Symptoms

What does it feel like to have a fracture?

A broken bone is a major event and will dominate your life for some time to come. The symptoms you experience are seen by the doctors as clues to what is wrong and what to do about it. You see these same symptoms as problems that should be improved by treatment. Because some of the symptoms get better with time and are not much affected by treatment it is easy to feel that they are being ignored or under-appreciated.

Pain

Pain is the hallmark of broken bones. When you are first seen by a doctor you will be asked about the pain, where it is, when did it start, what were the circumstances of the injury, what makes the pain worse etc. The answers to these questions help the doctor decide which parts to x-ray. When a patient is unconscious and cannot tell the doctors where it hurts, it is more difficult to find all the fractures.

But the pain continues. It hurts all the time, even at rest and even after treatment has put the bone straight and supported it in a cast. The process of healing begins with inflammation so some on-going pain and constant, deep-seated throbbing is almost always present. The ever-present pain is increased by moving the fracture – the raw bone ends are then moving against each other and into the surrounding tissue. Bearing weight through the bone also increases the pain as does contracting any muscles that go across the fracture. The muscles themselves hurt because they are injured and there is usually a great degree of bruising (contusion) which is also painful.

Pain is treated by medication, by splinting, rest, and elevation of the affected limb. So many small blood vessels are damaged by a fracture. If you let the limb hang down it stands to reason that they will bleed more, the blood will pool in the area of the fracture and cause more pain. The good news is that the pain will steadily improve. If you are resting, elevating the limb, and using medication appropriately and the pain is relentlessly increasing contact your doctor at once or go to a hospital to make sure there isn’t a problem.

Tenderness

When the fractured part of the bone or the surrounding region is touched it hurts more. This is normal. The region is swollen and inflamed. The doctor will likely feel the area suspected of being broken and ask if it is tender.

Putting local pressure on it is bound to hurt. However, this too is likely to get better quite quickly. Increasing tenderness is likely to be a sign that something is going wrong.

Swelling

Swelling is another universal feature of fractures. The injury causes local bleeding into the tissue and the healing process causes inflammation. Both these cause swelling over quite a large area surrounding the fracture. Because the circulation is disrupted by the injury the normal system for getting rid of swelling does not work.

Swelling persists for many weeks and may recur if you overdo it or have the limb hang down for a period of time. Increasing swelling may also be caused by tight casts or bandages or by clotting of blood vessels in the region. Swelling is treated by elevating the limb above the level of the heart. Ice is used sometimes, more often in the later stages.

Fracture blisters

These are very common and occur because of swelling or because the outer layer of the skin has been sheared by a ‘wringer’ type of action at the time of the injury. Blisters are more common where the skin is tethered to bone (ankle, elbow and shin). They are treated by dressings and should not be punctured if it can be avoided.

Bruising

The black and blue (and yellow and green) discoloration of the skin is a sign that there is internal bleeding in the area. Blood pigments, initially red, break down to form these other colors with time. Bruising is usually accompanied by swelling and tenderness. It sometimes takes some days for all the bruises to appear. If you hear doctors talking about ecchymosis or contusion they are referring to bruising. There is no treatment necessary for bruising.

Wounds

Any break in the skin near a fracture is cause for concern. These wounds may be caused by the jagged ends of the bone cutting from inside or by something penetrating down to the bone from the outside. In either case this means the fracture is contaminated by communication with the outside. These open fractures require special treatment including surgery and antibiotics to reduce the chance of infection.

Other shallower wounds may be caused by abrasion (sometimes called road rash). They heal normally but can be painful and can interfere with treatment. Surgeons prefer not to operate through damaged skin because of the risk of introducing infection. First aid for wounds of all sorts consists of dressings and pressure to control bleeding.

Deformity

After a break the bones are often out of alignment - meaning that the bones are not in their normal position. Sometimes this angulation is so large that the limb looks misshapen. Deformity of this sort seen directly after an injury is an unmistakable sign that a fracture has occurred. It is usually best to avoid trying to straighten the bones as part of first aid. It may be better to splint the limb in the deformed position and get medical attention.

Loss of function

It hurts to use a broken bone so most injured people avoid that. In more dramatic situations you can’t move a limb because it is so unstable that it "flops". This is someties referred to as a flail limb. Restoration of normal function is the goal of treatment for broken bones.

Neurovascular damage

Numbness or paralysis of the hand or foot below a fracture may be a sign that the nerves to those areas have been damaged. It is important to get medical help quickly in this situation and to draw attention to the numbness when you talk to the doctor. When an artery is injured there is a lot of bleeding and swelling at the site of the fracture or out into the wound if there is one. The lower part of the limb may be cold and pale if the blood supply is cut off and becomes numb with time. Injuries to veins also cause a lot of local bleeding and may also cause swelling and purple discoloration of the limb below the injury. Treatment of these injuries may require surgery.