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Fracture Care

Did you know that a broken bone of any kind is called a fracture? There are different types of fractures and each of them requires a specific treatment.

Common fracture types are:

 

  • Greenstick Fracture – often seen in children, a greenstick fracture is an incomplete fracture where the bone is bent.

  • Open or Compound Fracture – this is a fracture where the broken bone is exposed. This can be dangerous because of the increased chances of infection.

  • Complete Fracture – a fracture where the two pieces of the bone completely separate from each other.

  • Stress Fracture – is a common fracture caused by overuse. It is most often seen in athletes who run and jump on hard surfaces such as runners and basketball players.

  • Compression Fracture – a compression fracture is a closed fracture that occurs when two or more bones are forced against each other. It most often occurs in the bones of the spine and may be caused by falling or as a result of osteoporosis.


Common symptoms that you may need fracture care:
 

  • Swelling, bruising or bleeding

  • Intense pain

  • A visibly out-of-place or misshapen limb or joint

  • Broken skin with a bone protruding

  • Limited mobility or inability to move a limb


The physicians at Randolph Health Orthopedics & Sports Medicine are able to meet all of your fracture needs, regardless of the type. There are non-surgical approaches to fracture care which involve casting. The cast will immobilize the limb until the bones heal. After treatment, a patient will often benefit from physical therapy to help regain range of motion and then strength in order to get back to pre-injury function as quickly as possible. Another type of non surgical treatment is splinting. Splints are most often used in the early phases of a fracture to allow for swelling and frequent checks. A special shoe or boot can also be placed if the injury is to the lower leg or foot. Both of these options will help to immobilize the injured bone while it heals.

Often times surgery is required to best fix a fracture. Your surgeon may recommend fixing the broken bone with special hardware such as a rod, or plates and screws that will hold the fracture together while your body heals.

Hip Fracture

One of the most common fractures in the elderly population is the hip fracture. Hip fractures can occur at any age; however, most occur in people over the age of 65. In the elderly, a hip fracture can be very a very serious condition, especially if complications arise.

Hip fracture signs and symptoms:

 

  • Severe pain in the hip or groin region

  • Unable to bear weight on the leg

  • Unable to get up immediately after a fall


If you have a suspected hip fracture, it is imperative that you see a physician immediately. In addition to evaluating your symptoms, a physical exam is necessary. The doctor will order x-rays to confirm the fracture and at times an MRI or a CAT scan is necessary.

Hip surgery is the most common treatment for a hip fracture. The type of surgery required depends on the type of fracture you have.

Some fractures require a hip pinning procedure (if the fracture is in the neck portion of your femur, just below the top of the bone), while others require metal plates and screws (inter-trochanteric hip fracture, or the area below the femur neck). If bone quality is poor, the surgery could require a total or partial hip replacement.

Where to go after a hip fracture is often a dilemma. Most of the time you will be encouraged to start walking with physical therapy soon after your surgery, but a short stay in a skilled nursing facility is often required. This is only until you are able to move around safely and you are correctly exercising on your own.

Click here to download our Hip Fracture Guide

Wrist Fracture

Did you know that wrist fractures are the most commonly broken bone in people under the age of 65? Your wrist is made up of many bones; however, when speaking of a wrist fracture, a physician is usually referring to a fracture of one of the two forearm bones, the radius. Other bones that can break near the wrist joint include the ulna and the scaphoid (one of the tiny carpal bones).

Common causes of wrist fractures:

The most common cause of a wrist fracture is a fall. Typically the person falling tries to break their fall by putting their hand out which forces the wrist into a backward position.

Signs and symptoms of an wrist fracture:

 

  • Swelling, warmth, discoloration and pain located at the area just above the wrist joint

  • Limited mobility with difficulty moving the wrist in any direction. Movement of the fingers to grip or grab hold of an object may also prove to be difficult.

  • The appearance of deformity, where the wrist is bent in an odd way away from the body


What do I do about my fractured wrist?

If you suspect that you have had a wrist fracture, you should not try to move the wrist at all. Notify a medical professional as soon as possible to x-ray the wrist. This will help the physician determine the extent of the injury and proper course of treatment. Most of the time an x-ray will show a wrist fracture. These can be taken in the physician’s office or in the emergency room.

What does treatment for wrist fractures involve?

The majority of times a fractured or broken wrist can be treated by casting. If the bones are out of proper alignment, then light sedation may be used to reset the fracture. This is called “reducing” a wrist fracture and often times this is all that your physician needs to do to be able to realign the broken wrist.

When will a splint, cast, or a brace be used?

If the broken pieces are in place and not likely to move out of place, a splint or cast may let them heal. Sometimes it’s even safe to move the elbow during the healing process to prevent stiffness.

When is surgery necessary?

This is a difficult question to answer and must be addressed on a case by case basis. Even on a case by case basis, orthopedists often differ on their opinion of optimal treatment for a given fracture.

Some considerations when determining the need for surgery include:

 

  • Patient age and physical demands required – In the young active patient every effort will be made to restore the wrist to normal position. Perfect realignment may help prevent problems in the years to come. If the patient does not require heavy demands of the wrist, or if the patient is elderly, perfect alignment may not be necessary.

  • Bone quality – If the patient is osteoporotic, or has weakened bones, then surgery may not be the answer. Bone quality must be adequate to secure the metal fixation, so in these cases a cast will be the best treatment option.

  • Location of the fracture – If cartilage is involved, surgery may be more likely.

  • Displaced fracture – If the bones are severely out of line, then surgery may be performed to properly position the individual fragments. This is initially attempted through resetting the fracture, but some fractures may be unstable and not stay in place even with a well fit cast. These fractures will require surgery.


How long is the recovery from a wrist fracture?

Any fracture takes about six weeks to heal. This is true whether you have surgery or a cast.

Some factors make healing slow down, like smoking or bad circulation.

Remember that the severity of the injury will dictate how quickly you recover and recovery time varies considerably. If you have had a cast applied to your arm, you can usually have it removed about six weeks following the fracture. Talk to your doctor about physical therapy. Your doctor can help you decide if you can begin physical therapy immediately or within days to weeks following treatment. Physical therapy will help you restore the motion, flexibility and muscle tone to your wrist. It is not unusual for maximal recovery from a wrist fracture to take several months. Some patients may have residual stiffness or aching and if the cartilage was badly injured, arthritis may develop.

Elbow Fracture

Your elbow is made up of three bones: the humerus, the radius and the ulna. The humerus is the large bone of the upper arm. As you follow the humerus down, it connects with the smaller radius and ulna, ultimately forming the elbow joint.

Your elbow is capable of two main types of movement: bending and straightening. However, it is also able to rotate when you turn your palm up and down. The muscles and tendons that surround the elbow joint help it to move in these directions and all of these motions may be painful or stiff after an elbow injury.

Common causes of elbow fractures

Elbows often break after a fall onto a stretched out hand, such as when someone is trying to catch themselves or break their fall. You can also break your elbow if you fall and land directly on it, or by twisting it severely. Often times, broken elbows are accompanied by sprains, strains and dislocations as well.

Signs and Symptoms of an elbow fracture:

 

  • Pain, bruising and swelling around an elbow that is difficult to bend or twist

  • Hearing a pop or crack in the elbow during the injury

  • A crooked appearance to the elbow or arm, bleeding cuts in the skin around the elbow, or numbness/tingling in the hand after the injury that does not improve


Elbow Fracture Frequently Asked Questions

What do I do about my fractured elbow?

Most of the time an x-ray will show an elbow fracture. These can be taken in the physician’s office or in the emergency room. If an x-ray is not clear, it may be necessary to get a CT scan of the elbow. A CT scan is a type of x-ray that looks at the bones of the elbow in very fine detail. A CT may actually clarify how severe a break is or to determine if surgery will be necessary.

What does treatment for elbow fractures involve?

Elbow fractures can be treated with surgery or without surgery. Usually the right answer depends on how badly the elbow is broken.

 

  • Is the break in the joint?

  • Does the break involve multiple bones?

  • Is the fracture solid or are there loose fragments in the elbow?

  • Is a nerve or blood vessel damaged?


All these questions need to be answered during the decision process.

When will a splint, cast, or a brace be used?

If the broken pieces are in place and not likely to move out of place, a splint or cast may let them heal. Sometimes it’s even safe to move the elbow during the healing process to prevent stiffness.

When is surgery the right answer?

If the bones are broken in multiple places or if the break involves the joint, or the pieces are moved out of place a lot, surgery is usually the right answer.

Surgery is used to put the pieces back in the right alignment, solid enough (using metal hardware like screws and pins) to let you move the elbow after surgery (in therapy). If the bone comes through the skin, surgery is needed right away to wash out the cut and prevent infection.

How long is the recovery from an elbow fracture?

Any fracture takes about six weeks to heal. This is true whether you have surgery or just a splint.

Some factors make healing slow down, like smoking or bad circulation.

If the pieces of the broken bone can be stabilized in surgery or are stable on their own, early motion and therapy can prevent stiffness, but therapy is usually required on top of the bone healing time.

Therefore count on about three months of total healing and rehabilitation time to recover from an elbow fracture.

Some patients heal faster, some slower. The most common complication after an elbow fracture (with or without surgery) is stiffness.