Adult Fractures

"Fracture" is just the medical word for a broken bone. Healthy adult bone has two layers — a dense outer shell (the cortex) that gives the bone its strength, and a softer honeycomb inside (the cancellous or trabecular bone) that absorbs load. Bones break in three broadly different ways: from acute trauma (a fall, a sports collision, a direct blow that exceeds the bone's strength all at once), from stress (repetitive loading that accumulates microscopic damage faster than the bone can repair it — runners, military recruits, dancers), or from weakened bone (a low-energy fall that wouldn't have broken a healthy bone, often due to osteoporosis, and occasionally to a tumor or infection that's secretly hollowed the bone out from the inside).

The way a surgeon describes your fracture isn't medical jargon for its own sake — every word in the description drives a treatment decision. Location tells us which bone and where along it. Pattern tells us the shape of the break: transverse (clean across), oblique (angled), spiral (the bone twisted apart), or comminuted (broken into more than two pieces). Displacement tells us whether the pieces have moved out of alignment. Open vs. closed tells us whether the broken bone has come through the skin — open fractures are surgical emergencies because they're effectively contaminated wounds. Together those four descriptors decide whether you heal in a cast, in a brace, or in the operating room.

How a fracture heals is its own quiet biology. In the first week the body forms a soft hematoma at the break site that organizes into a fragile bridge of cartilage and immature bone (the soft callus) over the next few weeks. That callus is then progressively replaced by mature, lamellar bone (hard callus) over months, and finally the bone remodels itself for years afterward to restore its original architecture along the lines of stress it experiences. Anything that disrupts this sequence — too much motion at the break, infection, smoking (which constricts the small vessels that supply the healing site), poorly controlled diabetes, or steroid medication — slows or arrests it. That's why immobilization, smoking cessation, and bone-health optimization aren't optional add-ons; they're how the bone actually knits.

OSI manages the full spectrum of adult extremity fractures across all six locations, from a clean wrist fracture treated in a cast through complex multi-fragment fractures around major joints that need reconstruction.

X-rays are the foundation, and a single view is rarely enough — fractures hide in 2D. Standard practice is at least two views perpendicular to each other (typically front-on and side-on), and often a third oblique view, so a fracture line that's invisible from one angle is unmistakable from another. CT adds the third dimension when the fracture extends into a joint surface or breaks the bone into multiple pieces — surgeons use it to map the exact 3D geometry before going in. MRI is the test for fractures that don't show on X-ray (a true occult fracture — most commonly stress fractures and small hip-neck fractures in older patients), and for any case where the soft-tissue picture matters. Lab work for surgical fractures includes a basic blood count, kidney function, and clotting studies; for fractures in older adults, a DEXA scan to assess bone density and check for vitamin D deficiency comes next so the underlying weakness gets addressed alongside the immediate break.

Surgery is indicated for unstable fractures, displaced articular fractures, open fractures, fractures with associated neurovascular injury, and fractures that cannot be adequately maintained with casting.

External patient-education references and related OSI pages for additional background:

• Britannica — Bone disease (fractures)
• Britannica — Human skeleton
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language