Shoulder & Elbow Fractures

Although bones are strong, they can split or break with too much pressure or force. A broken bone is called a fracture, with respect to medical terminology. The most common causes of fractures are longer-term injuries, prolonged stress from overuse, and bone weakening diseases, such as Osteoporosis or tumors.

The types of fractures can range from a hairline crack to a bone that has broken into several pieces. Simple fractures may only require casting or splinting treatments. More complex fractures may need surgery to align the bones for proper healing.

Fracture Anatomy 

The outer layer of bone is called periosteum. The periosteum is considered the life support system for the bone because it provides the nutrient blood for bone cells.It  also produces bone-developing cells during growth, as well as after a fracture. Underneath the periosteum is compact bone, also known as the cortex. It covers the cancellous “spongy” bone. It can resist the stresses of weight, postural changes, and growth. In many bones, the cancellous bone contains or protects the bone marrow.

Causes of Fractures

Falls and motor crashes are the most common causes of fractures. Stress fractures can result from prolonged impact or repetitive forces, such as those sustained while playing sports. Fractures can occur during contact with a hard surface, for instance during a fall to the gymnasium floor during a basketball game.  Fractures can also be the result of physical violence.

Although, as mentioned, the majority of fractures result from motor vehicle crashes and falls, some fractures occur because of diseases. Osteoporosis is a medical condition that causes more bone calcium to be absorbed than is replaced. As we know, calcium is necessary for hard, healthy bones. Bone tumors are another disease-related cause of fractures. Most originate elsewhere in the body and spread to the bone. Very rarely do cancerous tumors begin in the actual bone itself.

Symptoms of a Fracture

In some cases, a snap or cracking sound may be heard when a bone is fractured. You may feel sharp, deep, or intense pain paired with numbness or tingling feeling. Your skin may swell, bruise, or bleed. You may see a combination of all the above. The place where your fracture occurs may look odd, bent, or out of place. Sometimes a broken bone may come through the skin. This is called an open fracture. More than likely, you won’t be able to put any weight on the fracture, and if you can, it will be extremely painful.

Fracture Diagnosis

Your doctor can diagnose a fracture with a physical examination but will need an X-ray to confirm this diagnosis. From here, an X-ray will be ordered to identify the type and location of your fracture. A few fractures, such as stress fractures, may not show up on an X-ray. In these cases, a CT scan or MRI scan may be used to take a more detailed look at your bones. Fractures are generally classified by a combination of general terms used to describe their features. Fractures are categorized by the characteristics of the broken bone, including the position of the fragments or broken bone and the direction of the fracture line. The most common fracture characteristics and classifications are:

  • Complete Fracture: The bone is completely broken into separate pieces
  • Incomplete or Partial Fracture: A crack that does not completely break the bone into two pieces
  • Greenstick Fracture: An Incomplete Fracture with a bowed bone, it is more common in children
  • Compound or Open Fracture: The bone fragments penetrate the skin. The bone is visible.
  • Simple or Closed Fracture: The bone fragments do not penetrate the skin
  • Comminuted: The bones are broken into several pieces or shattered
  • Nondisplaced: The bone is broken but maintains its natural alignment
  • Displaced: The bone is broken and the fragments are out of position
  • Segmental: More than one fracture line leads to a “floating” segment
  • Angulated: The fragments are out of position and at an angle to each other
  • Overriding: The fragments overlap each other
  • Impacted: One piece of bone is forced into a second piece of bone
  • Linear: The fracture line is parallel with the shaft
  • Transverse: The fracture line is at a right angle to the shaft
  • Oblique: The fracture line is at a 45° angle to the shaft
  • Spiral: The fracture line has a “corkscrewed,” “curled,” or angled pattern

Fracture Treatment

A fracture’s treatment varies greatly, depending of the actual fracture itself. The end goal is to put the “broken pieces” of bone back together and force them to heal that way. After all, a fractured bone is able to grow back together. When a bone is fractured, it produces a protective blood clot and callus at the end of the bones. This callus includes cells that go through phases leading to eventual bone formation and healing.

An X-ray is the guide to reset or position your bones.  Some bones can be kept in place with a cast while they heal. Casts are usually worn for about one to two months, depending on the type of fracture and the bone involved.

A “nonunion” is simply a fracture that just won’t heal. Your x-ray will show that your fracture has no chance of healing itself without intervention

A malunion is a fracture that has healed in a position outside acceptable parameters. This typically happens when people avoid getting their fractures reset in the first place.

Delayed unions, nonunions and malunions generally require additional treatment. Malunions and many nonunions require surgery to heal properly. Your doctor must have direct access to the fracture to straighten the bone, in the case of a malunion, or to remove soft tissues and stimulate blood flow at the site of a nonunion.

Your physical therapist will work with you to regain movement, strength, and flexibility that may have decreased while your bone or joint was immobile. The initial goal of physical therapy include pain relief and range of motion, followed by strengthening, and when necessary, balance retraining and sports or activity specific exercises.

Fracture Surgery

Surgery is only recommended for fractures that do not heal properly or when the bones have broken in such a way that they are unlikely to remain aligned when set with a cast. Although this is more rare, it does happen. There are several options with respect to surgery. The type of surgery that you have will depend on the location and type of your fracture. Some surgeries require anesthesia and some only require a simple nerve block.

Surgical options include the procedures: Open Reduction and Internal Fixation or an Open Reduction and External Fixation. Open Reduction and Internal Fixation refers to techniques that use surgical hardware to stabilize a fracture beneath the skin. The surgeon will make an incision and place your bones in the proper position for healing. The incision size varies, depending on the bone placement. The surgeon will secure the bones together with surgical hardware, such as rods, screws, or metal plates. If the surgery isn’t an emergency, you may even be given the option to choose which you prefer.

Open Reduction and External Fixation refers to using surgical hardware to stabilize a fracture from the outside of the skin. Your surgeon will make an incision and place your bones in the proper position for healing. Your surgeon will secure the bones with surgical pins that are placed through the outside of the skin. The surgical pins are attached to a metal frame on the outside of the skin.

Fracture Recovery

Physical therapy is usually prescribed following surgery or casting. The physical therapist will work with you to regain movement, strength, and flexibility that may have decreased while your bone or joint was immobile.The recovery time from a fracture is different for everyone, depending on the type of fracture you had and what kind of surgery you had, as well. Generally, fractures need about 6 weeks to heal, while some fractures can take several months to heal.

Fracture Prevention

Accidents happen and sometimes, fractures are unavoidable. The best prevention is to try to conduct day to day activities as safely as possible. Prevent vehicle crashes, drive carefully. Try to prevent falls. Once yearly, a general physical examination can help to identify medical conditions that are associated with balance disorders or dizziness.A vision exam can detect vision changes that are associated with falls. Some vision changes can be corrected with glasses. If you play sports, make sure that you wear the appropriate safety equipment. Keep your bones healthy. Don’t smoke. Make sure your diet contains healthy amounts of calcium and Vitamin D.

If you have an acute or chronic shoulder or elbow injury that needs medical attention, call SPORT at (469) 200-2832 to arrange a consultation or you can request one online. Hurt today? We can arrange a same-day urgent care visit to ensure you get fast, effective relief.

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