I,CAREGIVER: All kinds of fractures

DO you know that bone fractures, cracked bones and broken bones all mean the same thing? “Break” is what we, the laymen, call it. Among doctors and health care professionals, break is a less common word used when talking about bones.

Having said that, the general term “fractured” bones does not really indicate the severity of bone damage. You will have to read the second sentence (and more) of the diagnosis to know how bad that fracture is because there are many types, and it can get confusing.

We often hear of “hairline fractures” (a partial fracture of the bone that is harder to detect) and “fracture dislocation” (when a joint is dislocated and one of the bones of the joint has a fracture), among others.

It is best to discuss this with the doctor, or the orthopaedic (bone) specialist. Nothing can be worse than trying to decipher all the big words on your own and getting it all wrong.

How can our bone get fractured? Basically, our bones  break or fracture when they cannot withstand the force or trauma applied to them. Fractures caused by a fall, an accident or during a fight are categorised as “traumatic fractures”. A “pathological fracture” is caused when our bone is made weak by some diseases, like osteoporosis, bone degeneration or other genetical disorders.

Sometimes our bones can be so weak that the sheer force of gravity can cause “compression fractures” on the back (spine), especially in the elderly.

In short, fractures can happen to anyone and any time. Diagnosis of a fracture includes the patient’s report or complaints, physical examination, history and scans, like X-ray, CT or MRI that provide accurate pictures of the bone.

Doctors say children’s fractures may be more difficult to diagnose because their bones are more “elastic” and their fractures look different in an X-ray. In the elderly, a fracture is easily seen from an X-ray and it occurs just as easily too.

The older we get, the less force our bones can withstand.

This is the very reason why when we are caring for the elderly, we have to keep an eye out for this. I remember when my late mother complained that her foot hurt. Not long after that, it swelled. She said she was just getting up from her chair when her foot just kind of folded and cracked. It then hurt a lot.

It was difficult for us to imagine a folded foot. After looking at her X-ray, the orthopaedic surgeon told us that her metatarsal bones had fractured at three parts — from her second to fourth toes. The metatarsal bone is the long bone between the tips of the toes and the ankle. Her foot actually folded!

So mum had to have her foot in a cast for six weeks and because her healing rate was slower than most, she had to wear a lighter cast for another two months so that her bones would set well. These days, there are nicer casts that are heavily padded on the inside and can be opened, and closed for cleaning. We used to call it mum’s space boots. She didn’t like it much and we had to persuade her to wear it.

Through this experience, we learnt that some of the signs and symptoms of a bone fracture include pain, swelling, bruising, discoloured skin around the affected area, the inability to put pressure or weight on the injured area, or a grating sensation at the affected bone or joint. These are the signs to look out for in fractures when the skin is intact. It is harder to tell. This kind of fracture is called a  “simple fracture”.

An “open fracture” that is bleeding through broken skin is more obvious and dramatic, and gets immediate attention because it carries a higher risk of infection.

Whether it is a “closed” or “open fracture”, broken bones hurt for many reasons. Among them, the nerve endings that surround the bones contain pain fibre. These fibres may become irritated when the bone is fractured or bruised.

Broken or fractured bones bleed, and the associated swelling causes pain. There are muscles that surround the injured area that may go into spasms and cause further pain.

What we forget is that our bone is not a stagnant organ as such. It is our body’s reservoir of calcium. It protects some of our body parts and our bone marrow is the production centre for our blood cells. It has nerves and muscles attached to it. That’s why fractures are painful.

The most common medication given for fractures is painkillers. There are many types and doctors prescribe them to manage the pain and healing according to the treatment plan. Some fractures may require surgery while others don’t.

It is important to see the doctor so that the bones heal correctly and are placed in their normal alignments.