How Bad Is That Broken Bone? When a Fracture Requires More Than a Cast
Jonathan Yawman, MD
Orthopedics
Every broken bone needs immediate medical attention, but some breaks are worse than others.
Treatment for simple, clean breaks (also called fractures) or hairline cracks is straightforward. Maybe you trip on a curb and break a wrist while stopping your fall. Your doctor may reset (or reduce) the broken pieces and put you in a splint or cast for several weeks while your body heals itself, but surgery is also a possibility.
The picture, and treatment, becomes far more complicated with severe breaks. These include bones shattered into multiple pieces, fractures that extend into a joint, open fractures where the bone breaks through the skin or injuries associated with significant damage to the surrounding muscles, tendons, nerves, blood vessels or skin.
These complex injuries often require specialized evaluation and treatment to restore function and minimize long-term complications.
Common Symptoms and Types of Bone Fractures
In some instances, you can break a bone and not even know it. These more subtle fractures don’t have obvious causes or triggering events. Avid runners, for example, can develop stress fractures if they don’t give their bodies time to recover between sessions. Similarly, weakened bones in your back can lead to compression fractures in the spine. These fractures will still cause pain and discomfort, but you may need X-rays or other tests to diagnose what’s happening in your body.
Most fractures, however, have more obvious causes, including sports injuries, auto accidents and nasty falls. Usually, when you’ve broken a bone, you’ll immediately know something is wrong. Among the symptoms of a fracture:
- Pain
- Swelling
- Tenderness
- Inability to use the body part as normal
- Discoloration or bruising
- A noticeable deformity or bump
If you suspect you have a broken bone, it’s important that you seek immediate attention at an emergency room or, at minimum, urgent care facility. This isn’t the time to engage in self-diagnosis. X-rays will be needed to confirm a break – and the severity of that break.
When Does a Broken Bone Require Surgery?
With some fractures, surgery is an easy call. Consider the compound (or open) fracture. This well-known injury occurs when the fracture is so severe that the broken bone erupts through the skin. One well-known example occurred in 2021, when golfer Tiger Woods suffered a compound leg fracture, among other injuries, in a car crash.
As with Woods, these injuries usually need surgical treatment – regardless of which bone is involved. The wound and the bones need to be thoroughly cleaned to prevent infection after being exposed to the outside world. Surgery will also stabilize the break, often using rods inside the canals of hollow bones, plates and screws, or wires.
Other breaks may take a more careful analysis before surgery is recommended. Among the factors to consider is the amount of displacement or movement that occurred in the break. Some bones of your body can tolerate more displacement, while others are more sensitive.
The amount of acceptable displacement depends on factors such as which bone is involved, whether the fracture extends into a joint, the stability of the injury and the functional demands placed on that bone.
And when the break involves a joint – knees, ankles, elbows and hips, for example – there is greater danger of cartilage damage that can lead to arthritis later. Surgery can restore alignment of the joint surface and provide stability to make sure it heals properly.
Factors That Determine If You Need Fracture Surgery
While some fractures (a broken femur, for example) are obvious candidates for surgery, many of them fall into a gray area that’s dependent on factors such as age, general health and the demands that might placed on the bone going forward.
Surgery is less likely to be recommended for children, who still have open growth plates. The same is true for many older patients, because of the risks associated with surgery and anesthesia.
Whether surgery is recommended depends on a person’s overall health and functional status. This is particularly true when functionality is an important consideration. Returning broken bones to their correct length and alignment, for example, can be important for athletes and workers who lift heavy objects.
And timely surgery often is imperative in older patients for certain injuries, such as hip fractures, to allow them to mobilize early and not be bedridden, which prevents complications like blood clots and pneumonia.
Whether to have surgery is a decision you will make together with your surgeon after understanding what’s involved and the pros and cons of managing with or without surgery.
This content is not AI generated.
