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Patients suffering from a broken bone in the emergency room (ER) will be seen by a board-certified ER physician. The ER doctor will quickly assess the site of the break and determine the best course of treatment.
Pain control is almost always addressed and treated from the start.
- The ER doctor will almost certainly take X-rays to further examine the broken bone.
- They may treat the fracture with a splint, cast, or sling, depending on the type and severity of the fracture. Patients may require an orthopedic boot, crutches, or a cane.
- Intravenous fluids and pain relievers may be initiated if needed.
- Unfortunately, some broken bones may necessitate additional treatment such as surgery or prolonged hospital stay.
- In such cases, the ER facility can arrange for patients to be transferred to another medical facility or refer them to specialists for further treatment.
The treatment plan will be determined by numerous factors, such as the nature and severity of the injury, and may include:
- Manually repositioning a dislocated bone in its joint
- Using a sling or splint to immobilize a dislocated joint
- Using a cast or brace to support a broken bone while it heals
- Surgery to reposition and stabilize broken bones or to repair torn ligaments after a dislocation
- Orthopedic rehabilitation to regain muscle strength or joint range of motion after the patient has healed
Treatment options for broken bones include:
- Immobilization using a plaster or fiberglass cast. This is the most common method of treatment.
- Using a gentle pulling action called traction to reposition bone pieces.
- External fixation is a surgical procedure that involves inserting metal pins or screws into bone fragments. The pins or screws are attached to a metal bar on the skin's surface. This fixation system keeps the bone fragments in place while they heal.
- Open reduction and internal fixation is a surgery that repositions bone fragments and holds them together with metal pins, screws, or plates on the bone's surface. Once the wound has healed, the surgical hardware may or may not need to be removed.
- Joint replacement may be part of the treatment plan for fractures involving major joints such as the hip or shoulder.
People break bones in various ways, usually due to some sort of an impact, ranging from the crunch of a sports injury to an unintentional fall.
Bones are strong, but they have limits. They may even bleed following a serious break. Moreover, diseases such as cancer and osteoporosis can cause breaks because they weaken the bones.
Is a broken bone an emergency?
A broken bone must be treated in an emergency room (ER), regardless of the level of pain or visual severity of the injury.
To be sure, here are some telltale signs that a patient should go to the ER:
- If there are any open wounds with visible bone protruding from the skin, consult a doctor.
- If more than one bone appears to be broken, consult a doctor (the injured will be able to assume if the pain is radiating from more than one area).
- If the injury occurred anywhere other than a limb or appendage such as a rib, collarbone, neck, hip, shoulder, face, and so on.
- If the injured site appears disfigured, it requires setting and/or surgical correction.
If a person is concerned that the injury may fall into one of the above categories, it is best to go to the ER right away so that there is no delay in care or risk of worsening the injury.
What are the types of fractures?
Doctors use a few basic terms to describe broken bones as fractures, which include:
- Open or closed: Closed fractures, also known as simple fractures, do not break through the skin. Open or compound fractures may break through the skin.
- Partial or complete: Partial fractures do not extend through the bone. Complete fractures indicate that the bone is in two or more pieces.
- Displaced or nondisplaced: If the broken pieces still line up, it's a nondisplaced break. If they don't, it's displaced.
Common types of fractures include:
- Single fracture: When a bone is broken in a single location
- Complete fracture: When the bone splits into two pieces
- Comminuted fracture: When the bone is broken into more than two pieces or crushed
- Transverse fracture: Breaks straight across the bone
- Stress fracture: A very thin crack, also called a hairline fracture
- Oblique fracture: Breaks at an angle
- Greenstick fracture: Breaks on one side but bends on the other like a fresh stick from a tree
- Bowing fracture: Applies to children’s bones that have bent but not broken
- Compression fracture: Often occurs in the spine, spiral fractures, and avulsion fractures, when a tendon or ligament pulls off a piece of bone
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What to do if a person can’t get medical help right away
The foremost first aid to help a patient with a broken bone is to address their symptoms.
Symptoms of a bone fracture may include:
- Pain around the area of the injury
- Swelling
- Deformity
- Bruising or discoloration
- Difficulty or impossible to move the limb normally
- Loss of power in the limb
Over-the-counter pain relievers such as acetaminophen and ibuprofen can help. Aside from that, take the ICES approach: Ice, compression, elevation, and support.
- Ice reduces pain and swelling:
- In the absence of an ice pack, wrap some ice cubes in a dish towel or plastic bag and crush them with a hammer or by slamming them against the kitchen counter.
- Alternatively, take a bag of frozen vegetables from the freezer and wrap it in a towel.
- Apply an ice pack to the injured area for at least 20 minutes four times per day.
- Compression reduces swelling:
- Wrap an elastic or fabric bandage around the injured limb after it has been iced. It should be snug but not too tight.
- Check the tightness regularly; if the limb continues to swell, the bandage may become painful.
- Elevation reduces pain and swelling:
- If the patient can lie still, elevate the affected limb to about six inches above the heart level with a pillow.
- Support helps immobilize the limb and reduces pain:
- Put a splint on the affected limb. If it is a broken arm, rib, or collarbone, use a cloth or diaper sling to hold the arm in a bent position next to the body.
Broken bones or fractures typically heal in six to eight weeks. There are numerous factors at play, and healing times do not always go as planned. Some fractures can take up to 12 weeks to heal, and some can take even longer.
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How to strengthen the bones
Foods that are particularly good for the bones include:
- Dark leafy greens and vegetables
- Yogurt
- Salmon
- Walnuts
- Beans
- Milk
- Sardines
- Eggs
- Tuna
- Fortified cereals
Maintaining a physically active lifestyle and eating a balanced diet with plenty of calcium, vitamin D, and possibly other supplements as needed are important for healthy bones.
- Calcium-rich diet:
- 99 percent of the calcium we consume is stored in the bones, with the remaining one percent used for other biological functions.
- When calcium intake is low, bone breakdown occurs because the body requires stored calcium to maintain normal biological functions.
- Calcium levels are higher in foods such as low-fat or non-fat dairy products, dark green vegetables, fish, beans, and tofu.
- Calcium supplements:
- Calcium carbonate and calcium citrate malate are the two most common forms of calcium in supplements.
- Calcium carbonate must be taken with food, and it may cause stomach upset and bloating.
- Calcium citrate malate is better absorbed by the body when taken with or without food.
- Before taking any supplements, the patient must consult a good orthopedic doctor. They will provide insights into the patient’s specific needs, assisting them in making the best decision here.
- Calcium carbonate and calcium citrate malate are the two most common forms of calcium in supplements.
- Vitamin D:
- Vitamin D promotes bone development by increasing the body's calcium absorption from food.
- Vitamin D–rich foods include fortified beverages and cereals, fatty fish, and eggs.
- Patients who are susceptible to vitamin D deficiency should discuss with their doctor regarding vitamin D supplement.
- Sesame seeds and oil:
- According to Ayurvedic studies, sesame oil can be a remedy for bone strengthening as sesame seeds are high in protein, copper, magnesium, calcium, and healthy omega-3 fatty acids, and have high protein content, which can be beneficial for people with bone problems.
- 30 grams of unhulled sesame seeds provide 22 percent of the recommended dietary allowance for calcium.
- A handful of sesame seeds will provide the recommended amount of antioxidants, minerals, vitamins, and protein. Sesame seeds can be sprinkled on top of salads daily.
Doctors usually prescribe osteoclast inhibitors to patients who have brittle bones. These medications can postpone skeletal-related events in the bone (such as fractures or spinal cord compression) while strengthening the bones.
The medications work in various ways, but they all have the same effect.
- Xgeva (denosumab) is administered as a monthly injection (shot) under the skin.
- Zometa (zoledronic acid) is a bisphosphonate medication that is typically administered intravenously every one to three months.
Xgeva and Zometa are linked to a rare side effect called osteonecrosis of the jaw, in which the cells in the jawbone begin to die. Another uncommon side effect of these medications is kidney dysfunction.
Patients should, therefore, follow up with their physician regularly when on the above medications.
