What is a fracture
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Fractures: A guide to the different types

Most triathlon injuries start gradually and are associated with overtraining such as frustratingly common Achilles tendinopathies or iliotibial band syndrome. Occasionally, more acute, catastrophic injuries do occur, such as fractures, and they usually happen following a fall from the bike. Physiotherapist Julia Peters-Belk explains the common types of fractures and how they can be treated.

What is a fracture?

A fracture is the medical term for a “break” in the continuity of the bone. Most human bones are surprisingly strong and resilient. However, if the force applied to it is too powerful, or there is a weakness already in the bone, it can fracture. The break can occur in any bone in the body and may be a partial or complete one.

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There are several different ways in which fractures can happen. For instance, a break that does not disrupt the surrounding tissue or tear through the skin is a closed fracture. On the other hand, a break which pieces through the skin is an open or compound fracture. Compound fractures tend to be more serious as they are more at risk of getting infected.

What are the different types of fractures?

There are several types of fractures, but the common ones include:

* A transverse fracture is where there is a horizontal break.

* An oblique fracture is where the bone breaks at an angle.

* A comminuted fracture is where the bone shatters into three or more pieces.

* A displaced fracture is when the 2 ends of the bone are separated and out of position, looking deformed. A non-displaced fracture the bone stays aligned.

* In a pathological fracture, an underlying disease or condition has already weakened the bone, such as with osteoporosis, resulting in a fracture with very little additional force applied to it.

* A small, hairline crack in the bone caused by overuse and repetitive activity is known a stress fracture. The most commonly affected areas for runners are the tibia, metatarsals, pelvis, femur and tarsal navicular.

What are the signs and symptoms of a fracture?

These may vary according to which bone is affected and the severity of the injury. However, they often include some of the following:

* Pain. This can be quite severe, and it will be worse with movement. Meaning that you cannot put weight on a fractured ankle for example or move a fractured wrist.

* Swelling

* Bruising

* The affected bone may be bent at an unusual angle

* There may be grating sensation

How are fractures diagnosed and treated?

If you think you have a fracture, you need to go to your nearest A+E department immediately, or call an ambulance if you can’t move. In hospital, following a thorough assessment, an X-ray and in some cases an MRI or CT scan may be ordered to confirm the diagnosis and look at the affected area in more detail.

The aim of treating a fracture is to put the bones back into their normal position (known as reducing the fracture, which may be done under general or local anaesthetic) and to prevent them from moving until they heal (immobilisation). The duration of immobilisation is usually 2-8 weeks but depends on which bone is affected and whether there are any complications, such as with the blood supply or an infection.

* Cast Immobilisation

This is the most common treatment for closed fractures. A cast is a hard and rigid protective covering, which holds the bone in place allowing it to heal.

* Functional Cast or Brace

A cast or brace may be used if appropriate, allowing limited movement of nearby joints.

* Traction

Traction may be used in leg fractures to align the bones by a gentle but steady pulling action.

Depending on the type of fracture and how severe it is, it may be necessary to have surgery. In these cases, metal plates, rods or pins are used to fix the break.

* External Fixation

In this type of operation, the surgeon drills pins through the skin and into the bone above and below where the break is. These pins are joined together with a metal bar that’s placed on the outside of the body. This stabilises the bones and make sure they heal in the right position.

How long is the recovery?

The whole process may take up to 18 months... but the good news is that the strength of the healing bone is usually 80% of normal by 3 months. Several factors may help or hinder the bone healing process. For example, smoking hinders bone healing, and adequate nutrition, such as plenty of calcium, will help. During recovery, there will likely be a loss in muscle strength in the injured area, so extensive physiotherapy will be required to restore normal muscle strength, joint motion and flexibility and get you gradually back into training.

Can fractures be prevented?

Unfortunately, accidents such as falling off the bike happen, but appropriately adapting cycling speeds to the surface and conditions may help to reduce the risk. Also, a healthy well-balanced diet rich in calcium and vitamin D will promote bone strength, as well as performing appropriate weight-bearing exercises, so discuss this with a physiotherapist.

Julia Peters Belk is a physiotherapist and clinical director at Capital Physio and specialises in sports injuries

  

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