10.6 Fracture
A fracture occurs when there is a break or disruption in the integrity of a bone. Fractures can vary in severity, location, and the way in which the bone breaks.
Different types of fractures include the following[1],[2],[3]:
- Closed or Simple: Bone is broken but does not protrude the skin
- Open or Compound: Bone is broken and pierces through the skin
- Transverse: Bone is broken straight across
- Spiral: Bone has twisted apart
- Comminuted: A bone is crushed into pieces
- Impacted: One fragment of the bone is driven into the other, usually as a result of compression
- Greenstick: Bone is partially broken; a common fracture in children that occurs rarely in adults
- Oblique: Bone is broken at an angle
- Stress: Small crack in a bone
- Complete Fracture: The bone breaks entirely into two or more separate pieces
- Incomplete Fracture: The bone cracks but doesn’t break into separate pieces (e.g., stress fracture or greenstick fracture)
- Compression Fracture: Typically occurs in vertebrae and involves the bone being crushed or collapsing; often seen in conditions like osteoporosis
- Pathologic Fracture: A fracture that occurs due to disease process
See Figure 10.26[4] for an illustration of different types of fractures.
Hip Fractures
A hip fracture, commonly referred to as a “broken hip,” can be intracapsular or extracapsular. An intracapsular fracture occurs in the femoral neck, as illustrated in Figure 10.27.[5] Extracapsular fractures occur outside of the joint capsule and include the proximal one third of the femur.
Hip fractures are typically caused by a fall, especially in older adults with preexisting osteoporosis. Symptoms of a hip fracture include the following[6]:
- Pain
- An inability to lift, move, or rotate the affected leg
- An inability to stand or put weight on the affected leg
- Bruising and swelling around the hip
- The injured leg appears shorter than the other leg
- The injured leg is rotated outwards
Hip fractures typically require surgical repair within 48 hours of the injury. In approximately half of the cases, hip arthroplasty (i.e., hip replacement) is needed. In the remaining cases, the fracture is repaired during a surgery called open reduction internal fixation (ORIF). Read more information about ORIF in the “Medical Interventions” subsection.
Risk Factors for Fractures
There are numerous risk factors for fractures, including advancing age, trauma, and the presence of other medical conditions such as osteoporosis, metastatic cancer, or Cushing’s disease. Other risk factors include long-term use of corticosteroids, lack of physical activity or weight-bearing exercises, poor nutrition, and genetics. Women, especially after menopause, are at higher risk for fractures due to reduced bone density as a result of hormonal changes.
Stages of Bone Healing
When a fracture occurs, the healing process immediately begins with the following stages of bone healing[7]:
- Hematoma Formation (within 48 to 72 hours after inju