Fracture in Adults
What is a Fracture?
A Fracture is a break in the structural continuity of bone. It may be no more than a crack, a crumpling or a splintering of the cortex; more often the break is complete. The resulting bone fragments may be displaced or undisplaced. If the overlying skin remains intact, it is a closed fracture; if the skin one of the body cavities is breached, it is an open fracture ( also known as a compound fracture ), liable to contamination and infection.
How long does a fracture take to unite?
No precise answer is possible because age, constitution, blood supply, type of fracture and other factors all influence the time taken. A spiral fracture in the upper limb takes 6-8 weeks to unite; in the lower limb it needs twice as long. Add 25% if the fracture is not spiral or if it involves the femur. Children’s fractures, of course, join more quickly.
Fracture Healing
Fracture healing is characterized by a process of new bone formation with fusion of the bone fragments. The bone either heals by primary (without callus formation) or secondary (with callus formation) fracture healing. The process of fracture repair varies according to the type of bone involved and the amount of movement at the fracture site.
Factors Affecting Fracture Healing
Various local and systemic factors affect the duration and effectiveness of the healing process. Abnormalities in any of these areas may lead to abnormally slow healing (delayed union) or failure to heal (non union). These include:
Systemic factors
- Age: Children heal more quickly than adults; healing potential is decreased with advancing age
- Nutrition: Poor nutrition and/or vitamin deficiency adversely affects healing
- General health: Chronic illness depresses healing response (diabetes, anemia, systemic infection)
- Generalized atherosclerosis: Decreases healing
- Hormonal factors: Growth hormone enhances healing; corticosteroids depress healing
- Drugs: Non steroidal anti-inflammatory drugs (e.g. ibuprofen) depress healing
- Smoking: Decreases healing
Local factors
- Degree of local trauma/bone loss: A comminuted fracture with more soft tissue injury is slower to heal
- Area of bone affected: Metaphyseal fractures heal faster than diaphyseal
- Abnormal bone (infection, tumour, irradiated): Slower to heal
- Degree of immobilization of fracture: Motion at site delays healing
- Disruption of vascular supply: Delays healing
Treatment of the fracture
Treatment of the fracture consists of manipulation to improve the position of the fragments, followed by splintage to hold them together until they unite; meanwhile joint movement and function must be preserved. Most fractures are splinted in order to; (1) alleviate pain; (2) ensure that union takes place in good position; and (3) permit early movement of the limb and a return of fraction. Fracture healing is promoted by physiological loading of the bone, so muscle activity and early partial or full weight-bearing are encouraged. These objectives are covered by three simple injunctions:
- reduce
- hold
- exercise