Fractures, Sprains, and Strains

FRACTURES, SPRAINS, AND STRAINS

DEFINITION

---

Fractures, sprains, and strains are injuries caused to bones, ligaments, joint capsules, or muscles. A joint capsule consists of all the tissues that hold a joint together. Specifically, a fracture is a complete or incomplete break in a bone. A sprain is damage or tearing of ligaments or a joint capsule. A strain is damage or tearing of a muscle.

DESCRIPTION

---

Fractures usually result from a strong force applied to a bone. The bone and the tissue surrounding it may break apart completely, or they may be dislocated (pushed out of position).

Fractures are classified as being simple or compound. A simple fracture is one in which the skin is not broken. The area may be bruised and swollen, but it is not possible to tell simply by looking that a bone is broken. A simple fracture is also called a closed fracture. A compound fracture is one in which the skin is broken. The broken bone is actually visible to the eye. There may be damage to tissue surrounding the bone. Infection is a common complication of a compound fracture.

Fractures are also classified as complete or incomplete. A complete fracture is one in which the bone is broken all the way through. In an incomplete fracture, the break goes only part way through the bone. An incomplete fracture is also known as a greenstick fracture.

Bone breaks can also be classified as single or multiple. These terms describe the number of places in which a bone is broken. A single fracture is one in which the bone is broken in only one place. In a multiple fracture, a bone is broken in more than one place.

Fractures can also be described by other sets of terms. For example, they may be classified according to the direction of the break. A linear fracture runs in the same direction as the length of the bone. A transverse fracture is one that cuts across the width of the bone.

Sprains and Strains

Bones are connected to each other in joints by ligaments. When excessive force is applied to a joint, ligaments may be torn or damaged. This type of injury is a sprain. The seriousness of a sprain depends on how badly ligaments are damaged. Sprains can occur in any joint, but they occur most commonly in the ankle, knee, and finger.

Sprains are often classified as being in one of three categories. A grade I sprain is a mild injury. The ligament is not actually torn. The joint continues to function normally. There may be some swelling and tenderness.

Fractures, Sprains, and Strains: Words to Know

Ligament:

Tough, fiber-like tissue that holds bones together at joints.

Osteoporosis:

A condition in which bones lose protein and minerals, causing them to become weak and subject to fracture.

Reduction:

The restoration of a body part to its original position after it has been displaced, such as during a fracture.

Rickets:

A condition caused by the deficiency of certain minerals, including vitamin D and calcium, causing abnormal bone growth.

Traction:

The process of placing a bone, arm or leg, or group of muscles under tension by applying weights to them, in order to keep them in alignment while they heal.

A grade II sprain involves a partial tear in a ligament. There is obvious swelling, extensive bruising, pain, and reduced function in the joint.

A grade III sprain occurs when a ligament is completely torn. Pain becomes severe, and use of the joint is lost. These symptoms are somewhat similar to those of a bone fracture.

Strains are tears in muscle tissue. Strains are sometimes called pulled muscles. They usually occur when a person forces a muscle to work too hard. They are often caused by using incorrect lifting techniques.

CAUSES

---

Fractures, sprains, and strains are all caused when excessive force is applied to some part of the body. Normally, bones, muscles, ligaments, and other body parts are very resilient. They can withstand large forces and twisting actions. But sometimes these forces and actions become too great. In such cases, bones may be broken, ligaments torn, or muscles bruised.

Risk Factors for Fractures

Anyone can fracture a bone. People who are active are more likely to break a bone, however. For example, people who participate in contact sports, like football and basketball, are at high risk for fractures. The elderly are more likely to break bones than are younger people. Bones become more brittle as one grows older.

Before the age of fifty, more men than women suffer fractures. These fractures are often caused in work-related injuries. After the age of fifty, more women than men suffer fractures. Women tend to lose bone mass more quickly than do men as they grow older.

Some diseases of the bone can increase a person's risk for fractures. Two examples are rickets and osteoporosis (pronounced OSS-tee-o-puh-RO-sis; see osteoporosis entry).

Risk Factors for Sprains and Strains

Sprains and strains are common. Anyone can have them. But children under the age of eight are less likely to have sprains than older people. Their ligaments are quite tight. If too much force is placed on a joint, a bone is more likely to break than a ligament is to tear. People who are active in sports suffer more sprains and strains than less active people. Repeated sprains in the same joint can make the joint less stable and more likely to suffer sprains again in the future.

SYMPTOMS

---

The first symptoms of all three kinds of injuries are usually pain and swelling. The amount of discomfort depends on the extent of the injury. A serious fracture can produce other symptoms as well. There may be a loss of pulse below the fracture site. The patient may experience numbness, tingling, or even paralysis below the fracture. An open or compound fracture may also be accompanied by bleeding.

DIAGNOSIS

---

Some types of fractures can be diagnosed easily by simply observing the damaged area. In the case of a compound fracture, for example, the broken bone can actually be seen protruding through the skin. If the fracture cannot be seen clearly, an X ray is usually the next step. Most X rays show the presence of a damaged or broken bone. In some cases, X rays can themselves be questionable. For example, a broken rib is often difficult to see on a single X ray. A series of X rays taken from different angles may be necessary to diagnose a fractured rib.

One kind of fracture that may be difficult to diagnose is a stress fracture. A stress fracture is a very small break in a bone that may not show up on an X ray. A stress fracture can sometimes be diagnosed with a tuning fork. A tuning fork is a metal instrument used in tuning musical instruments. It is placed on the skin over the bone in which a stress fracture is suspected. If the patient reports increased pain, a stress fracture may be present.

Diagnosis of Sprains and Strains

In the case of sprains and strains, patients may actually recognize their own condition due to the swelling and pain. In mild cases, they may decide not to seek medical advice. Grade II and III sprains, however, are often seen by a doctor. The usual procedure is to have an X ray taken of the injured site. The X ray can be used to distinguish between a sprain and a fracture.

TREATMENT

---

The treatment of fractures depends on many factors, such as the seriousness of the injury, the patient's age, and his or her general health. In the case of serious fractures, a number of actions may be necessary. For example, patients with open fractures may need to have bleeding brought under control. They may also need antibiotics to protect against infection.

The fundamental goal in treating fractures is to restore a broken bone to its original position, if necessary, and then immobilize it. Bones begin to grow back soon after they are broken so this should be done by a trained medical person as soon as possible. In many cases, immobilization is the only treatment needed for a fracture. If there is displacement, the bone is first forced into the correct position and then held in place with a splint, cast, or brace. Once restored to its original position and held in place, the bone will re-grow to its former shape.

Getting the bone into its correct position is called fracture reduction. It can be done without breaking the skin or the doctor may need to perform surgery to realign the bones. Reduction done without breaking the skin is called a closed reduction and can be performed by a doctor with the patient under anesthetic. The doctor can move the bone parts around until they are back in their correct position. Some form of immobilization can then be applied.

Realigning the bones is sometimes difficult. The fractures may be complicated or serious enough to require an open reduction, or surgery, to reset the bones. The damaged area is cut open and the bones placed in their proper alignment. Devices such as plates, nails, screws, and rods may be used to hold the bones in this alignment while they heal. When healing is complete, the physician may or may not elect to remove these devices.

Traction is sometimes used to treat fractures. Traction involves the use of heavy weights to pull on a damaged bone. It forces the broken bone to line up correctly, the way it looked before the break. The traction may be necessary until the bone has grown back in its normal and correct position.

Treatment of Sprains and Strains

Grade I sprains and mild strains can be treated at home. Basic first aid for sprains consists of a system known as RICE. This term stands for four steps:

• R est
• I ce for forty-eight hours
• C ompression, such as wrapping the injured area with an elastic bandage
• E levation, or raising the sprained area above the heart

Over-the-counter pain medication, such as aspirin, acetaminophen, or ibuprofen, can be taken to relieve pain. Children should avoid aspirin, however, as it can cause Reye's syndrome (see Reye's syndrome entry).

People with grade II and grade III sprains should also follow the steps in RICE. They usually need additional treatment, however. In the case of sprains of the ankle or knee, they may need to stay off their feet by staying in bed or using crutches. Physical therapy or home exercises may be needed to restore normal joint function.

Grade III sprains usually require immobilization in a cast. The cast must stay on until the sprain heals, usually for several weeks. In extreme cases, surgery may be needed to repair torn ligaments. Physical therapy is often required after surgery.

Alternative Treatment

Calcium supplements are often recommended to help prevent fractures. The body uses calcium to build bones. Some physical therapists may recommend electrostimulation to treat a fracture. In electrostimulation, a small electrical current is passed through needles inserted near the damaged site. The electrical current is thought to increase the speed with which bones heal.

Two homeopathic remedies recommended for fractures are Arnica (pronounced AHR-nih-kuh) and Symphytum (pronounced SIM-fih-tum). These remedies are thought by some practitioners to increase the rate at which bones heal. Hydrotherapy is also recommended for fractures in the legs and arms. Warm water may increase the rate of circulation in the area and, thereby, the rate of healing.

Alternative treatments for sprains and strains may include the use of nutritional supplements, such as vitamin C and bioflavonoids. Certain herbs are recommended to reduce inflammation in a damaged area. These herbs include bromelain, turmeric, Arnica, Ruta, and Rhus toxicodendron.

PROGNOSIS

---

Fractures usually heal well when properly immobilized. Bones tend to grow back over time, correcting any breaks that may have occurred in them.

A key factor in healing is prompt treatment. Bones that are not immobilized within six hours of injury are much more difficult to re-align. Healing time varies considerably, depending on many factors. In older people, for example, bones re-grow more slowly.

Mild and moderate sprains usually heal in less than four weeks. Severe sprains may take much longer. At one time, a torn ligament meant the end of an athlete's career. Today, advanced surgical procedures can be used. Nearly normal function can be restored. Even then, however, the joint is never as strong as it was before the injury.

PREVENTION

---

An adequate level of calcium in the diet is essential to reduce the risk of fractures. People with too little calcium in their diet tend to have weak bones that break more easily. Calcium supplements may be necessary if a person does not get enough of the nutrient in his or her regular diet.

Exercise can help strengthen bones. Older people in particular can benefit from a regular program of moderate exercise.

The risk of fractures can also be reduced by making use of safety measures. For example, passengers in cars should always wear seat belts. Anyone who engages in contact sports should use protective equipment available for the sport. Women past the age of fifty should consider taking estrogen replacement medication to help reduce the chance of osteoporosis. Osteoporosis is a weakening of bones that occurs commonly in women past the age of menopause.

Sprains and strains can be prevented by following some simple guidelines, including warming up before exercise, using proper lifting techniques, wearing properly fitting shoes, and taping or bracing joints that may receive unusual stress.

FOR MORE INFORMATION

---

Books

American Red Cross. Community First Aid and Safety. St. Louis: Mosby, 1993.

Arnheim, Daniel D. Modern Principles of Athletic Training. St. Louis: Mosby, 1989.

Burton Goldberg Group. "Sprains," in James Strohecker, ed. Alternative Medicine: The Definitive Guide. Puyallup, WA: Future Medicine Publishing, 1994.

"Sprains and Strains," in The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. Alexandria, VA: Time-Life Books, 1996.

Periodicals

Wexler, Randall K. "The Injured Ankle." American Family Physician (February 1, 1998): p. 474.

Organizations

American College of Sports Medicine. P.O. Box 1440, Indianapolis, IN 46206–1440. (317) 637–9200.