The site of fracture is main determinant of how serious it will be. Regardless of location, pain is the main presentation. This happens because the nerves and muscle tissues surrounding the bone will invariably respond to the additional pressure they have to contend with, as the broken bone “bleeds”. Surrounding muscles also spasm as the defence system of the body attempts to fight the fracture. A fracture leads to inability to use the affected area partially or completely and there will also be swelling and discoloration as a result of the bruising.

• Severe Pain

  The patient complained of severe, painful limitation of motion on straightening or bending. [ncbi.nlm.nih.gov]

  […] and the inability to walk Ankle: Severe pain, swelling, tenderness to touch, bruising, deformity, and the inability to walk Foot: Severe pain, swelling, bruising, numbness in toes and foot, decreased range of motion, inability to walk comfortably, and [my.clevelandclinic.org]

  Surgery is normally reserved for those with severe pain, weakness, or inability to feel their arms or legs. [emedicinehealth.com]

  Severe Pain Burst fractures cause severe pain. Typically, this is pain at the level of the fracture, that is, in the back. However, pain may also be present in the legs following the distribution of the affected nerves. [spineuniverse.com]

• Chills

  The local men seemed to mostly be either talking, smoking or just chilling out. Sometimes they managed to do all three at the same time. There are Ksours all over a Tunisia. [raph.co.uk]

  Photo Credit Dolly Faibyshev for The New York Times Work Out and Chill? Cool temperature workouts may be the answer for those who want to exercise without becoming a hot mess. [nytimes.com]

  You may also feel dizzy or chilled from shock. [healthline.com]

  Choose the vibe of Legian or the relaxed chill of Sanur or, for the country feel, head to the mountains of Ubud. Being just eight degrees south of the equator, the temperature is pleasant all year round, wherever you choose. [internationalliving.com]

• Asymptomatic

  Eight months after operation, he was asymptomatic, showed a full range of motion and good strength. He had returned to work with no limitations. [ncbi.nlm.nih.gov]

  Bone mineral affection in asymptomatic adult patients with celiac disease. Am. J. Gastroenterol. 89, 2130–2134 (1994). 34. Valdimarsson, T., Toss, G., Ross, I., Lofman, O. & Strom, M. Bone mineral density in coeliac disease. Scand. J. [dx.doi.org]

• Arm Pain

  Here however, we describe the case of a young, amateur athlete presenting with acute right, upper arm pain after throwing a ball. Examination showed right upper arm deformity and tenderness to palpation, without any distal neurovascular deficits. [ncbi.nlm.nih.gov]

  Arm: Pain, swelling, abnormal bend, difficulty using or moving arm, warmth, bruising, or redness Elbow: Pain, swelling, bruising, stiffness, a ‘pop’ noise at the time of fracture, or visible deformity Wrist: Pain, swelling, decreased use of hand and wrist [my.clevelandclinic.org]

• Fracture

  Two fragments transverse fracture oblique fracture spiral fracture Three fragments bending wedge fracture spiral wedge fracture segmental fracture Multiple fragments segmental fracture fragmented wedge fracture irregular multifragmental fracture comminuted [radiopaedia.org]

  Radiographic findings of this case differed from previously reported cases of ulnar fracture in terms of showing a transverse fracture line with cortical thickening and an oblique fracture line with anterior cortical spike. [ncbi.nlm.nih.gov]

  Hip fractures refer to the femur fracture. Almost all hip fractures require surgery and the type of surgery depends upon where in the femur that the fracture is located. [medicinenet.com]

  After open reduction of fractures of the acetabulum. Displaced acetabular fractures. Complex acetabular fractures. Stabilization of acetabular fractures in elderly patients. CT of acetabular fractures: postoperative appearances. [web.archive.org]

• Hip Pain

  At 29 weeks of gestation, the patient complained of sudden pain on walking in both hips. Despite the bed rest, her hip pain increased; consequently, cesarean section was performed at 36 weeks. [ncbi.nlm.nih.gov]

  Hip fractures are more common in older persons, and any elderly riders who sustain a fall and complain of hip pain should be suspect for this injury. [whmentors.org]

• Neck Pain

  An 82-year-old woman presented with neck pain and bilateral upper limb paraesthesia after sustaining an unwitnessed fall at home the day before. [ncbi.nlm.nih.gov]

• Bone Pain

  Broken bones bleed, and the blood and associated swelling (edema) causes pain. Muscles that surround the injured area may go into spasm when they try to hold the broken bone fragments in place, and these spasms cause further pain. [web.archive.org]

  Because broken bones can cause significant amounts of pain, pain management is an important aspect of treating broken bones. Pain management is best accomplished with anti-inflammatory medicines and pain relievers. [emedicinehealth.com]

• Bone Disorder

  […] of unspecified bones (disorder), Fracture, cause unspecified (disorder), Fracture (disorder), Fracture - lesion (morphologic abnormality), Fracture of bones NOS (disorder), Fracture, bone, FRACTURE(S), Fracture of Bone, Broken bone, Fracture of bone, [fpnotebook.com]

• Tingling

  Symptoms of a fracture are out-of-place or misshapen limb or joint swelling, bruising or bleeding intense pain numbness and tingling limited mobility or inability to move a limb you need to get medical care right away for any fracture. [icd9data.com]

  Signs that circulation is inadequate include pale or blue skin, numbness or tingling, and loss of pulse. If circulation is poor and trained personnel are NOT quickly available, try to realign the limb into a normal resting position. [nlm.nih.gov]

  Symptoms of a fracture are Intense pain Deformity - the limb looks out of place Swelling, bruising, or tenderness around the injury Numbness and tingling Problems moving a limb You need to get medical care right away for any fracture. [medlineplus.gov]

• Seizure

  After the arrest, authorities called it the biggest seizure in the island's history. Your playlist will load after this ad But Thomas Michael Daly is intellectually disabled and has a doctor’s certificate for the medicine. [tvnz.co.nz]

  Additional mechanisms include violent muscle contractions from seizure activity, electrical shock, and athletic injuries. Finally, a direct blow to the proximal humerus may also lead to fracture. [emedicine.medscape.com]

  Some of the factors that increase the risk of developing osteoporosis include personal or family history of fractures; low levels of the hormone estrogen or testosterone; and the use of certain medications, such as glucocorticoids or anti-seizure medications [bones.nih.gov]

• Paresthesia

  Associated paresthesias and an enlarging mass must be viewed with caution. Most vascular injuries (84%) occur in patients older than 50 years; 53% are associated with brachial plexus injuries. [emedicine.medscape.com]

• Clumsiness

  Being the clumsy girl that she is she falls and cracks the ice, falling right into the water. She ends up being in a coma for a week when all of a sudden she wakes up, fully aware and fully functional. [goodreads.com]

Clinical diagnosis of a bone fracture is based on the history given as well as physical examination performed [8]. Imaging via X-Ray is performed to get a better view of the bone suspected to have been fractured. When X-ray proves insufficient, a CT or MRI scan can be performed.

In early fracture management, the main aim is to control hemorrhage, provide pain relief and remove potential sources of contamination (both foreign body and nonviable tissues) [9]. As soon as these are accomplished, the fracture will be reduced and reduction maintained. Following maintenance, fracture union is optimised and the chances of complications are reduced greatly.

Again, treatment is also focused on ensuring that following healing, the limb affected will return to its highest level of functioning. It is often accomplished by obtaining and maintenance of a reduction in the fracture with an immobilisation technique that makes it possible for the fracture to heal and also offering the patient decent functional aftercare. Depending on the type situation, non-operative or surgical treatment can be deployed.

The prognosis for most cases of fracture is dependent on the kind of bone injured, the part broken, the direction the breach of continuity faces, and other general complications [6]. When the fracture involves bones with many strong muscles inserted into them, cure becomes a lot more difficult. Prognosis is more positive when the fracture involves bones with little levers attached to them that are capable of displacing the fragments.

The main etiologic factors for bone fractures include fall from a height, commonly seen in children and the elderly, road and sports related accidents and direct impact on the bone. Repetitive force as can be seen with running can also lead to stress induced fracture in bones in some parts of the body such as the foot, ankle, tibia or hip. All of these are external factors that can lead to bone fracture [2].

There are however, certain internal factors that can bring about fractures. Apart from old age, tumor, infections and osteoporosis can also lead to fractures.

Fractures are relatively common. Every woman aged 50 years and above has a 50% chance of suffering from a fracture. In men, the possibility is reduced to 20% [3]. Around the world, nearly 10 million cases of fractures are recorded each year. Wrist fractures are the most common form of fractures with hip, humeral and symptomatic vertebral fractures being the next most popular fracture types. The highest incidence is seen in Europe and the Americas with 34.8% and 15.7% of cases seen here.

Actual fracture injuries to the bone affect the local soft tissue, the bone marrow, periosteum and the local soft tissues. The fracture destabilises the general structure making it difficult for this part of the body to carry out its normal activities until healing is complete [4].

The most important stage in the fracture healing is the inflammatory phase as well as subsequent hematoma formation. Around this stage, cellular signalling mechanisms work in line with chemotaxis and an inflammatory mechanism to attract the cells that are necessary to initiate the healing process. In less than 7 days, granulation tissue is formed by the body between the fracture fragments. Different biochemical signalling substances are involved in the formation of the soft callus which takes place over a period of two weeks [5].

With hard callus formation, cell proliferation and differentiation in the granulation tissue brings about production of osteoblasts and chondroblasts. The extracellular organic matrixes of woven bone and cartilage are synthesised respectively by the osteoblasts and chondroblasts after which a new formed bone is mineralised. The entire stage takes 4 to 16 weeks to complete.

There is no total way of preventing a fracture but these basic steps can help in the reduction of the risk [10].

• Consistent consumption of bone building meals such as milk, yoghurt, and cheese help in building strong bones. Vitamin supplements (A and D) can also be consumed as long as they do not interfere with other medications being consumed by the individual. 
• While engaging in any sport activities, wear the right clothing and gear. Also alternate exercise activities to prevent fractures.
• While working with heavy equipment, adhere to all precautionary instructions and avoid operating heavy equipment if you do not understand how they work.

A fracture occurs when any bone in the body loses its natural characteristics and most especially, its continuity. For a fracture to take place, the perisoteum, the bone marrow and other soft tissues around the bone must be injured. There are three known types of fractures. They include pathologic, stress and greenstick fractures [1]. The characteristic that determines what type of fracture an individual is facing include its anatomy, how the articular surface is involved, the fragmentation, etc.

A fracture refers to a crack in any bones in the body. Some of the common causes of fractures include falls, industrial injuries, vehicular accidents and sports related injuries.

Treatment and recovery from a fracture is dependent on the location and severity of the injury. A severe fracture may require surgery to implant devices into the bone so as to maintain the right alignment as the healing process plays out. In some cases, cast or splint maybe enough treatment to ensure full recovery. Regardless of type of fracture, early treatment and diagnosis is important to complete healing.

1. Lidgren L. The Bone and Joint Decade 2000 -2010. Bull World Health Organ [online]. Sept 2003;81(9):629.
2. Orthopaedic Trauma Association Committee for Coding and Classification. Fracture and dislocation compendium. J Orthop Trauma 1996 10 (Suppl 1:v-ix): 1–154.
3. Mollon B, da Silva V, Busse JW, Einhorn TA, Bhandari M. Electrical stimulation for long-bone fracture-healing: a meta-analysis of randomized controlled trials. J Bone Joint Surg Am 2008 90 (11): 2322–30.
4. Handa R, Ali Kalla A, Maalouf G. Osteoporosis in developing countries. Best Pract Res Clin Rheumatol. Aug 2008;22(4):693-708
5. Moran DS, Israeli E, Evans RK, Yanovich R, Constantini N, Shabshin N, et al. Prediction model for stress fracture in young female recruits during basic training. Med Sci Sports Exerc. Nov 2008;40(11 Suppl):S636-44.
6. Eiff MP, Hatch RL. Fracture Management for Primary Care, 3rd, Elsevier Saunders, Philadelphia 2012. p.26.
7. Wilkins KE. Principles of fracture remodeling in children. Injury 2005; 36 Suppl 1:A3.
8. Jones ET. Skeletal growth and development as related to trauma. In: Skeletal Trauma in Children, 3rd, Green NE, Swiontkowski MF. (Eds), Saunders, Philadelphia 2003. p.6.
9. McGowan HJ. Sports Medicine Reource Manual, 1st, Seidenberg P, Beutler AL. (Eds), Saunders, Philadelphia 2007. p.147.
10. Macmahon P, Eustace SJ. General principles. Semin Musculoskelet Radiol 2006; 10:243.