By James A. Shapiro, MD

A fracture is a break in a bone. It can usually be seen on an x-ray, but not always. These injuries can be very painful and cause swelling and bruising. If there is deformity of the injured area, the broken/fractured bones are not in good alignment. If there is no obvious deformity, it doesn’t mean the bone pieces are in good position.

A fractured bone can be very painful and frequently causes swelling and bruising. The severity of the broken bone and your body’s response to the break will determine the exact treatment needed.

The initial treatment is R.I.C.E. Rest is essential to reduce the stress on the injured tissue and give your body a chance to start the healing process. Ice helps to reduce the pain and swelling. Swelling slows down and interferes with the healing process. Compression also may help with minimizing the swelling and can make the injured area feel more stable. (Crutched or Cane to help reduce the stress on the injured area if a leg is involved.) Elevation means having the injured area above the level of you heart to help reduce the swelling. Decreased swelling means decreased pain. In addition to R.I.C.E., a splint helps reduce the movement of the fractured bone which reduces pain. Sling may be helpful to put an injured arm at rest.

Evaluation of the fractured area should be obtained to determine the extent of the injury. Your doctor will do a detailed history and focus in on how and when the injury occurred along with what you may have felt and heard. Your doctor will want to know if you notice a deformity after the injury. If the injury was witnessed, it would be helpful get that account as well. Next there will be a physical exam looking at both the immediate injured area and also the surrounding areas. X-rays and an MRI and/or a CT scan may also be obtained

Depending on the location, the bone, and extent of the fracture, the treatment options will be discussed along with the expected recovery.

The treatment options might include:

  1. Further rest, ice and elevation.
  2. Assistive walking aide such as crutches, cane, or walker if the leg was injured.
  3. Bracing, splinting, or casting.
  4. Slow progression back to normal activities as tolerated.
  5. Therapy
  6. Surgery

The recovery expectations will depend on a number of factors including:

  1. The bone broken.
  2. The location and pattern of the break in the bone.
  3. The severity of the injury to the surrounding soft tissues.
  4. Is any of the broken bone at or near an opening in the skin?
  5. Does the broken bone go into a joint?

Helpful hints regarding some of the treatments and things to be alert for:

  1. Keep ice on the injured area. For an area that has a wrap or cast/splint, a typical schedule is for icing is as long and often as you can. Consider putting a thin towel between the ice and the wrap to absorb the condensation. When applying the ice directly to the skin, a typical schedule is on for 10-15 minutes every hour. This should be done for at least the first 48 hours after the injury. (A nice reusable ice bag can be made by putting 3 parts crushed ice and 1 part rubbing alcohol into a re-sealable plastic bag and putting that bag into another re-sealable plastic bag.)
  2. Do not remove the cast or splint.
  3. Keep the injured area and the cast/splint clean and dry, unless instructed differently. Cover the injured limb and cast/splint with a plastic bag to keep dry while bathing. Alternately, take a sponge bath. If you have a “waterproof” cast, you may bath, swim, and get the cast wet. Please be aware that the cast will drip water for quite a while after coming out of the water.
  4. If the cast/splint or wrap feel too tight, first elevate the limb and put ice on the injured area. If this fails to reduce or alleviate the tight feeling and there is a bandage around the limb, then loosen the bandage. If the tight feeling persists despite the above measures, call the ER or our office at 656-3150.
  5. If you experience any numbness or tingling to the injured limb after casting/splinting, first elevate the injured limb. If the numbness or tingling does not improve quickly, then call the ER or our office at 656-3150.
  6. Take the medicine as prescribed. If this is not helping you, please call the doctor that ordered the medicine for you. Be aware that pain medicine only really helps sharp stabbing pain. If the pain is throbbing in nature, ice and elevation help more than medicine. (Dr. Shapiro does not prescribe medicines after office hours or on weekends and cannot prescribe medicine for a patient we have never seen before.) Typically, after splinting/casting, most pain is relieved by elevation and ice. Occasionally, Tylenol can be helpful.
  7. In the case of a leg injury, do not put any weight on the leg unless instructed to do so. Never put more weight on the injured limb than allowed. Always use pain as a guide. If having a lot of pain, reduce the pressure on the leg.
  8. In the case of an arm/hand injury, do not use the arm/hand until you have been instructed to do so.
  9. Please follow up in our office as instructed. Our office phone number is 1-262-656-3150.