Definition

A closed fracture refers to a broken bone where the bone does not break through the skin. It’s crucial to differentiate between closed and open fractures, as the treatment approaches differ. Open fractures are more prone to infections compared to closed fractures, making proper care essential.

Although closed fractures may require surgery, it is not an urgent procedure unless the bone’s location and severity demand immediate attention. In some cases, surgery can be delayed and performed weeks after the injury, depending on the specific situation. Even if the skin remains intact, the surrounding soft tissues such as muscles and ligaments may still suffer damage and require attention.

Common examples of closed fractures include:

• Wrist fractures (often seen in children)

• Pelvic fractures (common among older adults due to osteoporosis and falls)

• Ankle fractures (frequently seen in athletes)

• Spinal fractures (often caused by excessive pressure on the spine or osteoporosis)

Causes

Closed fractures can happen for several reasons. Like other fractures, they are often the result of too much force on the bone. This excessive stress can arise from accidents such as falls, car crashes, or injuries during sports. Additionally, overuse of a limb, known as a stress fracture, can also lead to closed fractures. Another cause is the weakening or softening of the bone itself.

When bones weaken due to certain medical conditions, it is referred to as a pathological fracture. Diseases such as infections, tumors, and osteoporosis are common contributors to this condition, making the bones more fragile and prone to breaking.

Risk Factor

Several factors increase the likelihood of experiencing a closed fracture, including:

• Smoking

• Heavy alcohol consumption

• Older age

• Obesity

• Chronic conditions like diabetes, rheumatoid arthritis, osteoporosis, Crohn's disease, and bone cancer

• Use of steroid medications

• Previous fractures

• A family history of fractures

• Infections

• Tumor history

• Vitamin D and calcium deficiency

• Previous injuries or falls

• Athletes, due to high physical activity

• High mobility or strenuous activities

Symptoms

The symptoms of closed fractures can differ depending on the individual’s condition, the cause of the injury, the mechanism behind the fracture, and the location of the break. However, the general signs of a closed fracture are similar to other bone fractures and include:

• Pain at the site of the fracture

• Swelling around the fractured area

• Bruising near the fracture

• Discoloration of the skin near the broken bone

• A bulge or protrusion where the bone has broken

• Difficulty bearing weight on the affected limb

• Inability to move the limb around the broken bone

Diagnosis

To diagnose a closed fracture, a doctor will gather information through a medical history, perform a physical test, and order any necessary supporting tests to ensure the correct treatment approach is applied.

Medical Interview

The first step in diagnosing a closed fracture involves a detailed medical interview where the doctor asks the patient various questions to understand the cause of the injury and any associated risk factors. During this interview, the doctor may inquire about:

• The main complaint of the patient

• Any other related symptoms

• A history of the injury, including how the accident occurred

• The patient’s medical background

• Family history of illnesses or fractures

• Relevant medical history

Physical Examination

The next step involves a physical test where the doctor will examine the injury closely. This examination begins with a general check-up, including vital signs such as blood pressure, body temperature, pulse, and respiratory rate. After that, the doctor will focus on the specific area of the fracture, looking for key indicators and performing the following checks:

• Look: The doctor will visually inspect the fracture site for deformities, discoloration, open wounds, bleeding, swelling, or bruising.

• Feel: The doctor will gently palpate the fractured area to assess any pain, temperature variations, or possible injuries to the surrounding tissues.

• Move: The doctor will move the injured area carefully to evaluate the extent of the fracture and any related complications.

Diagnostic Tests

In some cases, the doctor may recommend additional tests to gain a better understanding of the closed fracture. Common supporting tests include radiological imaging like X-rays, CT scans, and MRIs.

X-rays are the most commonly used test to diagnose closed fractures, providing clear images that help the doctor understand the nature and severity of the injury. If necessary, CT scans or MRIs may be used for more detailed images, depending on the situation. The doctor will determine which tests are appropriate based on the case.

Management

The main goal of treating closed fractures is to heal the bone, alleviate pain, avoid complications, and restore normal function.

Treatment options for closed fractures include:

• Splints and Casts: A splint is a support device used to immobilize a limb and restrict movement, aiding in the healing process. A cast is made from a special fiber bandage that hardens around the broken area to hold the bone in place. The choice between using a splint or cast depends on the fracture’s severity, and an orthopedic surgeon will make this decision.
• Medication: Pain management is crucial in treating fractures. Medications are prescribed based on the severity of the pain. In addition to painkillers, doctors may also recommend calcium supplements to promote healing and strengthen the bone.
• Traction: Traction involves the use of weights, pulleys, or ropes to gently stretch and align the bones. This method helps keep the bones in position and reduces the risk of deformities while encouraging healing.
• Surgery: In some cases, surgery is necessary to treat a closed fracture. An orthopedic surgeon may use metal pins to hold the broken bones together. These pins can be inserted inside the bone (internal fixation) or attached outside the bone (external fixation), depending on the nature of the fracture.

Complications

While most closed fractures heal successfully, there are potential complications that may arise, including:

• Bone infection

• Malunion (improper healing of the bone)

• Permanent or temporary loss of mobility in the affected bone

• Compartment syndrome (a serious condition where pressure builds up in the muscles)

• Local infection, such as cellulitis, around the fracture site

Prevention

To reduce the risk of closed fractures, consider the following preventative measures:

• Be cautious to avoid injury, especially when driving.

• Eat a balanced diet rich in vitamin D and calcium, including foods like milk, salmon, green vegetables, and nuts.

• If necessary, take calcium and vitamin D supplements to support bone health.

• Engage in regular physical activity, including outdoor exercises that expose you to sunlight for natural vitamin D production.

When to See a Doctor?

It is important to seek medical attention immediately if you experience severe pain and reduced mobility, especially if the injury results from a fall or accident. Visiting an emergency room (ER) is recommended, where a doctor will assess whether the injury is a closed fracture. If confirmed, they will refer you to an orthopedic specialist for the proper treatment.

Looking for more information about other diseases? Click here!