Fractures

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About lower limb fractures

Fractures are breaks or cracks in the bone. The bone may fracture crossways or lengthways. It may break in one place or several places. You may experience a clean break or the bone may fracture into many pieces. An open fracture is one where the bone pokes out of the skin. Closed fractures do not break through the skin.

Common fractures of the lower limbs affect the hips, knees, tibia and ankle. They include:

  • Fractured patella (kneecap) – this may occur as the result of a heavy blow to the knee, a collision or a fall. If the bones are weakened due to osteoporosis a fractured knee can develop from something as simple as missing your footing. The kneecap may crack or break into several pieces. If the fracture is displaced the broken pieces will become separated. This requires surgery to repair it. Repairing an open fracture (where the skin is broken) is a complex procedure with a risk of infection. Comminuted knee fractures are those where the bone is shattered into three pieces or more.
  • Hip fractures – these are serious injuries with potentially life-threatening complications. The risk of hip fractures increases with age as bones tend to weaken as people become older due to osteoporosis. Older people are more prone to falls due to becoming more unstable on their feet, as well as problems with eyesight and cognition. Certain medication and chronic health conditions can also lead to weakened bones and an increased risk of hip fracture. A sedentary lifestyle can also reduce bone density, leading to weaker bones.

Fractures are normally caused by a heavy impact or fall, or the bone being subjected to greater pressure than it can withstand. The symptoms that could indicate a fracture include:

  • Intense pain which may make you feel dizzy or cause you to faint.
  • Hearing a snap or grinding sound at the time of injury.
  • Signs of shock including feeling chilled and/or shaking.
  • Visible deformity or seeing the bone poking through the skin.
  • Being unable to put any weight on the injured limb.
  • Swelling, redness and a feeling of heat around the injury.

It is important to get a prompt diagnosis if a fracture is suspected as continuing to use a fracture limb could worsen the injury. Depending on the location and type of the suspected fracture, a number of different diagnostic techniques may be used including:

  • Physical examination to check for pain, swelling and deformity around the injury site.
  • An X-ray is used to view the bones and other structures of the body. It is quick and painless.
  • CT (computerised tomography) scans use X-rays and a computer to create detailed images of the inside of the body including the bones, blood vessels and internal organs.

The treatment you receive will depend on the type and severity of the fracture. It might include:

  • Splints or a cast to keep the bone immobile while it heals. This generally takes between six to eight weeks, during which time you will need to avoid putting weight on the injured area. You may need to use crutches for walking.
  • Surgery to repair the fracture. This is normally for fractures where the bone is broken in several places or the pieces have become displaced. If the pieces are too far apart, the bone may not heal properly without surgery. Open fractures require emergency surgery. If the skin is not broken the surgeon may wait until any bruising has healed before operating.
  • Internal repair using a metal plate attached to the bone with screws, wires and pins. This approach may be used to secure broken pieces of bone and hold them in place while the fracture heals.
  • Comminuted fractures of the kneecap may require a surgical procedure that involves attaching small piece of bone and loose tendon to whatever remains of the patellar bone. Screws and wires may be used to hold the bone in place. In rare cases, the kneecap may have to be removed.
  • Partial hip replacement – This involves removing the head and neck of the thighbone and inserting a metal replacement. It is normally recommended if the broken bones are damaged or displaced.
  • Total hip replacement – This involves replacing the upper thighbone and hip socket with a prosthetic implant. It is normally recommended for major hip fractures and severe osteoarthritis.
  • Maintaining a healthy body weight can help avoid putting too much strain on the lower limbs.
  • Regular exercising can help to strengthen muscles and maintain flexibility, which may help to prevent knee injuries.
  • Low impact sports, such as swimming and water aerobics, can help to avoid putting strain on lower limbs, particularly if you have osteoarthritis.
  • Good technique, correct footwear and wearing appropriate protective equipment can all help to prevent injury during sport.
  • Getting enough calcium and vitamin D can help to maintain strong, healthy bones.
  • If you are unsteady on your feet, a walking stick or frame may help to increase your stability and help prevent falls.  It is a good idea to assess your home for trip hazards, such as rugs, electric cables and excess clutter.

Whatever your age, our expertise can help you feel healthy, active and pain-free again.