Causes, Symptoms & Treatments of Wrist Fractures

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Article featured on the American Society for Surgery of the Hand

A wrist fracture is a medical term for a broken wrist. The wrist is made up of eight small bones which connect with the two long forearm bones called the radius and ulna. Although a broken wrist can happen in any of these 10 bones, by far the most common bone to break is the radius. This is called a distal radius fracture by hand surgeons.

Some wrist fractures are stable. “Non-displaced” breaks, in which the bones do not move out of place initially, can be stable. Some “displaced” breaks (which need to be put back into the right place, called “reduction” or “setting”) also can be stable enough to treat in a cast or splint. Other fractures are unstable. In unstable fractures, even if the bones are put back into position and a cast is placed, the bone pieces tend to move or shift into a bad position before they solidly heal. This can make the wrist appear crooked.

Some fractures are more severe than others. Fractures that break apart the smooth joint surface or fractures that shatter into many pieces (comminuted fractures) may make the bone unstable. These severe types of fractures often require surgery to restore and hold their alignment. An open fracture occurs when a fragment of bone breaks and is forced out through the skin. This can cause an increased risk of infection in the bone.

Causes

A wrist fracture occurs from an injury such as falling down onto an outstretched hand. Severe trauma such as car accidents, motorcycle accidents or falls from a ladder cause more severe injuries. Weak bones (for example, in osteoporosis) tend to break more easily.

Signs and Symptoms

When the wrist is broken, there is pain and swelling. It can be hard to move or use the hand and wrist. Some people can still move or use the hand or wrist even if there is a broken bone. Swelling or a bone out of place can make the wrist appear deformed. There is often pain right around the break and with finger movement. Sometimes the fingers tingle or feel numb at the tips.

Diagnosis

Your hand surgeon will do a physical examination and obtain x-rays to see if there is a broken bone. Sometimes, tests such as a CT scan or MRI scan may be needed to get better detail of the fracture fragments and other injuries. Ligaments (the soft tissues that hold the bones together), tendons, muscles and nerves may also be injured when the wrist is broken. These injuries may need to be treated also.

Treatment

Treatment depends on many factors, including:

  • Type of fracture, whether it is displaced, unstable or open
  • Your age, job, hobbies, activity level, and whether it is your “dominant” hand
  • Your overall general health
  • Presence of other injuries

A padded splint might be worn at first in order to align the bones and support the wrist to provide some relief from the initial pain. If the fracture is not too unstable, a cast may be used to hold a fracture that has been set. Other fractures may benefit from surgery to put the broken bones back together and hold them in correct place.

Fractures may be fixed with many devices. Pins, screws, plates, rods or external fixation can all be used. A small camera might be used to help visualize the joint from the inside. Sometimes the bone is so severely crushed that there is a gap in the bone once it has been realigned. In these cases, a bone graft may be added to help the healing process. Your hand surgeon will discuss the options that are best for your healing and recovery.

Recovery

During recovery, it is very important to keep your fingers moving to keep them from getting stiff. Your hand surgeon will have you start moving your wrist at the right time for your fracture. Hand therapy is often helpful to recover motion, strength and function.

Recovery time varies and depends on a lot of factors. It is not unusual for recovery to take months. Even then, some patients may have stiffness or aching. Severe wrist fractures can result in arthritis in the joint. Occasionally, additional treatment or surgery is needed.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Bone Fractures: 10 Things Doctors Want You to Know

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Mending Your Bone Fracture: What Doctors Say

About 6 million people break bones in the United States every year. The most frequently broken bone is the clavicle, or collarbone. Other common bone fractures include those in the arms, wrists and ankles. If you’re over 65, you’re more likely to break your hip than any other bone. You can break bones due to injury or diseases like osteoporosis, which weakens bones. Orthopedic surgeons specialize in treating broken bones in all scenarios. Here’s what three board-certified orthopedists want you to know about bone fractures, risk factors associated with them, and tips for helping them heal properly.

1. “A fracture and a break are the same thing.”

Patients frequently think bone fractures and bone breaks are different. Sometimes people think “fracture” means a crack while “break” means a clearly separated bone, but this is not true. “Fracture” is simply the term doctors use to refer to any break or crack in a bone.

2. “If you smoke, your fracture might not heal as fast.”

If you ingest nicotine—whether through cigarettes, cigars, chew tobacco, or even the nicotine patch—you may find that your fracture takes longer to heal than for a non-smoker. This is due to the effect of nicotine on the healing process. If you quit smoking, it will take three months before your body responds to bone breaks like a non-smoker’s would.

3. “Try RICE for non-emergency injuries.”

If you have a broken bone cutting through your skin or your bones are looking crooked and weird (what doctors call a deformity), you need emergency medical care. But if you only have pain and swelling, and aren’t sure if it’s a break, he says, you could try treating your injury at home for a day or two with “RICE”: rest, ice, compression (wrapping with an ace-type bandage) and elevation. If that doesn’t work, then you can be seen by a doctor.

4. “Don’t wait too long to be seen.”

If you wait too long to bring your possible bone fracture to your doctor’s attention, your bone could start healing on its own—and possibly in a crooked way. That makes fixing the problem more difficult than if you’d come in earlier. Or you could have underlying damage to the surface of the joint or other problems that are harder to treat the longer you wait. Waiting can also make it more likely you’ll need surgery. For non-emergency fractures it is recommended patients be seen within a couple of days. If you require an operation, this gives you time to get it scheduled before bones start knitting back together (which usually happens within a few weeks).

5. “Even little fingers and toes need to be checked out.”

You crack your little toe against a table leg. Should you bother getting it checked for fracture? It depends how bad you feel, noting that in similar situations, he might wait a couple days and, if still in pain, see a doctor to have it X-rayed. But in general, it’s better to err on the side of caution and see your doctor. After all, broken toes that heal crookedly can cause your shoes not to fit right, resulting in pain. Similarly, ignoring finger fractures can cause “significant disability” and lead to longer surgeries once patients finally come in, he says.

6. “Moving it doesn’t mean it is not broken.”

Patients say they didn’t think their bone was broken because they could still move the affected body part. But, he says, this is a fallacy. There’s only one way to know if it’s broken and that’s with an X-ray. The idea that if I can move it, therefore it can’t be broken is ridiculous. You can almost always move it, even if it is broken. Signs that it could be a bone fracture include significant swelling, tenderness around the site, bruising, and an inability to bear weight on it even after a couple of days’ rest. 

7. “I don’t always operate.”

People think orthopedic surgeons do surgery 99% of the time. This can cause some patients to avoid seeing them, because they think they’ll wind up in the operating room. It’s perhaps an understandable misconception, given that “surgeon” is part of his title. But, most of what they do isn’t surgery. Instead, orthopedists do the least invasive procedures possible first to promote bone fracture healing, only moving up to surgery if more conservative measures don’t work.

8. “When we tell you to elevate it, take us seriously.”

Folks come in a couple of days after a broken ankle, for example, and they may have been laying around on the couch but not with the ankle truly elevated—which is above the level of your heart. If you’re lying down, you can put two or three pillows under your leg to achieve proper elevation, but if you’re sitting, you’re going to have to use more than that to get your leg high enough. Elevation is key to preventing swelling, which also could delay surgery, if that’s needed.

 9. “Splints are not second-class citizens.”

Casts are non-removable and go all around your broken bone, while splints go only halfway around and can be taken off and on. Both casts and splints are used to immobilize your broken bone and both can be written on and decorated. Yet some patients think casts are best and get disappointed if they get a splint instead. A lot of times patients don’t give the splint a lot of respect. Doctors use splints for several reasons, including when a cast is difficult to place due to the location of the break or when doctors want to leave room for swelling.

10. “Forget the ‘6-week rule’ of bone healing.”

Patients think they know fractures are cured in six weeks, which is an incredible piece of misinformation; no adult is going to heal in six weeks. Most bone fractures take anywhere from 2 to 6 months to heal, depending on many factors, he says. There’s not just one rule for every broken bone. It’s important to understand there is specificity and details matter, such as where a bone is broken, what bone it is, what the fracture pattern looks like, and so on. It’s difficult to generalize.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Understanding Bone Fractures: The Basics

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Article featured on WebMD

What Are Fractures?

A fracture is the medical term for a broken bone.
Fractures are common; the average person has two during a lifetime. They occur when the physical force exerted on the bone is stronger than the bone itself.
Your risk of fracture depends, in part, on your age. Broken bones are very common in childhood, although children’s fractures are generally less complicated than fractures in adults. As you age, your bones become more brittle and you are more likely to suffer fractures from falls that would not occur when you were young.
There are many types of fractures, but the main categories are displaced, non-displaced, open, and closed. Displaced and non-displaced fractures refer to the alignment of the fractured bone.
In a displaced fracture, the bone snaps into two or more parts and moves so that the two ends are not lined up straight. If the bone is in many pieces, it is called a comminuted fracture. In a non-displaced fracture, the bone cracks either part or all of the way through, but does move and maintains its proper alignment.

A closed fracture is when the bone breaks but there is no puncture or open wound in the skin. An open fracture is one in which the bone breaks through the skin; it may then recede back into the wound and not be visible through the skin. This is an important difference from a closed fracture because with an open fracture there is a risk of a deep bone infection.
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Because of the unique properties of their bones, there are some defined fracture subtypes that present only in children. For example:

  • A greenstick fracture in which the bone is bent, but not broken all the way through
  • A buckle fracture results from compression of two bones driven into each other.
  • A growth plate fracture at the joint that can result in shorter bone length

These fracture subtypes can present in children and adults:

  • A comminuted fracture is when the bone breaks into several pieces
  • A transverse fracture is when the fracture line is perpendicular to the shaft (long part) of the bone.
  • An oblique fracture is when the break is on an angle through the bone
  • A pathologic fracture is caused by a disease that weakens the bone
  • A stress fracture is a hairline crack

The severity of a fracture depends upon the fracture subtype and location. Serious fractures can have dangerous complications if not treated promptly; possible complications include damage to blood vessels or nerves and infection of the bone (osteomyelitis) or surrounding tissue. Recuperation time varies depending on the age and health of the patient and the type of fracture. A minor fracture in a child may heal within a few weeks; a serious fracture in an older person may take months to heal.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Care of Casts and Splints

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Article from OrthoInfo medically reviewed in March 2020

Casts and splints support and protect injured bones and soft tissue. When you break a bone, your doctor will put the pieces back together in the right position. Casts and splints hold the bones in place while they heal. They also reduce pain, swelling, and muscle spasm. In some cases, splints and casts are applied following surgery. Splints or “half-casts” provide less support than casts. However, splints can be adjusted to accommodate swelling from injuries easier than enclosed casts. Your doctor will decide which type of support is best for you.

Types of Splints and Casts

Casts are custom-made. They must fit the shape of your injured limb correctly to provide the best support. Casts can be made of plaster or fiberglass — a plastic that can be shaped.

Splints or half-casts can also be custom-made, especially if an exact fit is necessary. Other times, a ready-made splint will be used. These off-the-shelf splints are made in a variety of shapes and sizes and are much easier and faster to use. Some have Velcro straps which make the splints easy to put on, take off, and adjust.

Materials

Fiberglass or plaster materials form the hard, supportive layer in splints and casts.
Fiberglass is lighter in weight and stronger than plaster. In addition, x-rays can “see through” fiberglass better than through plaster. This is important because your doctor will probably schedule additional x-rays after your splint or cast has been applied. X-rays can show whether the bones are healing well or have moved out of place.
Plaster is less expensive than fiberglass and shapes better than fiberglass for some uses.

Application

Both fiberglass and plaster splints and casts use padding, usually cotton, as a protective layer next to the skin. Both materials come in strips or rolls which are dipped in water and applied over the padding covering the injured area. In some cases, special waterproof padding and cast material may be used. Your doctor will let you know if your cast is made and padded with these waterproof materials.
The splint or cast must fit the shape of the injured arm or leg correctly to provide the best possible support. Generally, the splint or cast also covers the joint above and below the broken bone.
In many cases, a splint is applied to a fresh injury first. As swelling subsides, a full cast may replace the splint. If a cast is initially applied to your injury, it may be “valved” (cut) to allow for swelling, then repaired at your first follow-up appointment.
Sometimes, it may be necessary to replace a cast as swelling goes down and the cast gets “too big.” As a fracture heals, the cast may be replaced by a splint to make it easier to perform physical therapy exercises.

Getting Used to a Splint or Cast

Swelling due to your injury may cause pressure in your splint or cast for the first 48 to 72 hours. This may cause your injured arm or leg to feel snug or tight in the splint or cast. If you have a splint, your doctor will show you how to adjust it to accommodate the swelling.
It is very important to keep the swelling down. This will lessen pain and help your injury heal. To help reduce swelling:

  • Elevate. It is very important to elevate your injured arm or leg for the first 24 to 72 hours. Prop your injured arm or leg up above your heart by putting it on pillows or some other support. You will have to recline if the splint or cast is on your leg. Elevation allows clear fluid and blood to drain “downhill” to your heart.
  • Exercise. Move your uninjured, but swollen fingers or toes gently and often. Moving them often will prevent stiffness.
  • Ice. Apply ice to the splint or cast. Place the ice in a dry plastic bag or ice pack and loosely wrap it around the splint or cast at the level of the injury. Ice that is packed in a rigid container and touches the cast at only one point will not be effective.

Warning Signs

Swelling can create a lot of pressure under your cast. This can lead to problems. If you experience any of the following symptoms, contact your doctor’s office immediately for advice.

  • Increased pain and the feeling that the splint or cast is too tight. This may be caused by swelling.
  • Numbness and tingling in your hand or foot. This may be caused by too much pressure on the nerves.
  • Burning and stinging. This may be caused by too much pressure on the skin.
  • Excessive swelling below the cast. This may mean the cast is slowing your blood circulation.
  • Loss of active movement of toes or fingers. This requires an urgent evaluation by your doctor.

Taking Care of Your Splint or Cast

Your doctor will explain any restrictions on using your injured arm or leg while it is healing. You must follow your doctor’s instructions carefully to make sure your bone heals properly. The following information provides general guidelines only and is not a substitute for your doctor’s advice.
After you have adjusted to your splint or cast for a few days, it is important to keep it in good condition. This will help your recovery.

  • Keep your splint or cast dry. Moisture weakens plaster and damp padding next to the skin can cause irritation. Use two layers of plastic or purchase waterproof shields to keep your splint or cast dry while you shower or bathe. Even if the cast is covered, do not submerge it or hold it under running water. A small pinhole in the cast cover can cause the injury to get soaked.
  • Walking casts. Do not walk on a “walking cast” until it is completely dry and hard. It takes about one hour for fiberglass, and two to three days for plaster to become hard enough to walk on. You will be given a “cast shoe” to wear over your walking cast. The cast shoe will help protect the bottom of the cast.
  • Avoid dirt. Keep dirt, sand, and powder away from the inside of your splint or cast.
  • Padding. Do not pull out the padding from your splint or cast.
  • Itching. Do not stick objects such as coat hangers inside the splint or cast to scratch itching skin. Do not apply powders or deodorants to itching skin. If itching persists, contact your doctor. If something gets stuck inside your cast it may irritate your skin, so contact your doctor.
  • Trimming. Do not break off rough edges of the cast or trim the cast before asking your doctor.
  • Skin. Inspect the skin around the cast. If your skin becomes red or raw around the cast, contact your doctor.
  • Inspect the cast regularly. If it becomes cracked or develops soft spots, contact your doctor’s office.

Use common sense. You have a serious injury and you must protect your cast from damage so it can protect your injury while it heals.
After the initial swelling has subsided, proper splint or cast support will usually allow you to continue your daily activities with a minimum of inconvenience.

Cast Removal

Never remove the cast yourself. You may cut your skin or prevent proper healing of your injury.
Your doctor will use a cast saw to remove your cast. The saw vibrates, but does not rotate. If the blade of the saw touches the padding inside the hard shell of the cast, the padding will vibrate with the blade and will protect your skin. Cast saws make noise and may feel “hot” from friction, but will not harm you — “their bark is worse than their bite.”
If you do feel pain while the cast is being removed, let your doctor or an assistant know and they will be able to make adjustments.

Rehabilitation

Broken bones take several weeks to several months to heal. Pain usually stops long before the bone is solid enough to handle the stresses of everyday activities. You will need to wear your cast or splint until your bone is fully healed and can support itself.
While you are wearing your cast or splint, you will likely lose muscle strength in the injured area. Exercises during the healing process and after your cast is removed are important. They will help you restore normal muscle strength, joint motion, and flexibility.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

How to Tell if Your Foot is Broken: Symptoms & Treatment Options

How to Tell if Your Foot is Broken: Symptoms & Treatment Options

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Article Featured on Mayo Clinic

Overview

Foot and ankle bones

Foot and ankle bones

A broken foot is an injury to the bone. You may experience a broken foot during a car crash or from a simple misstep or fall. The seriousness of a broken foot varies. Fractures can range from tiny cracks in your bones to breaks that pierce your skin.

Treatment for a broken foot depends on the exact site and severity of the fracture. A severely broken foot may require surgery to implant plates, rods or screws into the broken bone to maintain proper position during healing.

Symptoms of a Broken Foot

If you have a broken foot, you may experience some of the following signs and symptoms:

  • Immediate, throbbing pain
  • Pain that increases with activity and decreases with rest
  • Swelling
  • Bruising
  • Tenderness
  • Deformity
  • Difficulty in walking or bearing weight

When to see a doctor if you think your foot is broken

See a doctor if there is obvious deformity, if the pain and swelling don’t get better with self-care, or if the pain and swelling gets worse over time. Also, see a doctor if the injury interferes with walking.

Common Causes of a Broken Foot

The most common causes of a broken foot include:

  • Car accidents. The crushing injuries common in car accidents may cause breaks that require surgical repair.
  • Falls. Tripping and falling can break bones in your feet, as can landing on your feet after jumping down from just a slight height.
  • Impact from a heavy weight. Dropping something heavy on your foot is a common cause of fractures.
  • Missteps. Sometimes just putting your foot down wrong can result in a broken bone. A toe can get broken from stubbing your toes on furniture.
  • Overuse. Stress fractures are common in the weight-bearing bones of your feet. These tiny cracks are usually caused over time by repetitive force or overuse, such as running long distances. But they can also occur with normal use of a bone that’s been weakened by a condition such as osteoporosis.

Risk factors

You may be at higher risk of a broken foot or ankle if you:

  • Participate in high-impact sports. The stresses, direct blows and twisting injuries that occur in sports such as basketball, football, gymnastics, tennis and soccer can causes foot fractures.
  • Use improper technique or sports equipment. Faulty equipment, such as shoes that are too worn or not properly fitted, can contribute to stress fractures and falls. Improper training techniques, such as not warming up and stretching, also can cause foot injuries.
  • Suddenly increase your activity level. Whether you’re a trained athlete or someone who’s just started exercising, suddenly boosting the frequency or duration of your exercise sessions can increase your risk of a stress fracture.
  • Work in certain occupations. Certain work environments, such as a construction site, put you at risk of falling from a height or dropping something heavy on your foot.
  • Keep your home cluttered or poorly lit. Walking around in a house with too much clutter or too little light may lead to falls and foot injuries.
  • Have certain conditions. Having decreased bone density (osteoporosis) can put you at risk of injuries to your foot bones.

Complications from a Broken Foot

Complications of a broken foot are uncommon but may include:

  • Arthritis. Fractures that extend into a joint can cause arthritis years later. If your foot starts to hurt long after a break, see your doctor for an evaluation.
  • Bone infection (osteomyelitis). If you have an open fracture, meaning one end of the bone protrudes through the skin, your bone may be exposed to bacteria that cause infection.
  • Nerve or blood vessel damage. Trauma to the foot can injure adjacent nerves and blood vessels, sometimes actually tearing them. Seek immediate attention if you notice any numbness or circulation problems. Lack of blood flow can cause a bone to die and collapse.

Prevention

These basic sports and safety tips may help prevent a broken foot:

  • Wear proper shoes. Use hiking shoes on rough terrain. Wear steel-toed boots in your work environment if necessary. Choose appropriate athletic shoes for your sport.
  • Replace athletic shoes regularly. Discard sneakers as soon as the tread or heel wears out or if the shoes are wearing unevenly. If you’re a runner, replace your sneakers every 300 to 400 miles.
  • Start slowly. That applies to a new fitness program and each individual workout.
  • Cross-train. Alternating activities can prevent stress fractures. Rotate running with swimming or biking.
  • Build bone strength. Calcium-rich foods, such as milk, yogurt and cheese, really can do your body good. Taking vitamin D supplements also can help.
  • Use night lights. Many broken toes are the result of walking in the dark.
  • Declutter your house. Keeping clutter off the floor can help you to avoid trips and falls.

Diagnosing a Broken Foot

During the physical exam, your doctor will check for points of tenderness in your foot. The precise location of your pain can help determine its cause. They may move your foot into different positions, to check your range of motion. You may be asked to walk for a short distance so that your doctor can examine your gait.

Imaging tests

If your signs and symptoms suggest a break or fracture, your doctor may suggest one or more of the following imaging tests.

  • X-rays. Most foot fractures can be visualized on X-rays. The technician may need to take X-rays from several different angles so that the bone images won’t overlap too much. Stress fractures often don’t show up on X-rays until the break actually starts healing.
  • Bone scan. For a bone scan, a technician will inject a small amount of radioactive material into a vein. The radioactive material is attracted to your bones, especially the parts of your bones that have been damaged. Damaged areas, including stress fractures, show up as bright spots on the resulting image.
  • Computerized tomography (CT). CT scans take X-rays from many different angles and combine them to make cross-sectional images of internal structures of your body. CT scans can reveal more detail about the bone and the soft tissues that surround it, which may help your doctor determine the best treatment.
  • Magnetic resonance imaging (MRI). MRI uses radio waves and a strong magnetic field to create very detailed images of the ligaments that help hold your foot and ankle together. This imaging helps to show ligaments and bones and can identify fractures not seen on X-rays.

Treating a Broken Foot

Treatments for a broken foot will vary, depending on which bone has been broken and the severity of the injury.

Medications

Your doctor may recommend an over-the-counter pain reliever, such as acetaminophen (Tylenol, others).

Therapy

After your bone has healed, you’ll probably need to loosen up stiff muscles and ligaments in your feet. A physical therapist can teach you exercises to improve your flexibility and strength.

Surgical and other procedures

  • Reduction. If you have a displaced fracture, meaning the two ends of the fracture are not aligned, your doctor may need to manipulate the pieces back into their proper positions — a process called reduction. Depending on the amount of pain and swelling you have, you may need a muscle relaxant, a sedative or even a general anesthetic before this procedure.
  • Immobilization. To heal, a broken bone must be immobilized so that its ends can knit back together. In most cases, this requires a cast.

    Minor foot fractures may only need a removable brace, boot or shoe with a stiff sole. A fractured toe is usually taped to a neighboring toe, with a piece of gauze between them.

  • Surgery. In some cases, an orthopedic surgeon may need to use pins, plates or screws to maintain proper position of your bones during healing. These materials may be removed after the fracture has healed if they are prominent or painful.

Preparing for your appointment for a Broken Foot

You will likely initially seek treatment for a broken foot in an emergency room or urgent care clinic. If the pieces of broken bone aren’t lined up properly for healing, you may be referred to a doctor specializing in orthopedic surgery.

What you can do

You may want to write a list that includes:

  • Detailed descriptions of your symptoms
  • Information about medical problems you’ve had
  • Information about the medical problems of your parents or siblings
  • All the medications and dietary supplements you take
  • Questions you want to ask the doctor

For a broken ankle or foot, basic questions to ask your doctor include:

  • What tests are needed?
  • What treatments are available, and which do you recommend?
  • If I need a cast, how long will I need to wear it?
  • Will I need surgery?
  • What activity restrictions will need to be followed?
  • Should I see a specialist?
  • What pain medications do you recommend?

Don’t hesitate to ask any other questions you have.

What to expect from your doctor

Your doctor may ask some of the following questions:

  • Was there a specific injury that triggered your symptoms?
  • Did your symptoms come on suddenly?
  • Have you injured your feet in the past?
  • Have you recently begun or intensified an exercise program?

What to do in the meantime

If your injury isn’t severe enough to warrant a trip to the emergency room, here are some things you can do at home to care for your injury until you can see your doctor:

  • Apply ice for 15 to 20 minutes at a time, every three to four hours to bring down the swelling.
  • Keep your foot elevated.
  • Don’t put any weight on your injured foot.
  • Lightly wrap the injury in a soft bandage that provides slight compression.

Broken Ankle (Fracture) Facts

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Article Featured on eMedicineHealth

What Is a Broken Ankle?

Ankle injuries are among the most common of the bone and joint injuries. Often, the degree of pain, the inability to walk, or concern that a bone may be broken is what usually causes people to seek care for an ankle injury. The main concern is whether there is a broken bone vs. an ankle sprain. Frequently it is difficult to distinguish a fracture (broken bone) over a sprain, dislocation, or tendon injury without X-rays of the ankle.

  • The ankle joint is made up of three bones that fit anatomically (articulate) together, the tibia, fibula, and talus (some medical experts also include the calcaneus bone and label the joint as the subtalar joint and consider it part of the ankle):
    • The tibia, the main bone of the lower leg, makes up the medial, or inside, ankle bone.
    • The fibula is a smaller bone that parallels the tibia in the lower leg and makes up the lateral, or outside, ankle bone.
    • The far ends of both the tibia and fibula are known as the malleoli (singular is malleolus). These malleoli are the lumps of bone that you can see and feel on the inside and outside of the ankle. Together they form an arch or mortise (a recess) that sits on top of the talus, one of the bones in the foot.
  • A fibrous membrane called the joint capsule, lined with a smoother layer called the synovium, encases the joint architecture. The joint capsule contains the synovial fluid produced by the synovium. The synovial fluid allows for smooth movement of the joint surfaces.
  • The ankle joint is stabilized by several groups of ligaments, which are fibers that hold these bones in place. They are the capsule ligament, deltoid ligament, the anterior and posterior talofibular ligaments, and the calcaneofibular ligament. Some of these ligaments may be disrupted if the ankle is fractured.

What Are the Signs and Symptoms of a Broken Ankle?

Signs and symptoms of ankle injuries and ankle fractures tend to be obvious.

  • Pain is the most common complaint.
    • Sometimes the pain will not come from the exact area of the fracture.
    • The person may experience associated foot fractures (especially on the side of the small toe) or knee that also cause pain similar to ankle pain.
    • It is usually pain in the ankle that stops individuals from walking.
  • Swelling frequently occurs around the ankle.
    • Swelling suggests either soft tissue damage with possible blood around the joint (hemarthrosis) or fluid within the joint itself, most likely blood.
  • A person may see bruising around the ankle joint, although not immediately. The bruising can track down toward the sole of the foot or toward the toes.
  • In severe fractures, there may be obvious deformities of bones around the ankle.
    • Skin may be stretched over an underlying broken bone.
    • Bone may be exposed.
  • If the ankle joint is dislocated, the foot and leg bones will be misaligned and will appear deformed.
  • If people injure nerves or blood vessels that supply the foot, there may be more pain along with pale skin in the foot, numbness, or an inability to move the foot or toes.

What Is the Difference Between Ankle Sprains and a Broken Ankle?

The difference between a broken ankle and a sprained ankle is that a fracture or break in the bone is necessary to have a broken ankle. Any crack, break, or chip in the anklebone is considered a fractured ankle. A sprained ankle is an injury where there is tear or disruption of the ligaments (the fibrous tissue that holds bone to bone in a joint). A severe injury to the ankle can consist of both a fracture and a sprain at the same time. Depending on the type and severity of the fracture or the sprain, the prognosis of a sprain may actually be worse than a fracture.

What Causes a Broken Ankle?

When a person stresses the ankle joint beyond the strength of its elements, the joint becomes injured.

  • If only the ligaments give way and tear, the damage is a sprained ankle.
  • If the ligaments that stabilize the joint are completely disrupted, the bones can come apart and the ankle can become dislocated.
  • If a bone gives way and breaks, the damage is an ankle fracture.
  • Fractured ankles can occur with simultaneous tears of the ligaments. This can happen in several ways:
    • Rolling the ankle in or out
    • Twisting the ankle side to side
    • Extreme flexing or extending of the joint
    • Severe force applied to the joint by coming straight down on it as in jumping from a high level

What Are the Types of Ankle Fractures?

The type of ankle fracture classification depends upon the location of the fracture and which bones of the ankle are fractured. There can be one bone injured, or multiple bones injured. The type and severity of the fracture will determine the treatment by the orthopedic surgeon; a classification list is as follows:

Lateral Malleolus Fracture

  • The lateral malleolus is the bump on the outer part of the ankle and is made up of the fibula bone.

Medial Malleolus Fracture

  • The medial malleolus is the bump on the inside of the ankle and is made up of the tibia bone.

Posterior Malleolus Fracture

  • The posterior malleolus is the bony prominence on the back side of the tibia, and is rarely injured on its own.

Bimalleolar Fractures

  • “Bi” means two, so two bones of the ankle are fractured with a bimalleolar fracture.
  • Most commonly the lateral malleolus and the medial malleolus are the bones that are fractured.
  • Bimalleolar fractures often make the ankle joint unstable.

Trimalleolar Fractures

  • “Tri” means three so in a trimalleolar fracture, all three malleoli (medial, lateral, and posterior) bones of the ankle are broken.
  • These are unstable injuries often caused by a large amount of force, disruption of the ligaments, or a dislocation.

Syndesmotic Injury

  • Also called “high ankle sprains.”
  • Usually a result of ankle eversion (outward twisting of the ankle joint).
  • May or may not be associated with an actual fracture of the bones of the ankle, but is often treated as a fracture.
  • May involve fracture of the fibula (outer bone in the lower leg) higher up in the calf near the knee (proximal) in severe ankle sprains, also called a Maisonneuve fracture.

There are other names for ankle injuries; however, most will fit into the general types listed above.

Which Type of Doctor Treats a Broken Ankle?

A broken ankle may be diagnosed by a general practitioner (family doctor, internist, pediatrician), or an emergency medicine doctor in a hospital. The patient may be referred to a podiatrist (foot specialist) or an orthopedic surgeon for the care and further treatment of the broken ankle depending on the severity of the injury or the need for possible surgery.

When Should You Call a Doctor If You Think That You Have A Broken Foot?

If a person has injured an ankle, contact a doctor or go to an emergency department. Seek medical treatment for an ankle injury in the following situations.

  • The person cannot bear weight on the ankle.
  • The pain remains intolerable despite using over-the-counter pain medications.
  • Home care fails to reduce the pain.
  • The foot or ankle becomes numb, partially numb, or pale.
  • A gross deformity of the ankle bones is present (this may indicate an ankle dislocation)
  • Open wound or bleeding over the injured area
  • Bones or bone fragments visible outside the ankle skin
  • Inability to move the toes
  • Inability to move the ankle
  • Cold or blue foot

How Is a Broken Ankle Diagnosed?

A doctor will evaluate the ankle to determine if there is an ankle fracture or if the joint has been damaged sufficiently to become unstable. Joint instability often suggests multiple fractures, a fracture with a ligament injury, ligament injury alone, or dislocation.

The doctor will seek a history of the injury and will ask questions to determine the possible fracture patterns.

  • Where does it hurt now?
  • How long ago did the injury happen?
  • Does the knee, shin, or foot hurt also?
  • How did the injury happen?
  • Did the ankle turn in or out?
  • Did the person hear a crack or a pop?
  • Was the person able to walk immediately after the injury?
  • Can the person walk now?
  • Does the person have any new numbness or tingling in their leg, ankle, or foot?
  • Has the person had previous ankle fractures, sprains, or surgeries on the injured ankle?

The doctor will perform a physical exam, looking for:

  • Evidence of bruising, abrasions, or cuts
  • Swelling, bleeding, and tissue damage
  • Pain, deformities, and the grinding or movement of broken bones of the knee, shin, ankle, and foot
  • Pain, excess looseness of a joint, or complete tear in ligaments
  • Fluid in the joint and joint stability
  • Seeking a pulse and looking for injured arteries
  • Testing sensation and movement in both the ankle and foot
  • Ankle X-rays if a broken bone is suspected; some doctors may try to avoid unnecessary and costly X-rays by following certain guidelines such as the Ottawa ankle rules (see reference 2)
  • X-rays of the knee, shin, or foot depending on where pain is; children may get a comparison X-ray of the uninjured ankle to see subtle changes in growth plates due to injury.

What Home Remedies and First Aid Methods Treat a Broken Foot at Home?

If a person suspects an ankle fracture, call a doctor or go to a hospital’s emergency department immediately. Until a person can get to a hospital or doctor’s office they may try the following:

  • Stay off the injured ankle to not to injure it further.
  • Keep the ankle elevated to help decrease swelling and pain.
  • Apply cold packs to the injured area to decrease swelling and pain. Do not apply ice directly. Cold packs are effective for the first 24 to 48 hours.
  • Ibuprofen (Advil, Motrin, etc.) is ideal for ankle injuries because it acts as both a pain medicine and a medicine to decrease inflammation.

What Is the Treatment for a Broken Ankle?

  • Doctors usually place a splint on the injured ankle for a few days to 2 weeks until the swelling decreases around the joint. The type of fracture and the stability of the fractured joint will determine the type of splint (cast or walking boot) that will be used, or whether surgery is needed.
  • Some minor ankle fractures do not require a splint or cast. In these cases the fracture will be managed as an ankle sprain.
    • Because these fractures are very small, they heal well with this management.
    • With any injured ankle, however, a person should not bear weight until advised to do so by a doctor or orthopedist.
  • After the swelling decreases and the patient is reexamined, an orthopedic doctor or a primary care doctor may place a better-fitting cast on the ankle. Depending on the type of fracture, the patient may be placed in a walking cast, which can bear some weight, or the patient may need a non-weight-bearing cast that will require the use of crutches to assist with walking.
  • Depending on the degree of pain, the doctor may prescribe pain medication. The patient should use the pain medication only as needed. Do not drive or operate heavy machinery while using these medications.

When Is Surgery Necessary for a Broken Foot?

Fractures that are severely displaced or may involve a dislocation will need to be realigned (reduced) in the emergency department. If the realignment is incomplete or if the underlying injury is severe, surgery is usually needed. If the fracture breaks through the skin (compound fracture), it will usually require surgery to clean the area thoroughly and limit the chance of infection.

Do You Need to Follow-Up with Your Doctor After the Ankle Has Been Treated?

Follow-up care for an ankle fracture depends on the severity of the fracture. Consultation with an orthopedist is recommended for most fractures. In some instances, a surgeon may need to be consulted, especially if there is any vascular compromise or deformity due to the fracture.

  • The patient may need emergency surgery, next-day follow-up, or follow-up in 1-2 weeks with an orthopedic doctor.
  • The patient may require follow-up with a family doctor.
    • If the patient’s injured ankle was splinted on the initial visit, he or she will probably need to have a cast placed on the ankle during the follow-up visit.
    • Recovery time varies depending upon the type of fracture or need for surgery. The average fracture requires 4-8 weeks for the bone to heal.
    • With severe ankle injuries, the doctor may recommend physical therapy for rehabilitation after the acute phase of healing.

What Is the Recovery Time for a Broken Ankle?

Most simple fractures heal well with immobilization and non-weight-bearing activity. Complex fractures may have good to fair outcomes, depending on the severity of the fracture(s), the effect of rehabilitation on function and the development of arthritis.

  • Patients can expect recovery from most ankle fractures, depending on how severe they are, to take 4-8 weeks for the bones to heal completely and up to several months to regain full use and range of motion of the joint.
  • More severe fractures, especially those requiring surgical repair, will take longer to heal; some may need implanted supports (metal rod or plate and screws) that may be removed later or left in place.
  • Fractures of any type increase the likelihood of developing arthritis in the affected joint. The more severe the fracture, the higher the risk of developing some degree of arthritis.

How Can a Broken Ankle Be Prevented?

Preventing ankle fractures can be difficult.

  • Many occur as “slip and fall” incidents. Being careful in activities is the best prevention.
  • Proper footwear when participating in sports also may reduce ankle fracture risk.
  • Splints, braces, or taping of a previously injured ankle may decrease the possibility of further injury or fracture.
  • Maintenance of strength of the muscles that stabilize ankle is an important part of prevention of ankle injuries.

 

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Adult Forearm Fractures

Adult Forearm Fractures

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Article Featured on AAOS

Your forearm is made up of two bones, the radius and ulna. In most cases of adult forearm fractures, both bones are broken.

Fractures of the forearm can occur near the wrist at the farthest (distal) end of the bone, in the middle of the forearm, or near the elbow at the top (proximal) end of the bone. This article focuses on fractures that occur in the middle segments of the radius and ulna. Fractures that involve the wrist or the elbow are discussed in separate articles.

Anatomy

If you hold your arms at your side with your palms facing up, the ulna is the bone closest to your body and the radius is closest to your thumb. The ulna is larger at the elbow — it forms the “point” of your elbow — and the radius is larger at the wrist.

The primary motion of the forearm is rotation: the ability to turn our palms up or down. The ulna stays still while the radius rotates around it. This is the motion used to turn a screwdriver or twist in a light bulb. Forearm fractures can affect your ability to rotate your arm, as well as bend and straighten the wrist and elbow.

Description

Forearm bones can break in several ways. The bone can crack just slightly, or can break into many pieces. The broken pieces of bone may line up straight or may be far out of place.

Fractures of both the radius and ulna.

Fractures of both the radius and ulna.

In some cases, the bone will break in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone. This is called an open fracture and requires immediate medical attention because of the risk for infection.

Because of the strong force required to break the radius or ulna in the middle of the bone, it is more common for adults to break both bones during a forearm injury. When only one bone in the forearm is broken, it is typically the ulna — usually as a result of a direct blow to the outside of your arm when you have it raised in self defense.

Related Articles

DISEASES & CONDITIONS

Fractures (Broken Bones)

TREATMENT

Internal Fixation for Fractures

RECOVERY

Care of Casts and Splints

DISEASES & CONDITIONS

Distal Radius Fractures (Broken Wrist)

Cause

The most common causes of forearm fractures include:

  • Direct blow
  • Fall on an outstretched arm, often during sports or from a height
  • Automobile/motorcycle accidents

Symptoms

A broken forearm usually causes immediate pain. Because both bones are usually involved, forearm fractures often cause an obvious deformity — your forearm may appear bent and shorter than your other arm. You will most likely need to support your injured arm with your other hand.

Additional symptoms include:

  • Swelling
  • Bruising (not as common as in other broken bones)
  • Inability to rotate arm
  • Numbness or weakness in the fingers or wrist (rare)

Doctor Examination

Most people with forearm fractures will go to an urgent care center or emergency room for initial treatment.

Physical Examination and Medical History

It is important that your doctor knows the circumstances of your injury. For example, if you fell from a ladder, how far did you fall? It is just as important for your doctor to know if you sustained any other injuries and if you have any other medical problems, such as diabetes. Your doctor also needs to know if you take any medications.

After discussing your symptoms and medical history, your doctor will do a careful examination. Your doctor will:

  • Examine your skin to see if there are any cuts from the injury. Bone fragments can break through the skin and create lacerations. This leads to an increased risk for infection.
  • Palpate (feel) all around your arm to determine if there are any other areas of tenderness. This can indicate other broken bones or injuries.
  • Check your pulse at the wrist to be sure that good blood flow is getting through your forearm to your hand.
  • Check to see if you can move your fingers and wrist, and can feel things with your fingers. Sometimes, nerves may be injured at the same time that the bone is broken, which can result in hand and wrist weakness and numbness.
  • The doctor may examine your shoulder, upper arm, elbow, wrist, and hand, even if you only complain of arm pain.

X-rays

X-rays are the most common and widely available diagnostic imaging technique. X-rays can show if the bone is broken and whether there is displacement (the gap between broken bones). They can also show how many pieces of broken bone there are.

Treatment

Treatment of broken bones follows one basic rule: the broken pieces must be put back into position and prevented from moving out of place until they are healed. Because the radius and ulna rely on each other for support, it is important that they are properly stabilized. If the bones are not accurately aligned during healing, it may result in future problems with wrist and elbow movement.

Most cases of adult forearm fractures require surgery to make sure the bones are stabilized and lined up for successful healing.

Immediate Treatment

While you are in the emergency room, the doctor may try to temporarily realign the bones, depending upon how far out of place the pieces are. “Reduction” is the technical term for this process in which the doctor moves the pieces into place. This is not a surgical procedure. Your pain will be controlled with medication. Afterward, your doctor will apply a splint (like a cast) to your forearm and provide a sling to keep your arm in position. Unlike a full cast, a splint can be tightened or loosened, and allows swelling to occur safely.

forearm fracture splint application

The emergency room doctor may apply a splint to protect your arm.

Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

It is very important to control the movement of a broken bone. Moving a broken bone can cause additional damage to the bone, nearby blood vessels, and nerves or other tissues surrounding the bone.

Additional immediate treatment will include applying ice to help reduce swelling, and providing you with pain medicine.

Nonsurgical Treatment

If only one bone is broken and it is not out of place, it may be possible to treat it with a cast or brace. Your doctor will closely monitor the healing of the fracture, and have you return to the clinic for x-rays frequently. If the fracture shifts in position, you may require surgery to put the bones back together.

Surgical Treatment

When both forearm bones are broken, or if the bones have punctured the skin (open fracture), surgery is usually required.

Because of the increased risk for infection, open fractures are usually scheduled for surgery immediately. Patients are typically given antibiotics by vein (intravenous) in the emergency room, and may receive a tetanus shot. During surgery, the cuts from the injury will be thoroughly cleaned out. The broken bones are typically fixed during the same surgery.

If the skin around your fracture has not been broken, your doctor may recommend waiting until swelling has gone down before having surgery. Keeping your arm immobilized and elevated for several days will decrease swelling. It also gives skin that has been stretched a chance to recover.

Open reduction and internal fixation with plates and screws. This is the most common type of surgical repair for forearm fractures. During this type of procedure, the bone fragments are first repositioned (reduced) into their normal alignment. They are held together with special screws and metal plates attached to the outer surface of the bone.

forearm fracture fixation with plates and screws

The broken bones of the forearm are held in position by plates and screws while they heal.

Open reduction and internal fixation with rods. During this procedure, a specially designed metal rod is inserted through the marrow space in the center of the bone.

External fixation. If the skin and bone are severely damaged, using plates and screws and large incisions may injure the skin further. This may result in infection. In this case, you may be treated with an external fixator. In this type of operation, metal pins or screws are placed into the bone above and below the fracture site. The pins and screws are attached to a bar outside the skin. This device is a stabilizing frame that holds the bones in the proper position so they can heal.

Complications

Complications from Forearm Fractures

Forearm fractures can cause further injury and complications.

  • The ends of broken bones are often sharp and can cut or tear surrounding blood vessels or nerves.
  • Excessive bleeding and swelling right after the injury may lead to acute compartment syndrome, a condition in which the swelling cuts off blood supply to the hand and forearm. It typically occurs within 24 to 48 hours of the injury and causes severe pain when moving the fingers. Compartment syndrome can result in loss of sensation and function, and requires emergency surgery once it is diagnosed. In such cases, the skin and muscle coverings are opened and left open to relieve pressure and allow blood to return.
  • Open fractures expose the bone to the outside environment. Even with good surgical cleaning of the bone and muscle, the bone can become infected. Bone infection is difficult to treat and often requires multiple surgeries and long-term antibiotics.

Complications from Surgery

There are risks associated with all surgery. If your doctor recommends surgery, he or she thinks that the possible benefits of surgery outweigh the risks.

  • Infection. There is a risk of infection with any surgery, whether it is for a forearm fracture or another purpose.
  • Damage to nerves and blood vessels. There is a minor risk of injury to nerves and blood vessels around the forearm. Although some temporary numbness is common right after your injury, if you experience persistent numbness or tingling in your fingers, contact your doctor.
  • Synostosis. Another rare complication is healing between the two bones of the forearm with a bridge of bone known as synostosis. This can decrease the rotation of the bones and prevent full movement.
  • Nonunion. Surgery does not guarantee healing of the fracture. A fracture may pull apart, or the screws, plates, or rods may shift or break. This can occur for a variety of reasons, including:
    • The patient does not follow directions after surgery.
    • The patient has other health issues that slow healing. Some diseases, like diabetes, slow healing. Smoking or using other tobacco products also slow healing.
    • If the fracture was associated with a cut in the skin (an open fracture), healing is often slower.
    • Infections can also slow or prevent healing.

If the fracture fails to heal, further surgery may be needed.

Recovery

Bones have a remarkable capacity to heal. Forearm bones typically take 3 to 6 months to fully heal. The more severe your injury, however, the longer your recovery may be.

Pain Management

Pain after an injury or surgery is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover faster.

Medications are often prescribed for short-term pain relief after surgery or an injury. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.

Be aware that although opioids help relieve pain after surgery or an injury, they are a narcotic and can be addictive.  It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your treatment.

Rehabilitation

Nonsurgical treatment. Rehabilitation typically begins after a few weeks of keeping the arm still by using a cast or brace. In many cases, a physical therapist will help with rehabilitation, beginning with gentle exercises to increase range of motion, and gradually adding exercises to strengthen the arm.

Surgical treatment. Depending on the complexity of the fracture and the stability of the repair, a cast or brace may be necessary for 2 to 6 weeks after surgery. Motion exercises for the forearm, elbow, and wrist usually begin shortly after surgery. This early motion is important to prevent stiffness. Your doctor may also prescribe visits to a physical or occupational therapist, depending on how long your arm was immobilized.

Outcome

Some stiffness after healing is common, but this does not usually affect the overall function of your arm.

Your doctor will advise you on when you may return to work and sports activities. This varies depending on the fracture pattern and the type and stability of the repair.

If you have had surgery, the plates and screws are usually left in place forever. If you consider removal, this second surgery is typically not scheduled until your bones have fully solidified (1 to 2 years after initial surgery)

Forearm Fractures in Children

Forearm Fractures in Children

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Article Featured on AAOS

Anatomy

The bones of the forearm.

The forearm is made up of two bones: the radius and the ulna. The radius is on the “thumb side” of the forearm, and the ulna is on the “pinky finger side.”
The bones of the forearm
Growth plates are areas of cartilage near the ends of the long bones in children and adolescents. The long bones of the body do not grow from the center outward. Instead, growth occurs at each end of the bone around the growth plate. When a child is fully grown, the growth plates harden into solid bone. Both the radius and the ulna have growth plates.

Description

Fractures can occur in one or both bones of the forearm, and in a number of places along the bone:

  • Near the wrist, at the farthest (distal) end of the bone
  • In the middle of the forearm
  • Near the elbow, at the top (proximal) end of the bone

Fractures in the radius and ulna

Fractures in both bones of the forearm.

There are several types of forearm fractures in children:

  • Torus fracture. This is also called a “buckle” fracture. The topmost layer of bone on one side of the bone is compressed, causing the other side to bend away from the growth plate. This is a stable fracture, meaning that the broken pieces of bone are still in position and have not separated apart (displaced).
  • Metaphyseal fracture. The fracture is across the upper or lower portion of the shaft of the bone and does not affect the growth plate.
  • Greenstick fracture. The fracture extends through a portion of the bone, causing it to bend on the other side.
  • Galeazzi fracture. This injury affects both bones of the forearm. There is usually a displaced fracture in the radius and a dislocation of the ulna at the wrist, where the radius and ulna come together.
  • Monteggia fracture. This injury affects both bones of the forearm. There is usually a fracture in the ulna and the top (head) of the radius is dislocated. This is a very severe injury and requires urgent care.
  • Growth plate fracture. Also called a “physeal” fracture, this fracture occurs at or across the growth plate. In most cases, this type of fracture occurs in the growth plate of the radius near the wrist. Because the growth plate helps determine the future length and shape of the mature bone, this type of fracture requires prompt attention.

Cause

Children love to run, hop, skip, jump and tumble, all of which are activities that could potentially result in a fracture to the forearm should an unexpected fall occur. In most cases, forearm fractures in children are caused by:

  • A fall onto an outstretched arm
  • A fall directly on the forearm
  • A direct blow to the forearm

Symptoms

A forearm fracture usually results in severe pain. Your child’s forearm and hand may also feel numb, a sign of potential nerve injury.

Doctor Examination

Physical Examination

After discussing your child’s symptoms and medical history, your doctor will perform a careful examination of your child’s arm to determine the extent of the injury. He or she will look for:

  • Deformity about the elbow, forearm, or wrist
  • Tenderness
  • Swelling
  • An inability to rotate or turn the forearm

During the physical examination, your doctor will also test to make sure that the nerves and circulation in your child’s hand and fingers have not been affected.

Forearm fracture

This child’s forearm fracture has resulted in a bent appearance of the forearm.
Courtesy of Texas Scottish Rite Hospital for Children

X-Rays

X-rays provide clear images of dense structures such as bones. Because the hand, wrist, arm, and elbow can all be injured during a fall on an outstretched arm, your doctor may order x-rays of the elbow and wrist, as well as the forearm, to determine the extent of the injury.

Treatment

Treatment for forearm fractures depends on the type of fracture and the degree of displacement. Your doctor will use one of the following treatments, or a combination of both, to treat a forearm fracture.

Nonsurgical Treatment

Some stable fractures, such as buckle fractures, may simply need the support of a cast or splint while they heal.

For more severe fractures that have become angled, the doctor may be able to manipulate or gently push the bones into place without surgery. This procedure is called a closed reduction. Afterward, the arm is immobilized in a cast or splint while it heals.

Forearm cast

Casts support and protect broken bones while they heal.
Reproduced from Pring M, Chambers H: Pediatric forearm fractures. Orthopaedic Knowledge Online Journal 2007; 5(5). Accessed October 2014.

Surgical Treatment

In some cases, surgery is needed to align the pieces of bone and secure them in place. Your doctor may recommend surgery if:

  • The bone has broken through the skin—this type of injury (called an open fracture) is at risk for infection and requires specific treatment
  • The fracture is unstable—the ends of the broken bones will not stay lined up
  • Bone segments have been displaced
  • The bones cannot be aligned properly through manipulation alone
  • The bones have already begun to heal at an angle or in an improper position

During surgery, your doctor will open the skin and reposition the broken bone fragments (a procedure called an open reduction). Your doctor may use pins, metal implants, or a cast to hold the broken bones in place until they have healed.

Internal fixation of forearm fractures

In these x-rays, fractures in both the radius and the ulna have been repaired with plates and screws.

Reproduced from Pring M, Chambers H: Pediatric forearm fractures. Orthopaedic Knowledge Online Journal 2007; 5(5). Accessed October 2014.

Recovery

The length of time the cast is worn will vary depending on the severity of the fracture. A stable fracture, such as a buckle fracture, may require 3 to 4 weeks in a cast. A more serious injury, such as a Monteggia fracture, may need to be immobilized for 6 to 10 weeks.

When the cast is removed, the wrist and elbow joints may be stiff for 2 to 3 weeks. This stiffness will go away on its own, usually without the need for physical therapy.

For a short period of time, the forearm bones may be weaker due to immobilization in the cast. To allow the bones to safely regain their normal strength, the child should avoid playing on playground structures, such as monkey bars, for 3 to 4 weeks after the cast is removed.

If the fracture disrupts the growth plate at the end of the bone, it could affect the development of the bone. Your doctor may recommend follow-up visits for up to one year to ensure that growth is proceeding normally.

Statistical data in this article was reviewed by the AAOS Department of Research and Scientific Affairs.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

How to Tell if Your Toe is Broken

How to Tell if Your Toe is Broken

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Is it a sprain or a break?

If you’ve ever stubbed your toe hard, the immediate, severe pain can leave you wondering if your toe is broken. In many cases, the injury winds up being a sprain. This is painful, but it means the bone itself is still intact.

If the toe bone breaks into one or more pieces, then you have a broken toe.

Learning to recognize the symptoms and treatment of a broken toe is important. If a broken toe is left untreated, it can lead to problems that may affect your ability to walk and run. A poorly treated broken toe may also leave you in a lot of pain.

Symptoms of a Broken Toe

Throbbing pain in the toe is the first sign that it may be broken. You may also hear the bone break at the time of injury. A broken bone, also called a fracture, may also cause swelling at the break.

If you’ve broken your toe, the skin near the injury may looked bruised or temporarily change color. You’ll also have difficulty putting any weight on your toe. Walking, or even just standing, can be painful. A bad break can also dislocate the toe, which can cause it to rest at an unnatural angle.

A sprained toe shouldn’t look dislocated. It will still swell, but will likely have less bruising. A sprained toe may be painful for several days, but should then begin to improve.

One other key difference between a break and a sprain is the location of the pain. Usually a break will hurt right where the bone has fractured. With a sprain, the pain may be felt in a more general area around the toe.

The only way to tell for sure if the injury is a break or a sprain is to see your doctor. They can examine your toe and determine the type of injury.

Causes

The two most common causes of a broken toe are stubbing it into something hard or having something heavy land on it. Going barefoot is a major risk factor, especially if you’re walking in the dark or in an unfamiliar environment.

If you carry heavy objects without proper foot protection, such as thick boots, you’re also at a higher risk for a broken toe.

What to expect when you see your doctor

A broken toe can usually be diagnosed with the use of an X-ray. If the pain and discoloration don’t ease up after a few days, you should definitely see your doctor.

A broken toe that doesn’t heal properly could lead to osteoarthritis, a painful condition that causes chronic pain in one or more joints.

Your doctor will examine your toe and ask for your medical history. Tell your doctor as many details as you can about the injury and your symptoms. Be sure to tell your doctor if you notice a loss of feeling or tingling in your toe. This could be a sign of nerve damage.

If there’s a chance the toe is broken, your doctor will likely want to get one or more X-rays of the injured toe. Getting images from different angles is important to understand the extent of the break.

Information from the X-ray will also help your doctor decide whether surgery is necessary.

Treatment of a Broken Toe

With most cases of a broken toe, there’s little your doctor can do. It’s mostly up to you to rest your toe and keep it stable.

Even before you know whether your toe is broken, you should ice the injured toe and keep it elevated. You may also take over-the-counter painkillers, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve).

If you have surgery to repair the toe, your doctor may prescribe stronger pain medicines.

Splinting your toe

Typical treatment for a broken toe is called “buddy taping.” This involves taking the broken toe and carefully securing it to the toe next to it with medical tape. Usually, a gauze pad is placed between the toes to prevent skin irritation.

The non-broken toe is basically used as a splint to help keep the broken toe from moving too much. By taping the broken toe to its neighbor, you give the injured toe the support it needs to begin healing.

Surgery and additional treatment options

More serious breaks may require additional treatment. If you have bone fragments in the toe that need to heal, taping may not be enough.

You may be advised to wear a walking cast. This helps keep the injured toe stable while also giving your foot enough support to reduce some of the pain you may have while walking.

In very serious cases, surgery may be necessary to reset the broken bone or bones. A surgeon can sometimes put a pin or a screw into the bone to help it heal properly. These pieces of hardware will remain in the toe permanently.

Your toe is likely to be tender and swollen, even after a few weeks. You’ll likely need to avoid running, playing sports, or walking long distances for one to two months after your injury.

Recovery time can be longer if the break is in one of the metatarsals. The metatarsals are the longer bones in the foot that connect to the phalanges, which are the smaller bones in the toes.

Your doctor can give you a good estimate of recovery time based on the severity and location of your injury. A mild fracture, for example, should heal faster than a more severe break.

With a walking cast, you should be able to walk and resume most non-strenuous activities within a week or two after injuring your toe. The pain should diminish gradually if the bone is healing properly.

If you feel any pain in your broken toe, stop the activity that’s causing the pain and tell your doctor.

Outlook

The key to a good outcome is following through on your doctor’s advice. Learn how to tape your toe properly so you can change the tape regularly.

Carefully try to put more pressure on your broken toe each day to see how it’s recovering. Take any slight improvements in pain and discomfort as signs that your injury is healing.

Tips for recovery

Here are some things you can do to improve your recovery.

Footwear

You may temporarily need a bigger or wider shoe to accommodate your swollen foot. Consider getting a shoe with a hard sole and a lightweight top that will put less pressure on the injured toe, but still provide plenty of support.

Velcro fasteners that you can easily adjust can provide additional comfort.

Ice and elevation

Continue to ice and elevate your foot if your doctor recommends it. Wrap the ice in a cloth so that it doesn’t come into direct contact with your skin.

Take it slow

Ease back into your activities, but listen to your body. If you sense that you’re putting too much weight or stress on the toe, back off. It’s better to have a longer recovery and avoid any painful setbacks than to rush back into your activities too quickly.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

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