Bone Fractures and Dislocations

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Our team of professionals and staff believe that informed patients are better equipped to make decisions regarding their health and well-being. For your personal use, we have created an extensive patient library covering an array of educational topics, which can be found on the side of each page. Browse through these diagnoses and treatments to learn more about topics of interest to you. Or, for a more comprehensive search of our entire website, enter your term(s) in the search bar provided below.

As always, you can contact our office to answer any questions or concerns.

 

Spine

Spinal cord and nerves. These "electrical cables" travel through the spinal canal carrying messages between your brain and muscles. Nerve roots branch out from the spinal cord through openings in the vertebrae (foramen).

Intervertrebral disks. In between your vertebrae are flexible intervertebral disks. They act as shock absorbers when you walk or run.

Intervertebral disks are flat and round and about a half inch thick. They are made up of two components:

  • Annulus fibrosus. This is the tough, flexible outer ring of the disk.
  • Nucleus pulposus. This is the soft, jelly-like center of the disk.                                                                                                                                                                                                                                                                                                                     

    Cervical radiculopathy most often arises from degenerative changes that occur in the spine as we age or from an injury that causes a herniated, or bulging, intervertebral disk.

    Degenerative changes. As the disks in the spine age, they lose height and begin to bulge. They also lose water content, begin to dry out, and become stiffer. This problem causes settling, or collapse, of the disk spaces and loss of disk space height.

    (Left) Side view of a healthy cervical vertebra and disk. (Right) A disk that has degenerated and collapsed.

    As the disks lose height, the vertebrae move closer together. The body responds to the collapsed disk by forming more bone —called bone spurs—around the disk to strengthen it. These bone spurs contribute to the stiffening of the spine. They may also narrow the foramen—the small openings on each side of the spinal column where the nerve roots exit—and pinch the nerve root.

    Degenerative changes in the disks are often called arthritis or spondylosis. These changes are normal and they occur in everyone. In fact, nearly half of all people middle-aged and older have worn disks and pinched nerves that do not cause painful symptoms. It is not known why some patients develop symptoms and others do not.

    Herniated disk (side view and cross section)

    Herniated disk. A disk herniates when its jelly-like center (nucleus) pushes against its outer ring (annulus). If the disk is very worn or injured, the nucleus may squeeze all the way through. When the herniated disk bulges out toward the spinal canal, it puts pressure on the sensitive nerve root, causing pain and weakness in the area the nerve supplies.

    A herniated disk often occurs with lifting, pulling, bending, or twisting movements.

    Symptoms

    In most cases, the pain of cervical radiculopathy starts at the neck and travels down the arm in the area served by the damaged nerve. This pain is usually described as burning or sharp. Certain neck movements—like extending or straining the neck or turning the head—may increase the pain. Other symptoms include:

  • Tingling or the feeling of "pins and needles" in the fingers or hand
  • Weakness in the muscles of the arm, shoulder, or hand
  • Loss of sensation
  • Some patients report that pain decreases when they place their hands on top of their head. This movement may             temporarily relieve pressure on the nerve root.

Fractures

A fracture is the medical term for a broken bone. There are 206 bones in an adult's body, more than half of which reside in the hands and feet. Most people will fracture a bone once or twice in a lifetime. A fracture occurs when too much force is exerted on a bone, usually from an accident or fall. Because our bones get brittle as we age, there is a higher incidence of fractures among the elderly. Children also experience more fractures, but because their bones are more supple, these breaks are usually less complicated and heal relatively quickly.

Fractures are characterized as either displaced or non-displaced and as either closed or open. A displaced fracture occurs when the bone breaks into two or more parts. A non-displaced fracture occurs when the bone cracks, but maintains its proper position and alignment. A closed fracture means that there is no puncture or open wound on the skin whereas an open fracture refers to a bone that breaks through the surface of the skin.

There are a number of different types of fractures. The most common include:

  • Simple Fracture — where the bone breaks into two pieces.
  • Stress Fracture — a hairline break that is usually caused by repetitive motion or overuse, like running.
  • Comminuted Fracture — where the bone breaks into multiple pieces.
  • Compound Fracture — also known as an open fracture, where the bone protrudes through the skin.
  • Complete Fracture — where the bone breaks cleanly into two or more pieces.
  • Incomplete Fracture — also known as a closed fracture, where the bone cracks but doesn’t break.

The seriousness of a fracture depends upon the person’s age and the location and nature of the fracture. In many cases, the break does damage to the surrounding soft tissue as well as the bone. It is critical to get the bone back into its proper alignment as quickly as possible, so you should always seek immediate medical attention if you suspect you have a fracture.

When a fracture first occurs, the broken bone should be immobilized from an area above to an area below the break, if needed using a splint or sling. Apply ice to limit pain and swelling and seek immediate medical attention. X-rays will be used to help diagnose the fracture and determine the best treatment for your specific condition.

Treatment for a fracture usually entails a period of immobilization via a splint or cast. In severe cases, surgery may be needed to realign the bone. In these cases, it is common for pins, rods, screws or plates to be used to help keep the bone in its proper position.

Rehabilitation through physical therapy is an important part of healing from a fracture. Depending on the location and severity of the break, a short period of rest and immobilization is followed by a period of light movement and exercise using the surrounding muscle and tissue to strengthen the bone and prevent stiffness. The physical therapy treatment plan will likely include at-home exercises to ensure that the individual can conduct activities of daily living and to keep all body parts fully functioning. Over time, the exercises are escalated to include more strengthening and resistance exercises to regain range of motion and rebuild muscle strength.

In cases of stress fractures, the combination of rest and rehabilitation are coupled with education to teach the person basic body mechanics and ways to prevent future injury.

Dislocation

A dislocation, also known as luxation, can be difficult to distinguish from a fracture because the initial symptoms appear to be the same. With dislocations, instead of a bone breaking, the bones in a joint separate, moving out of their natural position. A dislocation often impacts the surrounding ligaments, tendons and muscles. They can be very painful and are frequently seen in people who play contact sports.

Dislocations are predominantly caused by a trauma, fall or blow. In some cases, they can be caused by disease, such as rheumatoid arthritis. They most commonly occur in the shoulder or hands, but also happen in the hip, knee, elbow, ankle, fingers and toes. Symptoms includes intense pain, swelling and bruising, limited movement and a joint that is visibly out of place.

It is important to seek immediate medical attention for a joint dislocation. It is also important not to move the joint from its dislocated position. The joint should be immobilized with a splint or sling and ice can be applied to reduce swelling. Do not under any circumstances attempt to move the joint back into its proper position.

At the medical facility, a physician will perform some maneuvers to move the joint back into its proper position. In some cases, the dislocation damages the surrounding ligaments, blood vessels or nerves and may require surgery.

Rehabilitation is longer for dislocations than for fracture. Generally, the first several weeks the joint is immobilized. Then rehabilitation begins to restore range of motion and rebuild joint strength and stability. The physical therapist will slowly progress to more resistance exercises to regain normal joint strength.