What is a fracture?

What is a fracture?

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A fracture refers to a partial or complete break or crack in a bone. It occurs when a bone is subjected to more force or pressure than it can withstand. Fractures can happen in any bone in the body, ranging from small, delicate bones to larger, weight-bearing bones.

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Fractures can be classified into different types based on various factors, including the location and extent of the fracture, the type of force that causes it and whether the bone has pierced the skin. Some common types of fractures include:

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1. Closed or simple fracture: This type of fracture does not break the skin. The bone may be partially or completely broken, but there is no external wound.
2. Open or compound fracture: In an open fracture, the broken bone pierces through the skin, leading to an external wound. This type of fracture carries a higher risk of infection due to the exposure of the bone to the external environment.
3. Greenstick fracture: This is an incomplete type of fracture that occurs primarily in children, where the bone bends and partially breaks, similar to how a green twig bends but does not completely snap. The other side of the bone remains intact.
4. Comminuted fracture: A comminuted fracture refers to a fracture where the bone breaks into multiple fragments or pieces. This type of fracture can be more challenging to treat and may require surgery.
5. Stress fracture: Stress fractures are small cracks or breaks in the bone that typically occur due to repetitive stress or overuse. They are commonly seen in athletes or individuals who engage in repetitive activities.
6. Pathological Fracture: This is more common in elderly individuals and is caused by a type of disease that weakens the bone such as; osteoporosis, bony tumor or other diseased bone.

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Common symptoms of a fracture

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The signs and symptoms of a fracture can vary depending on the location and severity of the break. Common symptoms include:

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1. Pain: Fractures are typically associated with localized sharp pain at the site of the break. The pain may worsen with movement or pressure on the affected area.
2. Swelling and bruising: The area around the fracture may become swollen and bruised due to tissue damage and bleeding.
3. Deformity or misalignment: In some cases, a fracture can cause visible deformity or misalignment of the affected bone or joint. The affected area may appear crooked or out of place.
4. Limited range of motion: Fractures can result in decreased muscle flexibility and limited range of motion in the affected area.
5. Tenderness and sensitivity: The area around the fracture may be tender to the touch and sensitive to pressure.
6. Decreased function of the affected part: When there is a fracture, some degree of injury also occurs to the soft tissues surrounding the bone which also limits the function of the affected area. 

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When a fracture is suspected, it is essential to seek prompt medical attention. A healthcare professional, such as a doctor or orthopedic specialist, will evaluate the fracture through physical examination, imaging tests (such as X-rays, CT scans, or MRI), and medical history review.

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How can physical therapy help? 

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Physical therapy plays a crucial role in the rehabilitation process following a fracture. The primary goals of physical therapy for a fracture are to promote healing, restore strength and mobility, improve functional abilities, and facilitate a safe return to activities. It is important to note that the rehabilitation program for fracture varies depending on the type, site and extent of the fracture. Here's how physical therapy can help with a fracture:

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1. Initial management and protection: In the early stages of fracture healing, physical therapists may recommend immobilization and will provide guidance on proper positioning, splinting, or bracing to protect the fracture site and prevent further injury. They may also educate individuals on weight-bearing restrictions or modifications to ensure optimal healing.
2. Pain and inflammation management: Physical therapists can use various modalities such as ice therapy, electrical stimulation, or ultrasound to help reduce pain and inflammation in the affected area. They can also teach pain management techniques such as gentle movement, relaxation techniques, and may require the use of assistive devices to alleviate discomfort.
3. Joint mobilization: Joint mobilization techniques are effective for regaining lost joint movement without stressing the fracture site. Intervention begins with gentle stretches and progresses in intensity as joint reaction becomes predictable. 
4. Strengthening exercises: As the fracture continues to heal, physical therapists will initiate light resistance exercises and as the joint mobility and range of motion improve, progression is made from light resistance to a more intense dynamic exercise. These exercises help rebuild muscle strength and endurance, improve stability, and enhance overall functional abilities.
5. Weight-bearing and gait training: In cases wherein the lower limbs are affected, Physical therapists assist individuals in gradually resuming weight-bearing activities and relearning proper walking or gait patterns. They may provide assistive devices such as crutches, walkers, or canes if necessary, and guide individuals in transitioning from partial to full weight-bearing as permitted by the fracture healing process.
6. Balance and coordination training: Fractures can affect balance and coordination when the lower limbs are affected. Physical therapists can design exercises and activities to improve these skills and minimize the risk of falls or further injury.
7. Functional training: Physical therapists focus on restoring functional abilities required for daily activities and specific tasks related to an individual's occupation, hobbies, or sports. They provide customized exercises and activities to improve strength, endurance, and coordination for specific functional goals.
8. Scar tissue management: Fracture healing can sometimes lead to the formation of scar tissue, which may impact joint mobility or function. If there is restricting scar tissue, manual techniques are used to mobilize the scar to help manage and minimize adhesions and improve tissue flexibility.
9. Aerobic exercise: In cases where bed rest or immobilization are required for certain days or weeks, the cardiorespiratory endurance weakens. The physical therapists will initiate light and safe aerobic exercises that will not stress the fracture site until it is healed, and later on will progress to a more challenging aerobic exercise to improve cardiorespiratory endurance.
10. Education and self-management: Physical therapists provide education about fracture, its causes, the activity limitations until the fracture site is healed and the time frame of healing. They also teach functional adaptations and safe execution of home exercise programs to reinforce the interventions and prevent re-injury. 
11. Gradual return to activities: Physical therapists work with individuals to develop a progressive plan for returning to specific activities or sports safely. They assess readiness, monitor progress, and adjust the rehabilitation program accordingly.

It's important to consult with a healthcare professional, such as a doctor or physical therapist, for an accurate diagnosis, proper management, and personalized rehabilitation plan based on the specific fracture type and individual needs. The guidance and expertise of a physical therapist can greatly contribute to the successful recovery and restoration of function after a fracture.

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