Editing Bone fracture

{{Use dmy dates|date=April 2022}}{{Redirect|Broken bones||Broken Bones (disambiguation){{!}}Broken Bones}}
{{Short description|Physical damage to the continuity of a bone}}
{{Infobox medical condition (new)
| name            = Bone fracture
| synonyms        = broken bone, bone break
| image           = Broken fixed arm.jpg
| caption         = Internal and external views of an arm with a compound fracture, both before and after surgery
| pronounce       =
| field           = [[Orthopedics]], [[emergency medicine]]
| symptoms        =
| complications   =
| onset           =
| duration        =
| types           =
| causes          =
| risks           =
| diagnosis       =[[X-ray]], [[computed tomography]], [[MRI]]
| differential    =
| prevention      =
| treatment       =
| medication      =
| prognosis       =
| frequency       =
| deaths          =
}}

A '''bone fracture''' (abbreviated '''FRX''' or '''Fx''', '''F<sub>x</sub>''', or '''#''') is a medical condition in which there is a partial or complete break in the continuity of any [[bone]] in the body. In more severe cases, the bone may be broken into several fragments, known as a ''comminuted fracture''.<ref>{{Cite book|title=Official CPC Certification Study Guide|last=Katherine|first=Abel|publisher=American Medical Association|year=2013|pages=108}}</ref> An open fracture (or compound fracture) is a bone fracture where the broken bone breaks through the skin.<ref>{{Cite web |title=Open Fractures - OrthoInfo - AAOS |url=https://orthoinfo.aaos.org/en/diseases--conditions/open-fractures/ |access-date=2024-11-15 |website=www.orthoinfo.org}}</ref> 

A bone fracture may be the result of high force [[Impact force|impact]] or [[Stress fracture|stress]], or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as [[osteoporosis]], [[osteopenia]], [[bone cancer]], or [[osteogenesis imperfecta]], where the fracture is then properly termed a [[pathologic fracture]].<ref>{{cite book |first1=Daniel K. |last1=Witmer |first2=Silas T. |last2=Marshall |first3=Bruce D. |last3=Browner |chapter=Emergency Care of Musculoskeletal Injuries |chapter-url=https://books.google.com/books?id=KYstDAAAQBAJ&pg=PA462 |pages=462–504 |editor1-first=Courtney M. |editor1-last=Townsend |editor2-first=R. Daniel |editor2-last=Beauchamp |editor3-first=B. Mark |editor3-last=Evers |editor4-first=Kenneth L. |editor4-last=Mattox |year=2016 |title=Sabiston Textbook of Surgery |edition=20th |publisher=Elsevier |isbn=978-0-323-40163-0 |access-date=4 December 2016 |archive-date=17 January 2023 |archive-url=https://web.archive.org/web/20230117143917/https://books.google.com/books?id=KYstDAAAQBAJ&pg=PA462 |url-status=live }}</ref> Most bone fractures require urgent medical attention to prevent further injury.

==Signs and symptoms==
Although bone tissue contains no [[nociceptors|pain receptors]], a bone fracture is painful for several reasons:<ref>[http://www.medicinenet.com/fracture/article.htm MedicineNet – Fracture] {{webarchive|url=https://web.archive.org/web/20081221165251/http://www.medicinenet.com/fracture/article.htm |date=2008-12-21 }} Medical Author: Benjamin C. Wedro, MD, FAAEM.</ref>
* Breaking in the continuity of the [[periosteum]], with or without similar discontinuity in [[endosteum]], as both contain multiple pain receptors.
* [[Edema]] and [[hematoma]] of nearby [[soft tissues]] caused by ruptured [[bone marrow]] evokes pressure pain.
* Involuntary [[muscle spasms]] trying to hold bone fragments in place.

Damage to adjacent structures such as nerves, muscles or blood vessels, [[spinal cord]], and nerve roots (for spine fractures), or cranial contents (for skull fractures) may cause other specific signs and symptoms.<ref>{{cite web|title=Overview of Fractures|author=Danielle Campagne|date=September 2022|website=mdmanuals.com|url=https://www.msdmanuals.com/home/injuries-and-poisoning/fractures/overview-of-fractures#:~:text=after%20the%20injury.-,Nerve%20damage,nerve%20injuries%20never%20heal%20completely.|access-date=12 October 2022|archive-date=12 October 2022|archive-url=https://web.archive.org/web/20221012155003/https://www.msdmanuals.com/home/injuries-and-poisoning/fractures/overview-of-fractures#:~:text=after%20the%20injury.-,Nerve%20damage,nerve%20injuries%20never%20heal%20completely.|url-status=live}}</ref>

===Complications===
[[File:Nonunion2010.JPG|thumb|An old fracture with [[Pseudarthrosis|nonunion]] of the fracture fragments]]
Some fractures may lead to serious complications including a condition known as [[compartment syndrome]]. If not treated, eventually, compartment syndrome may require [[amputation]] of the affected limb. Other complications may include non-union, where the fractured bone fails to heal, or malunion, where the fractured bone heals in a deformed manner. One form of malunion is the malrotation of a bone, which is especially common after femoral and tibial fractures.<ref>{{cite web |url= https://www.lecturio.com/concepts/compartment-syndrome/ |title= Compartment Syndrome |website= The Lecturio Medical Concept Library |access-date= 2021-06-25 |archive-date= 25 June 2021 |archive-url= https://web.archive.org/web/20210625130431/https://www.lecturio.com/concepts/compartment-syndrome/ |url-status= live }}</ref>
Complications of fractures may be classified into three broad groups, depending upon their time of occurrence. These are as follows –
# ''Immediate'' complications – occurs at the time of the fracture.
# ''Early'' complications – occurring in the initial few days after the fracture.
# ''Late'' complications – occurring a long time after the fracture.
<br />
{| class="wikitable"
|-
! Immediate !! Early !! Late
|-
| '''''Systemic'''''
* Hypovolaemic shock
|| '''''Systemic'''''
* [[Hypovolemic shock]]
* ARDS – [[Acute respiratory distress syndrome]]
* [[Fat embolism]] syndrome
* [[Deep vein thrombosis]]
* Pulmonary Embolism syndrome
* Aseptic traumatic fever
* [[Sepsis]] (in open fracture )
* Crush syndrome
|| '''''Imperfect union of the fracture'''''
* Delayed union
* [[Pseudarthrosis|Non-union]]
* [[Malunion]]
* Cross union
|-
| '''''Local'''''
* Injury to major vessels
* Injury to muscles and tendons
* Injury to joints
* Injury to viscera
|| '''''Local'''''
* Infection
* Compartment syndrome
|| '''''Others'''''
* Avascular necrosis
* Shortening
* Joint stiffness
* Sudeck's dystrophy
* Osteomyelitis
* Ischaemic contracture
* Myositis ossificans
* Osteoarthritis
|}

==Pathophysiology==
{{Main|Bone healing}}
[[File:613 Stages of Fracture Repair.jpg|thumb|500px|upright=0.4|Stages in Fracture Repair: The healing of a bone fracture follows a series of progressive steps: (a) A fracture hematoma forms. (b) Internal and external calli form. (c) Cartilage of the calli is replaced by trabecular bone. (d) Remodeling occurs.]]
The natural process of healing a fracture starts when the injured bone and surrounding tissues bleed, forming a fracture [[hematoma]]. The [[clotting|blood coagulates]] to form a blood [[clot]] situated between the broken fragments.<ref>{{Cite web |last=Silva |first=Joana Cavaco |date=2018-07-11 |others=William Morrison, M.D. (medical reviewer) |title=Bone fracture repair: Procedures, risks, and healing time |url=https://www.medicalnewstoday.com/articles/322419 |access-date=2022-04-21 |website=[[Medical News Today]] |language=en |archive-date=23 March 2022 |archive-url=https://web.archive.org/web/20220323202620/https://www.medicalnewstoday.com/articles/322419 |url-status=live }}</ref> Within a few days, [[angiogenesis|blood vessels grow]] into the jelly-like matrix of the blood clot. The new blood vessels bring [[white blood cell|phagocyte]]s to the area, which gradually removes the non-viable material. The blood vessels also bring [[fibroblast]]s in the walls of the vessels and these multiply and produce [[collagen]] fibres. In this way, the blood clot is replaced by a matrix of collagen. Collagen's rubbery consistency allows bone fragments to move only a small amount unless severe or persistent force is applied.{{cn|date=June 2021}}

At this stage, some of the fibroblasts begin to lay down [[bone matrix]] in the form of collagen monomers. These monomers spontaneously assemble to form the bone matrix, for which bone crystals ([[calcium hydroxyapatite]]) are deposited in amongst, in the form of insoluble [[crystal]]s. This mineralization of the collagen matrix stiffens it and transforms it into bone. In fact, bone ''is'' a mineralized collagen matrix; if the mineral is dissolved out of bone, it becomes rubbery. Healing bone [[Fibrocartilage callus|callus]] on average is sufficiently mineralized to show up on [[X-ray]] within 6 weeks in adults and less in children. This initial "woven" bone does not have the strong mechanical properties of mature bone. By a process of remodelling, the woven bone is replaced by mature "lamellar" bone. The whole process may take up to 18 months, but in adults, the strength of the healing bone is usually 80% of normal by 3 months after the injury.{{cn|date=June 2021}}

Several factors may help or hinder the bone healing process. For example, [[tobacco]] smoking hinders the process of bone healing,<ref name="pmid20303894">{{cite journal |doi=10.1016/j.surge.2009.10.014 |pmid=20303894 |title=The effects of smoking on fracture healing |journal=The Surgeon |volume=8 |issue=2 |pages=111–6 |year=2010 |last1=Sloan |first1=A. |last2=Hussain |first2=I. |last3=Maqsood |first3=M. |last4=Eremin |first4=O. |last5=El-Sheemy |first5=M. }}</ref> and adequate nutrition (including [[calcium]] intake) will help the bone healing process. Weight-bearing stress on bone, after the bone has healed sufficiently to bear the weight, also builds bone strength.

Although there are theoretical concerns about [[NSAIDs]] slowing the rate of healing, there is not enough evidence to warrant withholding the use of this type analgesic in simple fractures.<ref>{{cite journal |doi=10.1100/2012/606404 |pmid=22272177 |pmc=3259713 |title=Do Nonsteroidal Anti-Inflammatory Drugs Affect Bone Healing? A Critical Analysis |journal=The Scientific World Journal |volume=2012 |pages=1–14 |year=2012 |last1=Pountos |first1=Ippokratis |last2=Georgouli |first2=Theodora |last3=Calori |first3=Giorgio M. |last4=Giannoudis |first4=Peter V. |doi-access=free }}</ref>

===Effects of smoking===
{{Main|Health effects of tobacco}}
Smokers generally have lower bone density than non-smokers, so they have a much higher risk of fractures. There is also evidence that smoking delays bone healing.<ref>{{cite journal |doi=10.1007/s00198-004-1640-3 |pmid=15175845 |title=Smoking and fracture risk: A meta-analysis |journal=Osteoporosis International |volume=16 |issue=2 |pages=155–62 |year=2004 |last1=Kanis |first1=J. A. |last2=Johnell |first2=O. |last3=Oden |first3=A. |last4=Johansson |first4=H. |last5=De Laet |first5=C. |last6=Eisman |first6=J. A. |last7=Fujiwara |first7=S. |last8=Kroger |first8=H. |last9=McCloskey |first9=E. V. |last10=Mellstrom |first10=D. |last11=Melton |first11=L. J. |last12=Pols |first12=H. |last13=Reeve |first13=J. |last14=Silman |first14=A. |last15=Tenenhouse |first15=A. |s2cid=19890259 }}</ref>

==Diagnosis==
[[File:Xraymachine.JPG|thumb|[[Medical radiography|Radiography]] to identify possible fractures after a knee injury]]
A bone fracture may be diagnosed based on the history given and the physical examination performed. [[Medical radiography|Radiographic imaging]] often is performed to confirm the diagnosis. Under certain circumstances, radiographic examination of the nearby joints is indicated in order to exclude dislocations and fracture-dislocations. In situations where projectional radiography alone is insufficient, [[Computed Tomography|Computed Tomography (CT)]] or [[Magnetic Resonance Imaging|Magnetic Resonance Imaging (MRI)]] may be indicated.{{cn|date=June 2021}}

===Classification===
{{Redirect|Compound Fracture|the 2013 horror film|Compound Fracture (film)}}
[[File:612 Types of Fractures.jpg|thumb|Compare healthy bone with different types of fractures: <br>&nbsp;&nbsp;&nbsp;(a) closed fracture <br>&nbsp;&nbsp;&nbsp;(b) open fracture <br>&nbsp;&nbsp;&nbsp;(c) transverse fracture <br>&nbsp;&nbsp;&nbsp;(d) spiral fracture <br>&nbsp;&nbsp;&nbsp;(e) comminuted fracture <br>&nbsp;&nbsp;&nbsp;(f) impacted fracture <br>&nbsp;&nbsp;&nbsp;(g) greenstick fracture <br>&nbsp;&nbsp;&nbsp;(h) oblique fracture]]

[[File:Offene Luxation.jpg|thumb|200px|Open ankle fracture with luxation]]
[[File: Periprosthetic fracture of left femur, case 1, before treatment.jpg|thumb|200px|Periprosthetic fracture of left femur]]
In [[Orthopedic surgery|orthopedic]] [[medicine]], fractures are classified in various ways. Historically they are named after the physician who first described the fracture conditions, however, there are more systematic classifications as well.{{cn|date=June 2021}}

They may be divided into stable versus unstable depending on the likelihood that they may shift further.{{cn|date=June 2021}}

====Mechanism====
* [[Trauma (medicine)|Traumatic]] fracture – a fracture due to sustained trauma. e.g., fractures caused by a fall, [[Traffic collision|road traffic accident]], fight, etc.
* [[Pathologic fracture]] – a fracture through a bone that has been made weak by some underlying disease is called pathological fracture. e.g., a fracture through a bone weakened by [[metastasis]]. [[Osteoporosis]] is the most common cause of pathological fracture.
* [[Periprosthetic]] fracture – a fracture at the point of mechanical weakness at the end of an [[Implant (medicine)|implant]].

====Soft-tissue involvement====
* Closed/simple fractures are those in which the overlying skin is intact<ref>{{Cite web|title=Simple fracture {{!}} pathology|url=https://www.britannica.com/science/simple-fracture|access-date=2021-05-19|website=Encyclopedia Britannica|language=en|archive-date=19 May 2021|archive-url=https://web.archive.org/web/20210519172848/https://www.britannica.com/science/simple-fracture|url-status=live}}</ref>
* [[Open fracture|Open/compound fractures]] involve wounds that communicate with the fracture, or where fracture [[hematoma]] is exposed, and may thus expose bone to [[contamination]]. Open injuries carry a higher risk of [[infection]]. Reports indicate an incidence of infection after internal fixation of closed fracture of 1-2%, rising to 30% in open fractures.<ref>{{cite journal |last1=Metsemakers |first1=WJ |last2=Onsea |first2=J |last3=Neutjens |first3=E |last4=Steffens |first4=E |last5=Schuermans |first5=A |last6=McNally |first6=M |last7=Nijs |first7=S |title=Prevention of fracture-related infection: a multidisciplinary care package. |journal=International Orthopaedics |date=December 2017 |volume=41 |issue=12 |pages=2457–2469 |doi=10.1007/s00264-017-3607-y |pmid=28831576|s2cid=12894601 |doi-access=free }}</ref>
** Clean fracture
** Contaminated fracture

====Displacement====
* Non-displaced
* Displaced
** Translated, or ''ad latus'', with sideways displacement.<ref>{{cite web|url=https://radiopaedia.org/articles/fractures-of-the-extremities-general-rules-and-nomenclature-1|title=Fractures of the extremities (general rules and nomenclature)|website=[[Radiopaedia]]|author=Roberto Schubert|access-date=2018-02-21|archive-date=13 May 2021|archive-url=https://web.archive.org/web/20210513070414/https://radiopaedia.org/articles/fractures-of-the-extremities-general-rules-and-nomenclature-1|url-status=live}}</ref>
** Angulated
** Rotated
** Shortened, a reduction in overall bone length when displaced fracture fragments overlap

====Fracture pattern====
{{main|List of fracture patterns}}
* Linear fracture – a fracture that is parallel to the bone's long axis
* Transverse fracture – a fracture that is at a right angle to the bone's long axis
* Oblique fracture – a fracture that is diagonal to a bone's long axis (more than 30°)
* [[Spiral fracture]] – a fracture where at least one part of the bone has been twisted
* [[Compression fracture]]/[[wedge fracture]] – usually occurs in the vertebrae, for example when the front portion of a [[vertebra]] in the spine collapses due to [[osteoporosis]] (a medical condition which causes bones to become brittle and susceptible to fracture, with or without trauma)
* Impacted fracture – a fracture caused when bone fragments are driven into each other
* [[Avulsion fracture]] – a fracture where a fragment of bone is separated from the main mass

====Fragments====
* Incomplete fracture – a fracture in which the bone fragments are still partially joined, in such cases, there is a crack in the osseous tissue that does not completely traverse the width of the bone.
* Complete fracture – a fracture in which bone fragments separate completely.
* Comminuted fracture – a fracture in which the bone has broken into several pieces.

====Anatomical location====
An anatomical classification may begin with specifying the involved body part, such as the head or arm, followed by more specific localization. Fractures that have additional definition criteria than merely localization often may be classified as subtypes of fractures, such as a [[Holstein-Lewis fracture]] being a subtype of a [[humerus fracture]]. Most typical examples in an orthopaedic classification given in the previous section cannot be classified appropriately into any specific part of an anatomical classification, however, as they may apply to multiple anatomical fracture sites.
* [[Skull fracture]]
** [[Basilar skull fracture]]
** [[Blowout fracture]] – a fracture of the walls or floor of the [[orbit (anatomy)|orbit]]
** [[Mandibular fracture]]
** [[Nasal fracture]]
** [[Le Fort fracture of skull]] – facial fractures involving the [[maxillary bone]] and surrounding structures in a usually bilateral and either horizontal, pyramidal, or transverse way.
* [[Spinal fracture]]
** [[Cervical fracture]]
*** Fracture of ''[[Atlas (anatomy)|C1]]'', including [[Jefferson fracture]]
*** Fracture of ''[[Axis (anatomy)|C2]]'', including [[Hangman's fracture]]
*** [[Flexion teardrop fracture]] – a fracture of the anteroinferior aspect of a cervical vertebral
** [[Clay-shoveler fracture]] – fracture through the [[spinous process]] of a [[vertebra]] occurring at any of the lower cervical or upper thoracic vertebrae
** [[Burst fracture]] – in which a vertebra breaks from a high-energy axial load
** [[Compression fracture]] – a collapse of a vertebra, often in the form of [[wedge fracture]]s due to larger compression anteriorly
** [[Chance fracture]] – compression injury to the anterior portion of a vertebral body with concomitant distraction injury to posterior elements
** [[Holdsworth fracture]] – an unstable fracture [[Joint dislocation|dislocation]] of the [[Thoracic vertebrae|thoraco]] [[Lumbar vertebrae|lumbar junction]] of the [[Vertebral column|spine]]
* [[Rib fracture]]
* [[Sternal fracture]]
* [[Shoulder fracture]]
** [[Clavicle fracture]]
** [[Scapular fracture]]
* [[Arm fracture]]
** [[Humerus fracture]] (fracture of upper arm)
*** [[Supracondylar fracture]]
*** [[Holstein-Lewis fracture]] – a fracture of the [[Anatomical terms of location#Proximal and distal|distal]] third of the humerus resulting in [[Compression neuropathy|entrapment]] of the [[radial nerve]]
** [[Forearm fracture]]
*** [[Ulnar fracture]]
**** [[Monteggia fracture]] – a fracture of the proximal third of the ulna with the dislocation of the [[head of the radius]]
**** [[Hume fracture]] – a fracture of the [[olecranon]] with an associated [[Anterior and posterior|anterior]] [[Joint dislocation|dislocation]] of the [[Head of radius|radial head]]
*** [[Radius fracture]]
**** [[Essex-Lopresti fracture]] – a fracture of the [[Head of radius|radial head]] with concomitant dislocation of the [[Distal radioulnar articulation|distal radio-ulnar joint]] with disruption of the [[Interosseous membrane of the forearm|interosseous membrane]]<ref name="wheeless">[http://www.wheelessonline.com/ortho/essex_lopresti_fracture Essex Lopresti fracture] {{webarchive|url=https://web.archive.org/web/20091001213135/http://www.wheelessonline.com/ortho/essex_lopresti_fracture |date=2009-10-01 }} at Wheeless' Textbook of Orthopaedics online</ref>
**** [[Distal radius fracture]]
***** [[Galeazzi fracture]] – a fracture of the radius with dislocation of the [[distal radioulnar joint]]
***** [[Colles' fracture]] – a distal fracture of the radius with dorsal (posterior) displacement of the wrist and hand
***** [[Smith's fracture]] – a distal fracture of the radius with volar (ventral) displacement of the wrist and hand
***** [[Barton's fracture]] – an [[intra-articular fracture]] of the distal radius with dislocation of the [[radiocarpal joint]]
* [[Hand fracture]]
** [[Scaphoid fracture]]
** [[Rolando fracture]] – a [[wikt:Comminuted|comminuted]] [[intra-articular]] [[fracture]] through the base of the first [[metacarpal]] bone
** [[Bennett's fracture]] – a fracture of the base of the [[first metacarpal bone]] which extends into the [[carpometacarpal joint|carpometacarpal]] (CMC) joint <ref>{{Cite GPnotebook|1288699906|Bennett's fracture-subluxation}}</ref>
** [[Boxer's fracture]] – a fracture at the neck of a [[metacarpal]]
* [[Broken finger]] – a fracture of the carpal phalanges
* [[Pelvic fracture]]
** Fracture of the [[hip bone]]
** [[Duverney fracture]] – an isolated pelvic fracture involving only the [[Ilium (bone)|iliac wing]]
* [[Femoral fracture]]
** [[Hip fracture]] (anatomically a fracture of the [[femur]] bone and not the [[hip bone]])
* [[Patella fracture]]
* [[Crus fracture]]
** [[Tibia fracture]]
*** [[Pilon fracture]]
*** [[Tibial plateau fracture]]
*** [[Bumper fracture]] – a fracture of the [[lateral (anatomy)|lateral]] [[tibia]]l plateau caused by a forced [[Valgus deformity|valgus]] applied to the [[knee]]
*** [[Segond fracture]] – an [[avulsion fracture]] of the [[Tibia|lateral tibial condyle]]
*** [[Gosselin fracture]] – a fractures of the tibial [[synovial joint|plafond]] into anterior and posterior fragments <ref name="hunter"/>
*** [[Toddler's fracture]] – an undisplaced and spiral fracture of the distal third to distal half of the tibia <ref name="pmid10532655">{{cite journal |doi=10.1097/00006565-199910000-00001 |pmid=10532655 |title=Childhood accidental spiral tibial (CAST) fractures |journal=Pediatric Emergency Care |volume=15 |issue=5 |pages=307–9 |year=1999 |last1=Mellick |first1=Larry B. |last2=Milker |first2=Laura |last3=Egsieker |first3=Erik }}</ref>
** [[Fibular fracture]]
*** [[Maisonneuve fracture]] – a spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane
*** [[Le Fort fracture of ankle]] – a vertical fracture of the [[Anterior and posterior|antero]]-[[Human anatomical terms#Front and back|medial]] part of the [[Anatomical terms of location#Proximal and distal|distal]] [[fibula]] with [[Avulsion fracture|avulsion]] of the [[anterior ligament of the lateral malleolus|anterior tibiofibular ligament]]<ref name="hunter">{{cite journal |doi=10.1148/radiographics.20.3.g00ma20819 |pmid=10835130 |title=Radiologic History Exhibit |journal=RadioGraphics |volume=20 |issue=3 |pages=819–36 |year=2000 |last1=Hunter |first1=Tim B. |last2=Peltier |first2=Leonard F. |last3=Lund |first3=Pamela J. }}</ref>
*** [[Bosworth fracture]] – a fracture with an associated fixed [[Anterior and posterior|posterior]] [[Joint dislocation|dislocation]] of the distal fibular fragment that becomes trapped behind the [[Tibia|posterior tibial tubercle]]; the injury is caused by severe [[external rotation]] of the ankle <ref name="perry">{{cite journal |pmid=6630259 |url=http://www.jbjs.org/cgi/pmidlookup?view=long&pmid=6630259 |year=1983 |last1=Perry |first1=C. R. |title=Posterior fracture-dislocation of the distal part of the fibula. Mechanism and staging of injury |journal=The Journal of Bone and Joint Surgery. American Volume |volume=65 |issue=8 |pages=1149–57 |last2=Rice |first2=S |last3=Rao |first3=A |last4=Burdge |first4=R |doi=10.2106/00004623-198365080-00016 |url-access=subscription }}{{Dead link|date=June 2019 |bot=InternetArchiveBot |fix-attempted=yes }}</ref>
** [[Combined tibia and fibula fracture]]
*** [[Trimalleolar fracture]] – involving the [[lateral malleolus]], [[medial malleolus]], and the distal posterior aspect of the tibia
*** [[Bimalleolar fracture]] – involving the lateral [[malleolus]] and the medial malleolus
*** [[Pott's fracture]]
* [[Foot fracture]]
** [[Lisfranc fracture]] – in which one or all of the [[metatarsal]]s are displaced from the [[Tarsus (skeleton)|tarsus]]<ref>{{Cite web |date=2009 |title=Lisfranc's fracture |url=http://medical-dictionary.thefreedictionary.com/Lisfranc%27s+fracture |url-status=dead |archive-url=https://web.archive.org/web/20190404164036/http://medical-dictionary.thefreedictionary.com/Lisfranc's+fracture |archive-date=Apr 4, 2019 |work=Mosby's Medical Dictionary |series=9th edition |publisher=Elsevier |via=The Free Dictionary}}</ref>
** [[Jones fracture]] – a fracture of the proximal end of the [[fifth metatarsal]]
** [[March fracture]] – a fracture of the distal third of one of the metatarsals occurring because of recurrent stress
** [[Cuneiform fracture]] – a fracture of one of the three cuneiform bones typically due to direct blow, axial load, or avulsion <ref>{{cite journal |last1=Mabry |first1=LM |last2=Patti |first2=TN |last3=Ross |first3=MD |last4=Bleakley |first4=CM |last5=Gisselman |first5=AS|title=Isolated Medial Cuneiform Fractures: A Systematic Search and Qualitative Analysis of Case Studies |journal=J Am Podiatr Med Assoc |volume=111|issue=4 |pages=1–9 |date=July 2021 |pmid=34478529 |doi= 10.7547/20-047|s2cid=225705519 |url=https://japmaonline.org/downloadpdf/journals/apms/111/4/i8750-7315-111-4-article_12.pdf |s2cid-access=free |url-status=dead |archive-url=https://web.archive.org/web/20220302054558/https://japmaonline.org/downloadpdf/journals/apms/111/4/i8750-7315-111-4-article_12.pdf |archive-date= Mar 2, 2022 }}</ref>
** [[Calcaneal fracture]] – a fracture of the calcaneus (heel bone)
* [[Broken toe]] – a fracture of the pedal phalanges

===OTA/AO classification===

{{main|Müller AO Classification of fractures}}

The Orthopaedic Trauma Association Committee for Coding and Classification published its classification system <ref>{{cite journal |pmid=8814583 |year=1996 |title=Fracture and dislocation compendium. Orthopaedic Trauma Association Committee for Coding and Classification |journal=Journal of Orthopaedic Trauma |volume=10 |issue=Suppl 1 |pages=v–ix, 1–154 }}</ref> in 1996, adopting a similar system to the 1987 [[AO Foundation]] system.<ref>{{cite book | title=Classification AO des fractures. Tome I. Les os longs | publisher=Springer-Verlag |vauthors=Müller ME, Nazarian S, Koch P | year=1987 | location=Berlin}}{{page needed|date=December 2016}}</ref> In 2007, they extended their system,<ref>{{cite journal |pmid=18277234 |year=2007 |last1=Marsh |first1=J. L. |title=Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee |journal=Journal of Orthopaedic Trauma |volume=21 |issue=10 Suppl |pages=S1–133 |last2=Slongo |first2=T. F. |last3=Agel |first3=J |last4=Broderick |first4=J. S. |last5=Creevey |first5=W |last6=Decoster |first6=T. A. |last7=Prokuski |first7=L |last8=Sirkin |first8=M. S. |last9=Ziran |first9=B |last10=Henley |first10=B |last11=Audigé |first11=L |doi=10.1097/00005131-200711101-00001 |s2cid=24535478 |doi-access=free }}</ref> unifying the two systems regarding wrist, hand, foot, and ankle fractures.

===Classifications named after people===
{{Main category|Orthopedic classifications}}
A number of classifications are named after the person ([[eponymous]]) who developed it.
* "Denis classification" for [[spinal fracture]]s <ref>{{Cite GPnotebook|1590689797|Denis classification of spinal fractures}}</ref>
* "[[Frykman classification]]" for [[forearm fracture]]s (fractures of [[radius and ulna]])
* "[[Gustilo open fracture classification]]" <ref Name="Rüedi">{{cite book|title= AO principles of fracture management, Volume 1|last= Rüedi, etc. all|author2= Thomas P. Rüedi|author3= Richard E. Buckley|author4= Christopher G. Moran|year= 2007|publisher= Thieme|isbn= 978-3-13-117442-0|page= 96|url= https://books.google.com/books?id=WEzRr4bM05gC&q=Gustilo%20open%20fracture%20classification&pg=PA96|access-date= 9 November 2020|archive-date= 26 July 2024|archive-url= https://web.archive.org/web/20240726175130/https://books.google.com/books?id=WEzRr4bM05gC&q=Gustilo%20open%20fracture%20classification&pg=PA96#v=onepage&q=Gustilo%20open%20fracture%20classification&f=false|url-status= live}}</ref>
* "Letournel and Judet Classification" for [[Acetabular fracture]]s <ref name="Fractures of the Acetabulum">{{cite web|url=http://www.wheelessonline.com/ortho/fractures_of_the_acetabulum|title=Fractures of the Acetabulum|work=wheelessonline.com|url-status=live|archive-url=https://web.archive.org/web/20090926194406/http://www.wheelessonline.com/ortho/fractures_of_the_acetabulum|archive-date=2009-09-26}}</ref>
* "Neer classification" for [[humerus fracture]]s <ref name="pmid9155417">{{cite journal |pmid=9155417 |year=1997 |last1=Mourad |first1=L |title=Neer classification of fractures of the proximal humerus |journal=Orthopedic Nursing |volume=16 |issue=2 |pages=76 }}</ref><ref name="titleeMedicine - Proximal Humerus Fractures: Article by Mark Frankle, MD">{{EMedicine|article|1261320|Proximal Humerus Fractures}}</ref>
* [[Seinsheimer classification]], [[Evans-Jensen classification]], [[Pipkin classification]], and [[Garden classification]] for [[hip fracture]]s<ref>{{cite web|url=https://www.lecturio.com/concepts/hip-fractures/|title=Hip Fractures|website=The Lecturio Medical Concept Library|access-date=24 July 2021|archive-date=24 July 2021|archive-url=https://web.archive.org/web/20210724221923/https://www.lecturio.com/concepts/hip-fractures/|url-status=live}}</ref>

== Prevention ==
Both high- and low-force trauma can cause bone fracture injuries.<ref name=":0">{{Cite news|url=https://orthoinfo.aaos.org/en/diseases--conditions/open-fractures/|title=Open Fractures - OrthoInfo - AAOS|access-date=2018-12-03|archive-date=4 May 2021|archive-url=https://web.archive.org/web/20210504181649/https://orthoinfo.aaos.org/en/diseases--conditions/open-fractures/|url-status=live}}</ref><ref name=":1">{{Cite journal|last1=Court-Brown|first1=Charles M.|last2=Bugler|first2=Kate E.|last3=Clement|first3=Nicholas D.|last4=Duckworth|first4=Andrew D.|last5=McQueen|first5=Margaret M.|date=June 2012|title=The epidemiology of open fractures in adults. A 15-year review|journal=Injury|volume=43|issue=6|pages=891–897|doi=10.1016/j.injury.2011.12.007|issn=1879-0267|pmid=22204774}}</ref> Preventive efforts to reduce motor vehicle crashes, the most common cause of high-force trauma, include reducing distractions while driving.<ref name=":2">{{Cite journal|date=2017-10-01|title=Trauma Education and Prevention|journal=Surgical Clinics of North America|language=en|volume=97|issue=5|pages=1185–1197|doi=10.1016/j.suc.2017.06.010|pmid=28958365|issn=0039-6109|last1=Sidwell|first1=Richard|last2=Matar|first2=Maher M.|last3=Sakran|first3=Joseph V.}}</ref> Common distractions are driving under the influence and texting or calling while driving, both of which lead to an approximate 6-fold increase in crashes.<ref name=":2" /> Wearing a seatbelt can also reduce the likelihood of injury in a collision.<ref name=":2" /> 30 [[kilometers per hour|km/h]] or 20 [[miles per hour|mph]] [[speed limit]]s (as opposed to the more common intracity 50 km/h / 30 mph) also drastically reduce the risk of accident, serious injury and even death in crashes between motor vehicles and humans. [[Vision Zero]] aims to reduce [[traffic deaths]] to zero through better traffic design and other measures and to drastically reduce [[traffic injuries]] which would prevent many bone fractures.

A common cause of low-force trauma is an at-home fall.<ref name=":0" /><ref name=":1" /> When considering preventative efforts, the [[National Institute of Health]] (NIH) examines ways to reduce the likelihood of falling, the force of the fall, and bone fragility.<ref name=":3">{{Cite web|url=https://www.bones.nih.gov/health-info/bone/osteoporosis/fracture/preventing-falls-and-related-fractures|title=Preventing Falls and Related Fractures {{!}} NIH Osteoporosis and Related Bone Diseases National Resource Center|website=www.bones.nih.gov|language=en|access-date=2018-12-03|archive-date=14 May 2021|archive-url=https://web.archive.org/web/20210514012122/https://www.bones.nih.gov/health-info/bone/osteoporosis/fracture/preventing-falls-and-related-fractures|url-status=live}}</ref> To prevent at-home falls they suggest keeping cords out of high-traffic areas where someone could trip, installing handrails and keeping stairways well-lit, and installing an assistive bar near the bathtub in the washroom for support.<ref name=":3" /> To reduce the impact of a fall the NIH recommends to try falling straight down on your buttocks or onto your hands.<ref name=":3" />

Some sports have a relatively high risk of bone fractures as a common [[sports injury]]. Preventive measures depend to some extent on the specific sport, but learning proper technique, wearing [[protective gear in sports|protective gear]] and having a realistic estimation of one's own capabilities and limitations can all help reduce the risk of bone fracture. In [[contact sports]] rules have been put in place to protect athlete health, such as the prohibition of [[unnecessary roughness]] in [[American football]].

Taking calcium and vitamin D supplements can help strengthen your bones.<ref name=":3" /> Vitamin D supplements combined with additional calcium marginally reduces the risk of hip fractures and other types of fracture in older adults; however, vitamin D supplementation alone did not reduce the risk of fractures.<ref>{{Cite journal |last1=Avenell |first1=Alison |last2=Mak |first2=Jenson C. S. |last3=O'Connell |first3=Dianne |date=2014-04-14 |title=Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men |journal=The Cochrane Database of Systematic Reviews |volume=2021 |issue=4 |pages=CD000227 |doi=10.1002/14651858.CD000227.pub4 |issn=1469-493X |pmc=7032685 |pmid=24729336}}</ref> Taking vibration therapy can also help strengthening bones and reducing the risk of a fracture.<ref>{{Cite web |date=2011-10-01 |title=Update on vibration therapy for bone health |url=https://www.health.harvard.edu/womens-health/update-on-vibration-therapy-for-bone-health |access-date=2024-12-10 |website=Harvard Health |language=en}}</ref><ref>{{Cite journal |last=Lee |first=Jong Hwa |last2=Kim |first2=Sang Beom |last3=Lee |first3=Kyeong Woo |last4=Lee |first4=Sook Joung |last5=Park |first5=Hyuntae |last6=Kim |first6=Dong Won |date=2017-08-18 |title=The effect of a whole-body vibration therapy on the sitting balance of subacute stroke patients: a randomized controlled trial |url=https://www.tandfonline.com/doi/figure/10.1080/10749357.2017.1305655?scroll=top&needAccess=true |journal=Topics in Stroke Rehabilitation |volume=24 |issue=6 |pages=457-462 |doi=10.1080/10749357.2017.1305655?scroll=top&needaccess=true |issn=1074-9357|url-access=subscription }}</ref>

== Patterns ==
{| class="wikitable sortable"
! width="20%" |Photo
!Type
!Description
!Causes
!Effects
|-
|[[File:Laengsfraktur_D4-Endglied_-_Verlauf_25M_-_CR_ap_-_001.jpg|thumb|In the fingertip. [[c:Category:Linear fractures|More images]]|center|257x257px]]
|Linear fracture
|Parallel to the bone's long axis
|
|
|-
|[[File:Kind_of_fractures_-_Closed_fracture_--_Smart-Servier.png|thumb|[[c:Category:Transverse fractures|more images]]]]
|Transverse fracture
|At a right angle to the bone's long axis
|May occur when the bone is bent,<ref name="mcdaniel">{{Cite book|last1=McDaniel|first1=Dalton J.|url=http://www.ncbi.nlm.nih.gov/books/NBK557625/|title=StatPearls|last2=Rehman|first2=Uzma H.|date=November 2, 2021|publisher=StatPearls Publishing|chapter=Phalanx Fractures of the Hand|pmid=32491557|via=PubMed|access-date=3 January 2022|archive-date=29 December 2020|archive-url=https://web.archive.org/web/20201229012018/https://www.ncbi.nlm.nih.gov/books/NBK557625/|url-status=live}}</ref><!--more general source needed-->and snaps in the middle.
|
|-
|[[File:Kind of fractures - Oblique -- Smart-Servier.png|thumb|center|400x400px]]
|Oblique fracture
|Diagonal to a bone's long axis (more than 30°)
|
|
|-
|[[File:Armbreak_-_Spiral_Fracture.jpg|thumb|[[c:Category:Spiral fractures|more images]]]]
|[[Spiral fracture]] or torsion fracture
|At least one part of the bone has been twisted (image shows an [[Arm wrestling|arm-wrestler]])
|Torsion on the bone<ref name="mcdaniel" />
|May rotate, and must be [[Fracture reduction|reduced]] to heal properly
|-
|[[File:Blausen_0250_CompressionFracture_Vertebrae.png|thumb|[[c:Category:Compression fractures|more images]]]]
|[[Compression fracture]]/[[wedge fracture]]
|Usually occurs in the vertebrae, for example when the front portion of a [[vertebra]] in the spine collapses due to [[osteoporosis]] (a medical condition which causes bones to become brittle and susceptible to fracture, with or without trauma)
|
|
|-
|
|Impacted fracture
|Bone fragments are driven into each other
|
|
|-
|[[File:MalletFinger.PNG|thumb|[[c:Category:Avulsion fractures|more images]]]]
|[[Avulsion fracture]]
|A fragment of bone is separated from the main mass (image shows a [[Busch fracture]])
|
|
|-
|[[File:Nagelkranzfraktur.jpg|thumb|[[c:Category:Comminuted fractures|more images]]]]
|[[Comminuted fracture]]
|The bone is shattered
|often from crushing injuries<ref name="mcdaniel" />
|
|}

==Treatment==
[[File:K-Knie-z2.jpg|thumb|X-ray showing the proximal portion of a fractured [[tibia]] with an [[intramedullary rod|intramedullary nail]] ]]
[[File: The patriotic open osteosynthesis.jpg|thumb|The surgical treatment of [[Mandible|mandibular]] angle fracture; fixation of the bone fragments by the plates, the principles of osteosynthesis are stability (immobility of the fragments that creates the conditions for bones coalescence) and functionality]]
[[File:Proximal femur nail.jpg|100px|thumb|right|Proximal femur nail with locking and stabilisation screws for treatment of femur fractures of left thigh]]
Treatment of bone fractures are broadly classified as surgical or conservative, the latter basically referring to any non-surgical procedure, such as pain management, immobilization or other non-surgical stabilization. A similar classification is ''open'' versus ''closed treatment'', in which ''open treatment'' refers to any treatment in which the fracture site is opened surgically, regardless of whether the fracture is an [[#Classification|open]] or [[#Classification|closed fracture]].<ref>{{cite web|url=https://www.lecturio.com/concepts/overview-of-bone-fractures/|title=Overview of Bone Fractures|website=The Lecturio Medical Concept Library|access-date=25 July 2021|archive-date=25 July 2021|archive-url=https://web.archive.org/web/20210725113420/https://www.lecturio.com/concepts/overview-of-bone-fractures/|url-status=live}}</ref>

===Pain management===
In arm fractures in children, [[ibuprofen]] has been found to be as effective as a combination of [[paracetamol]] and [[codeine]].<ref>{{cite journal |doi=10.1016/j.annemergmed.2009.06.005 |pmid=19692147 |title=A Randomized Clinical Trial of Ibuprofen Versus Paracetamol with Codeine for Acute Pediatric Arm Fracture Pain |journal=Annals of Emergency Medicine |volume=54 |issue=4 |pages=553–60 |year=2009 |last1=Drendel |first1=Amy L. |last2=Gorelick |first2=Marc H. |last3=Weisman |first3=Steven J. |last4=Lyon |first4=Roger |last5=Brousseau |first5=David C. |last6=Kim |first6=Michael K. }}</ref> In the [[Emergency medical services|EMS]] setting it might be applicable to administer 1mg/kg of iv [[ketamine]] to achieve a dissociated state.

===Immobilization===
Since [[bone healing]] is a natural process that will occur most often, fracture treatment aims to ensure the best possible ''function'' of the injured part after healing. Bone fractures typically are treated by restoring the fractured pieces of bone to their natural positions (if necessary), and maintaining those positions while the bone heals. Often, aligning the bone, called [[Reduction (orthopedic surgery)|reduction]], in a good position and verifying the improved alignment with an X-ray is all that is needed. This process is extremely painful without [[anaesthesia]], about as painful as breaking the bone itself. To this end, a fractured limb usually is immobilized with a [[plaster]] or [[glass-reinforced plastic|fibreglass]] [[Orthopedic cast|cast]] or splint that holds the bones in position and immobilizes the joints above and below the fracture. 

When the initial post-fracture [[oedema]] or swelling goes down, the fracture may be placed in a removable brace or [[orthosis]]. If being treated with surgery, [[intramedullary rod|surgical nails]], screws, plates, and wires are used to hold the fractured bone together more directly. Alternatively, fractured bones may be treated by the [[Ilizarov apparatus|Ilizarov method]] which is a form of an external fixator.

Occasionally smaller bones, such as phalanges of the [[toes]] and [[finger]]s, may be treated without the cast, by [[buddy wrapping]] them, which serves a similar function to making a cast. A device called a [[Suzuki frame]] may be used in cases of deep, complex intra-articular digit fractures.<ref name="pmid16217475">{{cite journal|vauthors=Keramidas EG, Miller G|date=October 2005|title=The Suzuki frame for complex intraarticular fractures of the thumb|journal=Plastic and Reconstructive Surgery|volume=116|issue=5|pages=1326–31|doi=10.1097/01.prs.0000181786.39062.0b|pmid=16217475|s2cid=31890854}}</ref> By allowing only limited movement, immobilization helps preserve anatomical alignment while enabling [[Fibrocartilage callus|callus]] formation, toward the target of achieving union.

Splinting results in the same outcome as casting in children who have a distal radius fracture with little shifting.<ref>{{cite journal |doi=10.1503/cmaj.100119 |pmid=20823169 |pmc=2950182 |title=Cast versus splint in children with minimally angulated fractures of the distal radius: A randomized controlled trial |journal=Canadian Medical Association Journal |volume=182 |issue=14 |pages=1507–12 |year=2010 |last1=Boutis |first1=K. |last2=Willan |first2=A. |last3=Babyn |first3=P. |last4=Goeree |first4=R. |last5=Howard |first5=A. }}</ref>

===Surgery===
[[Surgery|Surgical]] methods of treating fractures have their own risks and benefits, but usually, surgery is performed only if conservative treatment has failed, is very likely to fail, or is likely to result in a poor functional outcome.<ref>{{cite web
| url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/fractures
| title=Fractures
| website=Johns Hopkins Medicine
| date=28 February 2020
| access-date=25 July 2021
| archive-date=25 July 2021
| archive-url=https://web.archive.org/web/20210725060148/https://www.hopkinsmedicine.org/health/conditions-and-diseases/fractures
| url-status=live
}}</ref> With some fractures such as [[hip fracture]]s (usually caused by [[osteoporosis]]), surgery is offered routinely because non-operative treatment results in prolonged immobilisation, which commonly results in complications including chest infections, pressure sores, deconditioning, [[deep vein thrombosis]] (DVT), and [[pulmonary embolism]], which are more dangerous than surgery.<ref>{{cite web|url=https://www.lecturio.com/concepts/hip-fractures/|title=Hip Fractures|website=The Lecturio Medical Concept Library|access-date=24 July 2021|archive-date=24 July 2021|archive-url=https://web.archive.org/web/20210724221923/https://www.lecturio.com/concepts/hip-fractures/|url-status=live}}</ref> When a joint surface is damaged by a [[fracture]], surgery is also commonly recommended to make an accurate anatomical reduction and restore the smoothness of the joint.

[[Infection]] is especially dangerous in bones, due to the recrudescent nature of bone infections. Bone tissue is predominantly [[extracellular matrix]], rather than living cells, and the few [[blood vessels]] needed to support this low metabolism are only able to bring a limited number of [[immune cell]]s to an injury to fight infection. For this reason, open fractures and [[Osteotomy|osteotomies]] call for very careful [[antiseptic]] procedures and [[prophylactic]] use of antibiotics.

Occasionally, [[bone grafting]] is used to treat a fracture.<ref>{{cite book | vauthors = Klokkevold PR, Jovanovic SA |chapter=Advanced Implant Surgery and Bone Grafting Techniques | veditors = Newman MG, Takei HM, Carranza FA |title=Carranza's Clinical Periodontology |publisher=W.B. Saunders |year=2002 |pages=907–8 |edition=9th |isbn=9780721683317}}</ref>

Sometimes bones are reinforced with metal.<ref>{{cite web
| url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/fractures
| title=Fractures
| website=Johns Hopkins Medicine
| date=28 February 2020
| access-date=25 July 2021
| archive-date=26 July 2024
| archive-url=https://web.archive.org/web/20240726175204/https://www.hopkinsmedicine.org/health/conditions-and-diseases/fractures
| url-status=live
}}</ref> These [[implant (medicine)|implant]]s must be designed and installed with care. ''[[Stress shielding]]'' occurs when plates or screws carry too large of a portion of the bone's load, causing [[atrophy]]. This problem is reduced, but not eliminated, by the use of low-[[Young's modulus|modulus]] materials, including [[titanium]] and its alloys. The heat generated by the friction of installing hardware can accumulate easily and damage [[bone tissue]], reducing the strength of the connections. If dissimilar metals are installed in contact with one another (i.e., a titanium plate with [[cobalt]]-[[chromium]] alloy or [[stainless steel]] screws), galvanic [[corrosion]] will result. The metal [[ion]]s produced can damage the [[bone]] locally and may cause systemic effects as well.

=== Bone stimulation ===
Bone stimulation with either [[electromagnetic]] or [[ultrasound]] waves may be suggested as an alternative to surgery to reduce the healing time for non-union fractures.<ref name=":4">{{cite journal |last1=Leighton|first1= R. |last2= Watson |first2=J.T |last3= Giannoudis|first3=P.|last4=Papakostidis|first4=C.|last5=Harrison|first5=A. |last6=Steen|first6=R.G. |title= Healing of fracture nonunions treated with low-intensity pulsed ultrasound (LIPUS): A systematic review and meta-analysis|journal=Injury|date=May 2017|volume=48|issue=7|pages=1339–1347|pmid= 28532896 |doi=10.1016/j.injury.2017.05.016|doi-access=free}}</ref><ref name="VictoriaPetrisor2009">{{cite journal|last1=Victoria|first1=Galkowski|last2=Petrisor|first2=Brad|last3=Drew|first3=Brian|last4=Dick|first4=David|title=Bone stimulation for fracture healing: What′s all the fuss?|journal=Indian Journal of Orthopaedics|volume=43|issue=2|year=2009|pages=117–20|issn=0019-5413|doi=10.4103/0019-5413.50844|doi-broken-date=1 November 2024 |pmid=19838359|pmc=2762251 |doi-access=free }}</ref> The proposed mechanism of action is by stimulating osteoblasts and other proteins that form bones using these modalities. The evidence supporting the use of ultrasound and shockwave therapy for improving unions is very weak<ref name=":4" /> and it is likely that these approaches do not make a clinically significant difference for a delayed union or non-union.<ref>{{Cite journal |last1=Searle |first1=Henry Kc |last2=Lewis |first2=Sharon R. |last3=Coyle |first3=Conor |last4=Welch |first4=Matthew |last5=Griffin |first5=Xavier L. |date=2023-03-03 |title=Ultrasound and shockwave therapy for acute fractures in adults |url= |journal=The Cochrane Database of Systematic Reviews |volume=2023 |issue=3 |pages=CD008579 |doi=10.1002/14651858.CD008579.pub4 |issn=1469-493X |pmc=9983300 |pmid=36866917 }}</ref>

=== Physical therapy ===
[[Physical therapy]] exercises (either home-based or physiotherapist-led) to improve functional mobility and strength, gait training for hip fractures, and other physical exercise are also often suggested to help recover physical capacities after a fracture has healed.<ref>{{Cite journal |last1=Pradhan |first1=Sara |last2=Chiu |first2=Sarah |last3=Burton |first3=Claire |last4=Forsyth |first4=Jacky |last5=Corp |first5=Nadia |last6=Paskins |first6=Zoe |last7=van der Windt |first7=Danielle A. |last8=Babatunde |first8=Opeyemi O. |date=2022-06-03 |title=Overall Effects and Moderators of Rehabilitation in Patients With Wrist Fracture: A Systematic Review |url= |journal=Physical Therapy |volume=102 |issue=6 |pages=pzac032 |doi=10.1093/ptj/pzac032 |issn=1538-6724 |pmid=35421234|doi-access=free }}</ref><ref>{{Cite journal |last1=Fairhall |first1=Nicola J. |last2=Dyer |first2=Suzanne M. |last3=Mak |first3=Jenson Cs |last4=Diong |first4=Joanna |last5=Kwok |first5=Wing S. |last6=Sherrington |first6=Catherine |author-link6=Cathie Sherrington |date=2022-09-07 |title=Interventions for improving mobility after hip fracture surgery in adults |url= |journal=The Cochrane Database of Systematic Reviews |volume=2022 |issue=9 |pages=CD001704 |doi=10.1002/14651858.CD001704.pub5 |issn=1469-493X |pmc=9451000 |pmid=36070134}}</ref>

==Children==
{{Main|Child bone fracture}}
In children, whose bones are still developing, there are risks of either a growth plate injury or a [[greenstick fracture]].
* A greenstick fracture occurs due to mechanical failure on the tension side. That is since the bone is not so brittle as it would be in an adult, it does not completely fracture, but rather exhibits bowing without complete disruption of the bone's [[Cortex (anatomy)|cortex]] in the surface opposite the applied force.
* Growth plate injuries, as in [[Salter-Harris fractures]], require careful treatment and accurate reduction to make sure that the bone continues to grow normally.
* [[Plasticity (physics)|Plastic deformation]] of the bone, in which the bone permanently bends, but does not break, also is possible in children. These injuries may require an [[osteotomy]] (bone cut) to realign the bone if it is fixed and cannot be realigned by closed methods.
* Certain fractures mainly occur in children, including fracture of the [[clavicle]] and [[Supracondylar humerus fracture|supracondylar fracture of the humerus]].{{citation needed|date=December 2016}}

==See also==
* [[Stress fracture]]
* [[Distraction osteogenesis]]
* [[Rickets]]
* [[Catagmatic]]
* [[H. Winnett Orr]], U.S. Army surgeon who developed [[Orthopedic plaster cast]]s

==References==
{{Reflist}}

== External links ==
{{Medical resources
|  DiseasesDB     = 4939
|  ICD10          = [http://apps.who.int/classifications/icd10/browse/2010/en#/XIX S'''''x'''''2] (where x=0–9 depending on the location of the fracture)
|  ICD9           = {{ICD9|829}}
|  ICDO           =
|  OMIM           =
|  MedlinePlus    = 000001
|  eMedicineSubj  =
|  eMedicineTopic =
|  MeshID         = D050723
}}
{{Commons category|Bone fractures}}
* [https://web.archive.org/web/20090325003313/http://orthoinfo.aaos.org/ Authoritative information in orthopaedic surgery] American Association of Orthopedic Surgeons (AAOS)
* [http://gentili.net/fracturemain.asp Radiographic Atlas of Fracture]

{{Fractures}}
{{Trauma |state=autocollapse}}

{{Authority control}}

[[Category:Bone fractures| ]]
[[Category:Acute pain]]