Adult Fractures

Overview

A "fracture" is just the medical word for a broken bone. Bones break in three broadly different ways. The first is acute trauma: a fall, a sports collision, or a direct blow that overwhelms the bone all at once. The second is stress: repeated loading that builds tiny damage faster than the bone can repair it. This is the pattern seen in runners, military recruits, and dancers. The third is weakened bone: a low-energy fall that would not have broken a healthy bone. That usually means osteoporosis. Now and then it means a tumor or infection that has hollowed the bone from the inside.

The way a surgeon describes your fracture is not jargon for its own sake. Every word drives a treatment decision. Location tells us which bone, and where along it. Pattern is the shape of the break: transverse (clean across), oblique (angled), spiral (the bone twisted apart), or comminuted (more than two pieces). Displacement tells us whether the pieces have moved out of line. Open vs. closed tells us whether the broken bone has come through the skin. Open fractures are surgical emergencies, because they are in effect contaminated wounds. Together, those four words decide whether you heal in a cast, in a brace, or in the operating room.

A broken bone heals in stages. In the first week, your body forms a blood-rich clot at the break. Over the next few weeks, that clot turns into a soft bridge of new tissue. Over months, that soft bridge hardens into mature bone, and the bone then reshapes itself for years to rebuild its original strength. Several things can slow or stop this. The list includes too much motion at the break, infection, poorly controlled diabetes, and steroid medication. Smoking is on it too, because it starves the healing site of blood flow. That is why keeping the break still, quitting smoking, and bone-health work are not optional add-ons. They are how the bone actually knits.

OSI manages the full range of adult fractures of the arms and legs. That runs from a clean wrist fracture treated in a cast to complex, multi-piece breaks around major joints that need reconstruction.

Common Adult Fracture Sites We Treat

Start with a body region to see the most common adult fractures in that area:

• Wrist fractureDistal radius, scaphoid, ulnar styloid, the FOOSH injury
• Shoulder fractureClavicle, proximal humerus, scapula, sternoclavicular
• Hip fractureFemoral neck, intertrochanteric, subtrochanteric, acetabular, pelvic ring
• Ankle fractureLateral, medial, posterior malleolus, syndesmosis, pilon

Or jump directly to a specific fracture:

• Humeral shaft fracture
• Clavicle fracture

Symptoms

A fresh fracture usually announces itself the moment it happens. The pain is sharp and focused right at the break. Swelling and bruising build over the next hours. The limb is hard to use or put weight on. A bend where the bone should be straight points to displaced pieces. But plenty of fractures look unremarkable from the outside, especially stress fractures and small breaks in older bone. Sometimes the only sign is tenderness over one specific spot.

Two patterns are worth knowing because they change the urgency. The first is a fracture where the broken bone has torn through the skin, called an open fracture. That is a surgical emergency and needs immediate care. The second is any fracture where the limb beyond the break turns pale, numb, cold, or steadily more painful. That can signal pressure on, or injury to, the nerves and blood vessels. When in doubt, the safe move is to keep the limb still and get checked promptly. Do not wait to see whether the pain settles.

X-rays are the foundation, and a single view is rarely enough, because fractures hide in 2D. Standard practice is at least two views at right angles to each other, usually front-on and side-on. A third, angled view is often added. A fracture line that is invisible from one angle is unmistakable from another. CT adds the third dimension when the break reaches into a joint surface or splits the bone into many pieces. Surgeons use it to map the exact shape before going in. MRI is the test for a break that does not show on X-ray (a true occult fracture). Most often that is a stress fracture, or a small hip-neck fracture in an older patient. MRI is also used when the soft-tissue picture matters. Before surgery, lab work checks a basic blood count, kidney function, and clotting. For fractures in older adults, a DEXA scan to measure bone density and a check for low vitamin D come next. That way the underlying weakness gets treated along with the break itself.

If the fracture is stable and the pieces line up well, the goal is simple. Protect the break. Let the bone’s own biology do the work. Watch the healing on X-ray until it is solid. The options below are matched to which bone broke and how, not applied as a one-size plan.

1. Splint & Cast Immobilization

   Fractures that are stable and already in acceptable alignment heal in a cast or rigid splint. The cast's job is to deny the broken pieces any meaningful motion while the bone knits. Too much motion at the break slows or stops healing. Repeat X-rays at one, three, and six weeks confirm the alignment is holding and the bone is filling in. Once the X-ray shows solid healing, the cast comes off. Gradual loading and strengthening begin from there.

2. Functional Bracing

   Some fractures heal better with a small amount of controlled motion than locked fully still. The shaft of the upper arm bone is the classic example. A close-fitting brace lets you use the muscles around the fracture. Each contraction presses the bone ends together, which speeds healing. The brace still prevents the kind of large motion that would disrupt the callus.

3. Bone Health Optimization

   This matters most after a low-energy fall in an older adult. The broken bone is a signal that the bone underneath is fragile. Left unaddressed, the next fracture is statistically the next fall away. The standard work-up includes a DEXA scan, vitamin D and calcium levels, and a review of medicines that affect bone (especially long-term steroids). Treatment is calcium and vitamin D, weight-bearing exercise, and quitting smoking. For confirmed osteoporosis, we add a prescription medication that slows bone loss or rebuilds bone density.

Surgery is considered for unstable fractures, displaced fractures that involve a joint surface, open fractures, fractures with a nerve or blood-vessel injury, and fractures that cannot be held in line with a cast. The exact procedure depends on which bone broke and how. The general principle is the same across the body. It is called open reduction and internal fixation (ORIF): the surgeon lines the pieces back up through an incision and holds them with plates, screws, rods, or wires. The implants and the approach are tailored to each location.

If non-surgical care is not enough, these are the procedures we use most often, grouped by region:

• Distal radius fracture fixationWrist, volar plate
• Metacarpal fracture fixationHand
• Phalangeal fracture fixationFinger
• Radial head fixation or replacementElbow
• Humeral shaft fracture fixationArm, when functional bracing won’t hold
• Proximal humerus fracture fixationShoulder, locking plate with cuff sutures
• Clavicle fracture fixationShoulder, plate-and-screw fixation
• Reverse shoulder replacementFor complex proximal humerus fractures in older patients
• Patella fracture fixationKneecap, tension band or plate
• Tibial plateau fracture fixationKnee joint surface
• Tibial shaft intramedullary nailLower leg
• Ankle fracture fixationAnkle
• Talus fracture fixationAnkle / foot
• Calcaneus fracture fixationHeel
• Fifth metatarsal (Jones) fracture fixationOutside of the foot

Providers Who Treat Adult Fractures

David B. Templin, M.D.

Michael S. Vrana, M.D.

Trent Twitero, M.D.

External patient-education references and related OSI pages for additional background:

• AAOS OrthoInfo, patient education library
• OSI glossary, orthopedic terminology in plain language