Bone fractures

Fractures are often referred to as breaks in the bone, but there are many types of fractures that your bones can sustain. These relate to the extent, direction and causes of the fractures.

Types of bone fractures

The different types of fractures are:

  • Stress fractures – tiny cracks in the bone caused by overuse
  • Greenstick fractures – only one side of the bone is fractured
  • Transverse fractures – the bone is broken straight across its width
  • Spiral fractures – the bone is broken across its width in a curved line because the limb was twisted
  • Oblique fractures – the bone is broken across its width at an angle
  • Compression fractures – fractures in the spinal vertebrae, often caused by osteoporosis
  • Comminuted fractures – the bone is broken in at least 2 places
  • Segmental fractures – the bone is broken in at least 2 places and a piece of bone is separated from the rest
  • Impacted fractures – the ends of bones are shattered by being forced against each other
  • Avulsion fractures – a piece of bone is pulled off by a tendon or ligament

Displaced or non-displaced, open or closed

Fractures can also be described as “displaced” (bones are not aligned) or “non-displaced” (bones are aligned), and “open” (bone has broken the skin) or “closed” (skin is still intact).

The type and location of the fracture will determine the treatment that is needed. Displaced and/or open fractures typically need surgery, but some fractures can be treated by immobilising them and taking all weight and pressure off the area (“offloading” them). Your consultant will be able to advise you after an X-ray and/or MRI scan.

Are fractures always painful?

Yes. You can have pain with a fracture immediately after and during the healing process. It is typically a deep intense ache that slowly reduces. The pain is not normally just due to the injury to the bone, it will also be coming from the damage to the surrounding soft tissues and nerves, as well as pressure from the swelling in the area. As these heal and the swelling reduces, the pain will subside.

When to start physiotherapy after a fracture

Typically you can start physiotherapy for the fractured area 6 weeks after the injury and/or surgery. However, you may be able to start slightly earlier depending on the type and location of the fracture.

For stress fractures, you can start physiotherapy immediately to deal with the causes of the stress fracture. At the same time, you will remove any weight or pressure from the area to allow the fracture to heal.

In the 6 weeks after any fracture, it’s important to keep the rest of your body strong and mobile while your bone heals. It can be worth seeing a physiotherapist to give you an appropriate exercise programme to help you do this.

Why is physiotherapy important and necessary after a fracture?

It is advisable to have physiotherapy after a fracture to manage swelling, general stiffness in the limb and pain in soft tissues around the bone injury. It can also help with the healing process of the bone.

Physiotherapy after a fracture can ensure that you make a complete recovery from your injury and return to your chosen activities with no problems. The correct physiotherapy will include progressions in exercises and treatment that are focused on preparing you for the activities you want to return to doing.

The physiotherapist will also be able to assess and manage all injuries related to the cause of the fracture. This avoids any delays in healing and being able to use the limb normally.

What if you don’t do physiotherapy after a fracture?

If you choose not to work with a physiotherapist, you may progress with your mobility or weight-bearing exercises too quickly and irritate the injured area. You may also not regain full joint mobility, which will cause compensatory movements. These often lead to other injuries. Although your fracture may heal well, without physio, you may not address the soft tissue injuries. This can result in chronic pain and difficulties returning to certain activities.

Other factors to consider when recovering from a fracture

During your healing process, it’s worth remembering that these factors can impact on how fast you heal:

  • Nutrition – make sure that you have enough protein, calcium, vitamin D and C, and fats in your diet to help with the fracture healing.
  • Smoking and alcohol consumption – these can slow down the healing process.
  • Diabetes, hypothyroidism and your circulation – these can all affect healing time, and you may need to adjust your expectations and take things a little more slowly.
  • Age – As we age, it takes longer for our bones to knit and inflammation to subside.