A closed fracture is a broken bone that does not break through the skin. There are four commonly seen closed fractures. These fractures include wrist fractures, hip fractures, ankle fractures and spinal compression fractures. Hip fractures and spinal compression are often seen in the elderly. Fractures require emergency treatment. If neck, back or hip injury is suspected or if there is exposed bone do not move the person.
Diagnosis of fractures can generally be made through physical examination and x-rays. A compression fracture or a wrist fracture may not show on an x-ray. In this case, a CT or MRI can be used to locate the fracture. Often, the fracture will only be immobilized and a repeat x-ray done in 10-14 days when the healing makes the fracture more visible. With a skull fracture, a CT may be done, rather than an x-ray, to determine if there is brain injury secondary to the fracture.
Factors that predispose bones to fractures are:
- Advanced age
- Endocrine and GI issues
- prolonged use of steroids
- smoking and alcohol
Treatment of these fractures is dependent on the severity and can include the following:
- Cast, sling or walking boot for immobilization
- External fixation – intervention used with traumatic soft tissue injury and open fracture
- Internal fixation – Surgical intervention with placement of pins, screws, plates, or rods.
Additional treatment includes medications for pain and to prevent infection.
A cast or other form of immobilization is meant to hold the bones in proper alignment and to provide protection from additional injury. Reduction is when the bone is set back in place to heal. Some fractures are realigned and held in place through internal fixation or external fixation. External fixation is a way to hold fragments of fractured bone together using metal pins with a compression device attached on the surface of the skin.
External fixation is used when:
- there is an open fracture with soft tissue damage
- fractures with deficient bone (osteoporosis)
Rehabilitation begins right away because long-term immobilization causes muscles to become stiff. It takes 4 to 6 weeks to heal depending on the severity of the fracture and surrounding damage. Physical Therapy begins rehabilitation and has several goals.
The goals of Physical Therapy include:
- promoting circulation
- preventing clots
- enhances the healing process
- Once the cast is removed, exercise in a pool is beneficial and promotes mobility. The water also relaxes muscles making movement easier.
Treatment of closed fractures is highly dependent on age, patient preference and surgeon preference.