Fracture Vs Break
One of the questions our clinicians are always asked is what is the difference between a fracture and a break?
The answer is simply; they are both the same. Within a medical environment clinicians will always refer to a break as a fracture.
There are 2 types of fractures
Stable – nondisplaced or minimally displaced
Unstable - Displaced
A stable fracture is normally the result of a low energy twists or falls or indirect trauma. In some cases, it can be caused through repetitive stress. The force is enough to crack the bone but not enough to shatter or displace it.
Examples of low energy twist or falls:
Simple fall from standing height, tripping or slipping
Sport injury – e.g football, tennis, running
A twisting motion on a planted limb can create a stable spiral fracture, often seen on the tibia (the shin bone)
Compression is a result of direct, compressive force that can cause a stable buckling or vertebral compression fractures, common in the spine or children’s long bones (buckle/torus fracture)
Bending forces in children can result in a greenstick fracture. This occurs when a bending force causes the bone to crack on one side, whilst the remains in place
Stress fractures are caused by repeated/excessive loading rather than a single, sudden impact leading to a hair line fracture e.g running
Toddler fractures. These are very fine cracks to a bone which are very difficult to detect. Practitioners will go on the mechanism of injury and clinical presentation to help with a diagnosis of a toddler fracture.
Due to toddler fractures being difficult to see. Parents are always advised that if their child continues to complain of pain and unable to weight bear properly despite regular analgesia to reattend AE.
What is the treatment of a stable fracture
As the bones remain in place the treatment will either be a splint or a back slab. The reason we apply a back slab rather than a full cast is to allow for swelling thus preventing any issues with blood flow.
A back slab is essentially half a cast. The reason a full cast is not put into place is due to swelling. If a full cast is placed on too soon it can cause compartment syndrome. This is where pressure is placed on the arteries due to swelling, thus reducing blood flow. This can result in surgical intervention. By placing half a cast in place, this will prevent restriction as the limb is able to expand thus no pressure on the arteries.
Back slab for either tibia or fibula break
An unstable fracture is normally a result of a high energy trauma or impact. This will cause structural integrity of the bone and the surrounding ligamentous supports, this causes segments of the bone to move out of normal alignment
Examples of high energy trauma:
Severe multidirectional forces such as rapid deceleration – road traffic accident
Falls from a height more than 2 meters – fall from a ladder, roof
Crush injuries –trapped between objects such as a car, machinery
High energy trauma can lead to the following injuries:
Fracture to the spine – Unstable spinal fractures usually involve damage to at least 2 or 3 spinal columns (front, middle and back). These types of fractures often result from:
Flexion-Distraction (chance fractures) - Caused by motor vehicle collisions when the impact causes the spine to bend forward while being pulled apart
Axial loading/burst fractures – caused by sudden intense vertical force that crushes the vertebra, such as falling from a height and landing on the feet or buttocks
Hyperflexion/hyperextension – extreme bending of the neck or back often with rotational forces, causing fracture-dislocations – high speed, multidirectional car accidents
Fracture to the pelvis – Unstable pelvic fractures often involve the rupture of ligaments that keep the pelvis attached to the spine – typical causes:
Anteroposterior (back and front) compression (ACP) – Caused by a head on impact, e.g motorcycle accident, pedestrian vs car) causes the pelvis to open like a book, damaging the front ligaments ad in severe cases the back sacroiliac ligaments.
Lateral (side) compression (LC) – Caused by a side impact, e.g T bone car accident (hit in the side of a car) that can drive the ilium into the sacrum, causing vertical fractures of the sacrum or ilium.
Vertical shear (straight up/down) – A high energy fall from a great hight landing on one leg, forcing one side of the pelvis upward, causing complete posterior and anterior (back and front) break.
Fractures to the long bones (Femur/Tibia – bones in the lower leg)
High velocity trauma such as, motor vehicle accidents, motorcycle crashes or pedestrian injuries which usually cause unstable, comminuted (multiple fragment) fractures of the femoral shaft.
Falls from height – these normally result in a periarticular fracture e.g tibia plateau, this is where the joint surface is destroyed
Special scenarios
Pathological/Insufficiency fractures – these are normally stable, but patients with severe osteoporosis, cancer or metabolic diseases, even if a minor trauma, can cause an unstable pathological fracture due to the underlying bone in very weak.
At Taylor Grey, we can manage minor trauma. This can be anything from tripping on a pavement, twisting an ankle whilst playing sport, minor collision with a car/motorcyclist. We do not treat complex trauma. If you have had a high energy injury we advise that you go straight to your nearest AE department, however should you arrive at the clinic the team would do their utmost to control your pain and refer you to the appropriate team.
We are able to provide walking boot, slings, splints for wrists and thumb, supports for those who have had a sprain. We will apply a back slab for simple fractures. We are also able to give analgesia for pain.
A sprain is a twisting of the ligaments resulting in significant swelling, bruising and in some cases unable to weight bear
How can we do this?
Xray on site
Skilled clinicians trained and have worked in the Emergency Department and are able to X-ray, apply back slab, clean and close open wounds.
Referral to orthopaedic team if follow up is required
Examples of some types of fractures
Spiral Fracture Displaced fracture Nondisplaced fracture
Minimally displaced Unstable Stable
Treatment
Back slab non weight bearing Surgical intervention Walking boot