Throughout the years interesting questions have always come up regarding fractures such as what is the difference between a fracture and a break? When physicians talk about bone fractures, this is the same thing as saying the bone is broken. Breaks and fractures are synonymous. As suspected, a fracture of any kind can affect the individual athletes for a particular season and/or ability to work out depending on location of the fracture.
Fractures can be categorized in several ways: anatomical location such as proximal, middle or distal; direction of the fracture line such as transverse, oblique, or spiral; and whether the fracture is linear or comminuted with comminuted being several small fragments. Fractures are either open or closed. Fractures classified as open is when the overlying soft tissue such as muscle or skin has been broken, so that the fracture is open to the outside world. Fractures classified as closed are when the skin remains intact.
For the most part the majority of fractures occur as a result of one single traumatic episode where the force is great enough to cause a break of the bone. This is the cause primarily with all fractures except two, pathological and stress fractures. In a nutshell, pathological fractures are where the bone has been broken in the area weakened by some type of preexisting disease process such as a malignant lesion. Stress fractures on the other hand are caused by breakdown of the bone with the fracture due to repetitive loading of the bone over an extended period of time.
Once the individual has a bone fracture, the question is always raised regarding how long does this individual have to be out of action and if there will be any long-term problems. The length of time of immobility and fracture protection depends on multiple factors. One is bone hardness. Certain bones in the body are made up of more cortical bone, which are harder and take longer to heal more so than cancellous types of bone, which is a softer type of bone. For example, the tibia or the lower leg bone in the talus or the ankle bone are more cortical types of bone and take longer to heal than do bones in the wrist which are more of a cancellous type of bone. This fracture will definitely affect the length of immobilization and protection of these areas. Age is another mitigating factor. The younger population will heal faster than the older population.
Other health-related problems such as diabetes can play a significant role in the healing of any type of fracture. Also the person will play a significant role in the healing process. On numerous occasions, we have had athletes who felt they were smarter and more knowledgeable than the attending physician. They were determined to walk earlier than it was recommended and removed their cast earlier than advised, breaking all the rules relative to proper fracture care. This will cause long-term problems such as nonunions or malunions.
It is important to understand that the bone is a lightweight but very strong material. But when there has been sufficient trauma to cause the break down in the fracture, appropriate treatment is critical to the healing of this, avoiding as many adverse long-term effects as possible. On occasion and again depending on recommendations of the physicians, certain types of fractures are able to be protected with minimal casting and/or splinting to allow the individual to return to their particular activities. In all, this decision is made by the physician as they know how to read an x-ray and are able to determine the type and location of the fracture.
The only other type of fracture that I think needs to be mentioned are those involving a particular joint. Fractures that go through the joint space are cause for concern as any displacement causes a step off of the joint. Joint fractures have a tendency to cause abnormal amounts of friction within the joint space itself and can cause early arthritic problems. The physician and the attending medical staff or health care provider can only do so much. It is again up to the individual athlete to listen to the advice that was given and follow the steps for healing to begin. This will safely allow the athlete to return to their specific athletic event or physical activity endeavors as quickly as possible.
Tom Jensen, P.T.
