Fractures (Broken Bones)

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 than 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 support structure for the attachments of muscles and ligaments to allow for movement, along with encasing and protecting vital organs. To do this, bones must 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 bony 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 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, or 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 separates the cortex from the bone and is maintained. Think of a single crack in a windshield; the window is clearly broken, but it is maintaining its overall structure. Stress fractures, if neglected, have a habit of worsening and eventually become complete fractures. For more information on stress fractures, check my blog post on the subject here. Complete fractures occur 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 injure your foot or ankle and experience 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-displaced or minimally displaced, then your doctor may recommend conservative care in the form of immobilization (boot or cast), non-weight bearing, etc. Fracture patterns that are displaced more than 2mm, severely rotated, or bones left in a shortened position often 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 fracture patterns. There are special cases, such as a Jones fracture (base of the 5th metatarsal), where your doctor may recommend surgery despite 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 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!