Robert J. Snyder, MD
Bone fractures are a common occurrence that affects individuals of all ages and result from various causes, ranging from traumatic accidents to underlying medical conditions. In this article, I will explore the five most commonly broken bones and look at the underlying mechanisms of injury of these fractures, diagnosis and treatment.
- Clavicle (Collarbone) Fractures:
The clavicles, or collarbones, are long bones which connect the sternum and scapula, and are easily seen at the base of the neck, extending towards the ends of both shoulders. They are vulnerable due to their exposed position and minimal muscular protection surrounding them. A clavicle fracture can occur due to falls, sports injuries, and motor vehicle accidents. Direct trauma or a fall on an outstretched arm can also lead to a clavicle fracture.
Symptoms include pain, swelling, bruising, tenderness, deformity, and restricted shoulder movement. There may be numbness or “pins and needles” if nerves have been traumatized.
Diagnosis is made by an x-ray, physical examination and patient observation.
Conservative treatment involves immobilization in a sling for a period of six to twelve weeks typically. Physical Therapy afterwards will help to strengthen the muscles and increase range of motion.
Surgical intervention may be necessary in more complex fractures where the broken bone ends do not meet or if the bone is in pieces. That will require fracture reduction (setting the bone or bone pieces into proper position for healing).
- Hip Fracture:
The hip is a ball-and-socket joint, where fractures typically occur in the proximal femur, which is a fancy way of saying the upper part of your thigh bone where it goes into the hip socket. These fractures commonly occur in the elderly and often result from a combination of age-related bone loss (osteoporosis) and falls. In addition, certain medical conditions like osteoarthritis and osteomalacia can weaken the bone, further increasing the risk of hip fractures. They can also occur in younger people as a result of high velocity impacts such as sports injuries and motor vehicle accidents.
Symptoms are severe pain, bruising and swelling, inability to bear weight and leg shortening on the affected leg.
Diagnosis is made by an x-ray, physical examination and patient observation.
Surgical intervention is usually required, with internal fixation (mostly in younger persons) or hip replacement, followed by rehabilitation to restore mobility, strength, and range of motion.
- Colles’ Fracture (Distal Radius – wrist bone):
Colles’ fracture refers specifically to a fracture of the distal radius, typically occurring within an inch of the wrist joint. This type of fracture is frequently encountered, especially among older individuals with osteoporosis and typically occurs due to a fall on an outstretched hand, where the force is transmitted through the wrist joint. In severe cases, the radius fractures with dorsal displacement, resulting in a characteristic “dinner fork” deformity.
Symptoms include pain, swelling, bruising, and limited wrist and hand function.
Diagnosis is made by an x-ray, physical examination and patient observation.
Conservative Treatment involves fracture reduction, immobilization with a cast or splint, and Physical Therapy afterwards is a must.
Surgical Intervention will be necessary with dorsal displacement and requiring internal fixation, casting or splinting and a prolonged period of recovery and physical therapy for healing.
- Ankle Fracture:
Ankle fractures often result from twisting or rolling the ankle, leading to excessive stress on the bones and ligaments. High-impact accidents, such as sports injuries, falls, and motor vehicle accidents are common causes. Fractures can occur in the fibula, tibia, or both bones simultaneously.
Symptoms include pain, swelling, bruising, deformity, and difficulty walking.
Diagnosis is made by an x-ray, physical examination and patient observation.
Conservative treatment will consist of ice, elevation, compression, NSAIDS, bracing, behavior modification and physical therapy.
Surgical intervention for severe or complex fractures will involve stabilization with plates, screws, or rods, casting or bracing, prolonged recovery with non-weight bearing and partial weight bearing and intense physical therapy.
- Radius and Ulna Fractures (Forearm):
The radius and ulna are the two long bones in the forearm. Fractures in this region commonly occur from falls, motor vehicle accidents, and sports injuries. The mechanism involves direct impact or twisting forces transmitted through the arm.
Symptoms include pain, swelling, bruising, deformity, and limited forearm movement.
Diagnosis is made by an x-ray, physical examination and patient observation.
Conservative treatment includes fracture reduction, casting or splinting, physical therapy after 6-8 weeks of healing.
Surgical Intervention will be necessary for severe or complex fractures, with internal fixation, casting or splinting, 8-12 weeks of rest and healing, intense physical therapy to recover strength, range of motion and flexibility.
