In this section Cypress Foot and Ankle Expert Dr. Christopher Correa discusses broken bones. The medical term for a “broken bone“ is a fractured bone. Think of these terms as interchangeable and not one as a lesser degree to the other. I have encountered patients presenting to my office explaining to me that they were told that their bone was merely fractured but not broken. I wish to make this seemingly pedantic distinction because confusion on basic terms can lure a patient into a false idea that their injury is not as bad as it really is. This could lead to a delay in seeking treatment and can lead to worsening of symptoms. “But isn’t it quite obvious when a bone is fractured?” ….and the answer is….usually but not always….. To understand why let’s take a closer look at fractures.
The function of the skeleton is to provide a rigid structure support structure for the attachments of muscle and ligaments to allow for movement along with encasing and protecting vital organs. To do this, bones much be stiff yet flexible at the same time. Naturally a stiff bone clearly allows for the performance of the tasks listed above. The flexibility or bending of the bone however, actually greatly increases boney resiliency and strength. This flexibility allows for the dissipation of force along a large area of the bone thereby reducing said force at any one location. If bones were inflexible, they would in fact be more brittle and be more prone to shattering like a plate glass window. This pliability allows the bone to deform slightly and spring back to its normal shape without damage. This sort of deformation is called elastic deformation. If the strain is too great and the bone bends beyond the point of elastic deformation to plastic deformation the overall shape of the bone either changes or breaks. This is known as plastic deformation. Bones do not allow a great degree of plastic deformation and quickly fracture. This occurs when a crack develops through the cortical structure creating two or more pieces. Depending on the way amount and distribution of the energy used to break a bone it can either cause a structural failure with no displacement like a stress fracture a complete break into 2 or more separate pieces.
Types of fractures – I like to break down fractures into 2 categories stress fractures and full or complete fractures. Stress fractures are insidious and tend to occur from excessive repeated strain across a bone causing it to crack but not separate. This crack does separate the cortex by the bone shape is maintained. Think of a single crack in a wind shield, the window is clearly broken but it is maintaining its overall structure. Stress fractures if neglected have a habit of worsening and eventually becomes complete fractures. For more information on stress fractures check of my blog post on the subject here. Complete fractures occurs when a single bone cracks and is separated into 2 or more pieces. This is like breaking a stick in half or throwing a baseball through a plate glass window.
When should you go to the doctor? Any time you injury your foot or ankle and experiencing pain, bruising and swelling you should see a doctor and at least have an x ray to rule out any fractures. Without an x ray it is difficult if not impossible in most cases to tell the difference between a simple sprain and a fracture. The treatments for sprains and fractures are not the same and treating a fracture as a sprain can lead to worsening of the fracture to the point of needing surgery.
Do fractured bones always need surgery to fix? The answer is……maybe. There are many factors involved in deciding whether or not a patient needs surgery to fix a fracture. Many of these factors are outside the scope of this discussion such as patient age, bone density, other health problems, etc. Looking simply at the merits of the fracture itself whether or not you need surgery depends mostly on displacement. If the fracture is non or minimally displaced then your doctor may recommend conservative care in the form of immobilization (boot or cast), non-weight bearing etc. Fractures patterns that are displaced more than 2mm, severely rotated, or bones left in a shorten position often times need to be reduced and fixated surgically. There is no way to tell the severity of a fracture without at least an x ray, and sometimes a CT for more complex facture patterns. There are special cases such as a Jones fracture (base of the 5th metatarsal) where you doctor may recommend surgery in spite of minimal displacement. The reason for these highly specific cases is due to a well-known and documented tendency for certain bones and certain fracture locations where the there is a higher nonunion or re-fracture rate. If you are experiencing pain and swelling in your foot or ankle, give the experts at Select Foot and Ankle Specialists a call and take the first step toward recovery today!
