Bones are strong, but not unbreakable. A fall onto an outstretched hand, a road or workplace accident, an unlucky moment during sport – and the bone gives way. Typical signs are severe pain, swelling and bruising, together with an area that can no longer be moved or bear weight. Sometimes an arm or leg is visibly out of line.
Not every fracture can be seen from the outside. Only the X-ray shows where the bone is broken, whether the fragments are displaced and whether a joint is involved; for complex fractures, a CT scan with a three-dimensional image helps. The skin, nerves and blood vessels are just as important: an open fracture, in which the skin is also injured, must be treated quickly because germs can get in.
The principle of treatment is simple: the fragments must lie still in the right position until new bone joins them. For stable fractures, a cast, splint or brace achieves this. If the fragments are displaced or a joint is involved, they are realigned surgically and fixed with plates, screws or an intramedullary nail – a metal rod inside long bones such as the thigh bone or shin bone.
In older age, a fall at home is often enough, because osteoporosis has weakened the bone; a typical example is the hip fracture. Then it is about more than the fracture: about getting up again soon, preventing thrombosis and pneumonia, and how everyday life can work again afterwards.
Ahmed Saber
