fracture during healing. Bracing can also be used to help maintain bone position during healing. However, this method usually allows for minimal movement.
Reduction
Reduction aims to reposition the bone to its original position. This procedure is usually performed for deformed fractures. Repositioning is divided into closed and open. With closed reduction, the bone is repositioned without surgery or incisions. This procedure is usually performed in conjunction with cast immobilization.
Open reduction, on the other hand, is usually performed in the operating room because it requires surgical intervention. This procedure is usually reserved for more complex fractures.
Fixation
Fixation efforts can be divided into internal and external. Internal fixation typically uses devices such as plates or pins to help hold bone fragments inside the body to maximize healing and minimize deformity. External fixation can also be performed if necessary. This effort uses external devices connected to the bone to help maintain its position during the healing process.
This procedure is usually performed for complex conditions with extensive surrounding tissue damage. After various procedures, including surgery, rehabilitation and physiotherapy are crucial. The primary treatment for fractures is immobilization. Prolonged immobilization of a body part can lead to decreased strength and function.
Therefore, this stage plays a crucial role. Regular check-ups with the treating orthopedic specialist are also crucial during the recovery process. Clinical examinations can assess the healing process and reduce the risk of deformity.
Prevention
Preventive efforts in bone fractures are greatly influenced by various risk factors. If you have a history of certain diseases that require regular follow-up, compliance plays a crucial role in preventing fractures. It is also important to undergo regular or periodic screenings if you have a history of certain diseases that affect bone strength so that early detection can be possible.
If you work in an environment with a high risk of trauma, impact, or accidents, it is crucial to use personal protective equipment (PPE) to minimize these risks. If you regularly exercise by lifting heavy objects, pay close attention to proper methods and muscle readiness. It is important to warm up, complete each step, and use the correct form. Also, pay attention to your intake. Maintaining a healthy lifestyle with a balanced diet, especially one high in calcium and vitamin D, is crucial for bone health and strength.
Complications
If not properly treated, broken bones can lead to various complications. In open fractures, there is an open wound caused by bone fragments penetrating the skin. If not treated promptly, the risk of infection is very high. This condition can lead to inflammation, infection, and osteomyelitis. If a bone is broken, especially a complete fracture, the risk of malunion, or deformity, is very high if not treated properly.
In addition to changing the shape of the bone, this condition can also cause functional impairment. In addition to malunion, incomplete fractures that are not properly treated can also lead to non-union, where the separated bone parts cannot be reconnected. In addition to malunion and non-union, fractures that are not treated with proper steps such as immobilization, reduction, and fixation can experience delayed union. This condition causes the healing process to take longer than expected.
When an internal fracture is not properly treated, it can increase the risk of compartment syndrome. In this condition, increased pressure on the affected area can cause damage to muscles and nerves. Furthermore, deep vein thrombosis (DVT) can increase the risk of pulmonary embolism.
If a broken bone fragment tears a blood vessel, this can trigger severe bleeding and even shock. In children, if fractures are not properly treated, they can inhibit bone growth, especially if the fracture occurs at the growth plate.
When Should You See a Doctor?
If you have a history of trauma or a severe impact accompanied by severe pain, it's crucial to see a doctor for further evaluation, especially if it's accompanied by inflammation and deformity. The doctor will perform further examinations to confirm the fracture's diagnosis, including the type and treatment options. This is crucial to rule out other possible diagnoses. However, if the fracture is open, where bone fragments penetrate the skin, go to the nearest emergency room immediately. Avoid touching the fracture to reduce the risk of infection.
It's also important to note that massage is strongly discouraged when the fracture is severe. This can worsen the fracture, cause malposition, and increase the risk of inflammation. The first step is to take analgesics to relieve pain and anti-inflammatories to reduce inflammation.
Furthermore, immobilize the fracture, as even the slightest movement can trigger pain. Although symptoms may improve slightly with medication, it's highly recommended to see a doctor for further evaluation to confirm the current condition and ensure proper management before potential complications arise if treatment is delayed.
Written by Dr. Valda Garcia Reviewed by Dr. Ernest Eugene
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