Broken Bones and Bone Health

All You Ever Wanted To Know About Bones

Broken bones, a.k.a. fractured bones, take between 6 and 8 weeks to mend. This is an average only. Varying factors are involved and healing times don’t exactly go according to any calculated plan.

There are fractures that can take 3 months, or even longer, to heal. With children, some broken bones heal in 3 to 5 weeks.

It would not be uncommon for a First Aider to encounter a person who has broken a bone. Our Provide First Aid and Child Care First Aid courses cover the recommended approaches to tending these and similar injuries.

The tell-tale signs of a broken bones include:

• Pain
• Swelling
• Deformity

Even more telling, a bone might poke through the skin. An audible snap might be heard the second the injury is sustained. This would be a “cracking”, rather than “popping”, sound. Alternatively, a grinding sound might be evident.

When you’re falling down a set of stairs or busy being belted by a solid object, you can’t always count on it being quiet enough to listen out for such noises.

More often than not, it will be painful to put weight or pressure on the injured area and painful to move it.

Broken Bone or Sprain?

How can you tell if it’s a broken bone (fracture), or a strain, or a sprain? The symptoms for all three are similar.

An X-ray will confirm or rule out a broken bone. The doctor can then provide the appropriate treatment for recovery. But let’s take a closer look at these three types of injury.

Strain? Sprain? What’s difference?

A strain is an injury to a muscle, or the tissue that attaches a muscle to the bone. Whereas a sprain is an injury to the tissue that connects two bones together.

The tissues that connect muscles to bones are the tendons. A strain is when the tendon or muscle is stretched or torn.

Strains can happen from overuse or by using muscles that are not ready for the effort they’re about to make. For example, you may be ready to tackle the job of moving a house full of furniture but your body may not be as ready.

Signs of a strain are:

• Pain
• Swelling
• Difficulty moving the muscle
• Muscle spasms

Twisting an ankle or knee is typically the cause of a Sprain. Another example of a sprain injury is a torn Achilles tendon (connects the calf muscles to the heel).

Treatment for Strains & Sprains – RICER

Treatment for minor Strains is the same as for a Sprain – Rest, Ice, Compression, Elevation, and Referral (RICER).

• Rest the injury for a day or two. After that, try gentle stretches and exercises to increase blood flow to the affected area and promote healing.
• Ice or a cold pack should be applied to the injury to reduce swelling. But not directly on the skin. Wrap the ice or cold pack in a towel. Apply for 10 minutes on, 10 minutes off,. Repeat as often as possible for the first day or two.
• Compression involves wrapping the injured limb in elastic bandaging — firm enough so it feels like a gentle squeeze, not so tightly it hinders circulation. This will help reduce swelling and maintain stability.
• Elevation is resting the injured limb so it’s positioned higher than your heart, while sitting or lying down. This will help keep swelling to a minimum.
• Referral requires referring the casualty to a medical professional for assessment of the soft tissue damage.

Use the RICER method as soon as possible after the injury to ease some of the discomfort, swelling and bruising.

If, after a couple of days, the pain remains severe and the sore limb is still unable to support any weight, or if major bruising or blisters are evident, medical intervention is recommended.

What Happens When Bones Break?

Usually pain. Although it’s not the same for everyone. And when the fracture is minor, the pain may be insignificant to the point the person may not realise they’ve broken a bone.

People can have a fall, then spend the rest of the day skiing, walking, dancing, without realising there’s been a fracture.

For many bone breaks, it’s more often like the deep ache from a bad stomach ache or headache. Some people experience sharper pain — in the case of an open fracture, especially.

Pain increases as pressure is applied or when the injury is moved. The injured limb simply cannot be used. Taking even 3-4 steps on the injured foot or ankle, for example, would be too painful.

There will probably be pain directly over the bone where there’s little or no soft tissue.

Otherwise severe swelling or bruising is evident over the top of the bone. Numbness or tingling can also be present. The area could look lopsided or deformed.

It’s often a shock to the system to break a bone. The person could feel woozy or chilly. The shock of the injury, for some people, masks any pain, at least for the time being. Others might pass out until their bodies adjust to the trauma.

Although not always the case, according to research, people who fracture their arm, leg, spine or hip are also more likely than other people to have widespread pain in their body decades later.

A broken bone will begin to repair within hours of the injury. Swelling around the break allows for blood clotting. Your immune system helps eliminate small bone pieces and fight infection. Blood vessels also repair and aid the healing. This all happens in the first week or two.

During the healing process, it’s helps to refrain from smoking and eat a healthy diet.

Resting the broken bone as much as possible is important, although doctors also advise which exercises are recommended.

Wearing a cast, while critical for healing, also results in muscles losing their vitality. Early physical therapy with basic exercises helps ease stiffness, breaks down scar tissue and builds muscle.

A soft callus forms around the broken bone between about day 4 and week 3. What is happening is that collagen is replacing the blood clot — not strong like bone, but certainly more firm than a clot. Movement could break this soft callus and set back recovery, hence the need for a cast to protect against this.

About 2 weeks after the break, cells called osteoblasts begin forming new bone, adding minerals to strengthen the repair. This is the hard callus and the process usually continues for 6-12 weeks after the break.

Bone remodelling is next and here, cells called osteoclasts fine-tune the process, breaking down any extra bone that has formed during healing so the bones return to their regular shape. At this stage, resuming normal activities helps the healing. This step can continue for years after.

Around 6 to 8 weeks is usually when the cast comes off. What it reveals is usually body hair that is darker than usual, skin that’s pale or flaky, and the injured body part will have lost its muscle bulk.

Complications

The doctor will want to know about the following signs:

• Skin turning a bluish tinge
• Inability to move fingers or toes
• Pain persisting
• Problems with the cast, such as cracks or feeling too tight or too loose
• Redness, swelling, or smelly discharges that indicate infection
• Tingling, numbness, pins and needles, or other odd feelings

Categories of Fractures

Fractures are described in the following ways:

• Complete Fracture — when the bone breaks into two pieces
• Greenstick Fracture — when the bone cracks on one side but not all the way through
• Single Fracture — when the bone is broken in one place
• Comminuted Fracture — when the bone breaks into more than 2 pieces or is crushed

• Bowing Fracture — applies to children’s bones that have bent but not broken
• Open Fracture — when the bone pokes through the skin

Treatment for Broken Bones

If you are a first responder and you suspect a broken bone in the neck or back, or you’re unsure which bone is broken, wait for a trained medical professional to arrive.

Do not try to move the injured person.

Moving a broken bone is not a good idea. Not only will it cause pain, it could easily make the injury worse. Cushioning or supporting the injury with towels or pillows should be done with care.

Hospital X-ray facilities will enable accurate diagnose. In hospital, all types of fractures can be set, splint, and cast. In more serious cases, surgery is possible.

ER is where the patient needs to go if a broken or dislocated bone or joint is suspected. This is especially the case for breaks in large bones, such as the femur (thigh), pelvis, or hip, or fractures to the skull, eye socket, or dental bones. So too for a spinal fracture, which could benefit from better imaging by CT scan.

Once the broken bone has been set, usually the next step involves a cast. Made from bandages soaked in plaster, casts harden to form a tough shell capable of keeping the bone in place for a month or two until the break mends. Some casts are fibreglass or plastic.

For breaks in larger bones, or when a bone breaks into more than two pieces, metal pins (or screws, rods and plates) are often inserted to help set it. Sometimes this hardware stays in, sometimes they are removed after the bone has healed.

In some cases, bones need to be held in the right position using traction, a system of pulleys and weights around the hospital bed.

What are Bones Made Of?

Bones are composed of calcium, phosphorus and sodium, along with other minerals and the protein collagen.

Calcium is instrumental in helping make bones hard, which gives them the ability to support body weight. Bones can also release calcium into the bloodstream as needed by other parts of the body.

The soft marrow inside many of our bones contains stem cells. This is where the body’s red blood cells and platelets are made, as well as some types of white blood cells.

Red blood cells deliver oxygen throughout the body. Platelets help with clotting to arrest bleeding from wounds. White blood cells help fight infection.

There are 2 types of bone tissue:

• Compact bone — the hard outer shell of the bones that make up much of the human skeleton. Blood vessels and nerves run through channels within this bone.
• Cancellous bone, inside the compact bone, looks like a sponge. Tiny pieces of bone called trabeculae form this network, where red and white blood cells are produced in the marrow.

Fibrous straps called ligaments fasten bones to other bones ( specifically the compact bone). Cartilage cushions our joints, supporting and protecting bones where they rub against one another.

Muscles Move Bones

Muscles pull on our joints, allowing us to move. They also help with other movements, such as chewing food and moving those nutrients through the digestive system.

The human body has more than 650 muscles, accounting for half of our body weight. These muscles connect to our bones by cord-like tissues called tendons, which allow them to pull on the bones. When you wiggle your fingers, you can see the tendons move on the back of your hand.

3 Different Kinds of Muscle

Skeletal muscle is known as voluntary muscle because, generally, you control the actions. These striated muscles (so-called because of their horizontal stripes when viewed under a microscope) attach to bone, mostly in the legs, arms, abdomen, chest, neck, and face. They hold the skeleton together, give the body shape, and help with everyday movements. They can contract quickly and powerfully, but tire easily and need rest between workouts.

Smooth, or involuntary, muscle (the fibres look smooth, not striated) is controlled, not by us consciously, but by the nervous system automatically (hence involuntary). The walls of the stomach and intestines are examples of smooth muscle. They help break up food and move it through the digestive system. Smooth muscle also squeezes blood vessel walls to help maintain blood pressure and flow. Slower moving than skeletal muscles, smooth muscles can stay contracted for a long time and don’t tire easily.

Cardiac muscle — the walls of the heart’s chambers are composed almost entirely of muscle fibres. Also an involuntary muscle, your heart ‘beats’ as the cardiac muscle contracts powerfully to propel blood through your blood vessels.

Analysing Movement

Your movements are coordinated and controlled by your brain and your nervous system. Specifically, your voluntary muscles are regulated by the cerebral motor cortex and the cerebellum.

When you decide to make your move, an electrical impulse is sent through your spinal cord from the motor cortex, triggering the muscles to contract.

Flexor muscles contract to bend your limb at a joint. Once the movement is done, the flexor relaxes. At the same joint, the extensor muscle contracts and the limb is again extended or straightened.

Your biceps, for example, are flexors. Your triceps are extensors. The bicep contracts to bend your arm at the elbow. When the bicep relaxes, your tricep contracts to straighten your arm.

Within your muscles and joints, sensors relay messages through peripheral nerves so the cerebellum and other parts of your brain are aware of the position of the limb and its movements.

The cerebellum coordinates the movements ordered by the motor cortex. This is how movement is controlled smoothly and in a coordinated manner.

The motor cortex on the right side of your brain controls the muscles on the left side of your body, and vice versa.

The Work of Your Joints

Joints are the points where two bones meet, through which movement is possible.

Your knee and elbow joints open and close like a hinge. Hinge joints, such as knees and elbows, allow movement in one direction.

Pivot joints allow for rotation or twisting motion, such as that of the head moving side to side.

Your hips and shoulders are joints that allow for more complex manoeuvres, such as backward, forward, sideways, and rotating movement. To allow this freedom of movement, these ball-and-socket joints are comprised of one bone with a hollow that encapsulates the round end of a longer bone.

Our body’s main joints — hips, shoulders, elbows, knees, wrists, ankles — are freely movable and filled with synovial fluid, a lubricant that eases movement in the joints.

We also have fibrous joints that don’t move. The bony plates in the dome of the skull are joints of fibrous tissue that are not designed for movement but for protection. Fibrous joints also hold the teeth in our jawbones.

Other joints that move only a little, as in the spine, are linked by cartilage. Our spine’s flexibility depends on each vertebrae being able to move in relation to the vertebrae above and below it.

Problems for Bones, Muscles & Joints

Arthritis is inflammation of the joint. It causes swelling and pain, leading to trouble moving.

Muscular dystrophy is an inherited group of diseases that leads to muscles weakening and breaking down over time.

Osgood-Schlatter disease (OSD) is inflammation of the bone, cartilage, and/or tendon at the top of the shinbone, where the kneecap attaches. OSD usually strikes teens around the time of their growth spurts.

Osteomyelitis is a bone infection caused by Staphylococcus aureus bacteria, among others. It usually affects the arms and legs and can develop following injury or trauma.

Osteoporosis leads to bone tissue becoming brittle and prone to breaking easily. The spine can sometimes begin to crumble and collapse.

Repetitive strain injury (RSI) is a group of injuries caused by excess stress on a part of the body, resulting in inflammation, muscle strain, or tissue damage. Often, this is a result of repeating the same movements continuously. Tennis, musical instrument playing, and video games are common sources for the kind of repetitive motions can also lead to RSI.

Scoliosis is where the spine curves more than is normal. It is evident in 3–5 people out of 1,000 and can be hereditary.

Tendonitis can result from over-exercising a muscle. The tendon and tendon sheath become inflamed and painful. Relief generally comes from resting the muscles and/or taking anti-inflammatory medication.

Nutrition for Bone Health 

[source]

Calcium

Calcium is a vital mineral for building and maintaining our bones and teeth. It’s also important in other functions, including muscle control and blood circulation.

It comes from the food we eat and is not made in the body. If our diets are lacking in calcium, then calcium will be removed,  as needed for the functions previously mentioned, from where it is stored in our bones.

If this were to continue, our bones would become weaker over time and osteoporosis could result.

To effectively absorb calcium from food, we need Vitamin D.

Calcium needs vary with age. The guidelines below formed after the revision of Human Vitamin and Mineral Requirements (FAO:WHO 2001) and the earlier Australian /New Zealand RDIs.

mg – milligram is one thousandth of a gram and one thousand micrograms.

µg – microgram (also seen as mcg) is one millionth of a gram and one thousandth of a milligram.

IU – International Unit, used to measure fat soluble vitamins, including Vitamin A, D, and E.

Converting IU to mg varies depending on the nutrient.

Recommended Daily Intake for Calcium [source]

0-6 months	210 mg
7-12 months	270 mg
1-3 years	500 mg
4-8 years	700 mg
9-11 years	1,000 mg
12-18 years	1,300 mg
19–50 years	1,000 mg

Dietary Sources of Calcium

Milk, yogurt, cheese, and other dairy products are the biggest food sources of calcium. Other high-calcium foods include:

• Kale, broccoli, Chinese cabbage (bok choy), other green leafy vegetables
• Sardines, salmon, other soft-boned fish
• Tofu
• Breads, pastas, grains
• Calcium-fortified cereals, juices, and other beverages

Be aware that sodas and carbonated beverages decrease calcium absorption in the intestines.

Calcium absorption varies across foods. It can be poorly absorbed from foods rich in oxalic acid (eg spinach, rhubarb, beans) or phytic acid (seeds, nuts, grains, certain raw beans and soy isolates). For example, calcium absorption from dried beans, compared to milk, is about 50%, from spinach, 10%.

Formula-fed babies need around 350 mg/day additional, compared to breast-fed babies.

Calcium Supplements

If you don’t eat dairy products, calcium supplements may be needed to reach the Recommended Dietary Allowance.

Research shows that taking doses smaller than 500 mg will allow you to absorb calcium more efficiently. Simply take doses at separate times if you need 1,000 mg of supplementation each day. Or look for slow release formulations of calcium citrate that supply at least 1,000 mg.

Most calcium supplements also contain Vitamin D, which helps the body absorb calcium.

Children who lack Vitamin D develop rickets, which causes bone weakness, bowed legs, and other skeletal deformities, such as stooped posture.

Adults with very low Vitamin D can develop a condition called osteomalacia (soft bone). Like rickets, osteomalacia can also cause bone pain and deformities of long bones.

Too much calcium from dietary supplements can have adverse health effects, including higher risks for kidney stones, heart problems, and prostate cancer.

It’s always a good idea to talk to your doctor about your intake levels. What is right for one person may not be right for you.

Vitamin D

Many foods contain Vitamin D, although rarely enough to meet the daily recommended levels for optimal bone health.

Exposure to sunlight is another source of Vitamin D. Sunscreen, which is highly recommended, however, blocks our skin’s ability to make Vitamin D.

The Food and Nutrition Board recommends 400 International Units (IU) of Vitamin D during the first year of life, with the RDA for everyone from age 1 through 70 years, being 600 IU.

Recent research, however, recommends everyone 5 years and older get at least 1000 IU of Vitamin D per day for good bone health.

Recommended Safe Daily Intake Vitamin D [source]

0 months – 50 yrs	5 µg/day
51-70 years	10 µg /day
>70 years	15 µg /day

Very high levels of Vitamin D (in excess of 10,000 IUs per day) can cause kidney damage and dangerously high serum calcium levels.

As previously mentioned, talk to your doctor about your intake levels. What is right for one person may not be right for you.

Other Key Nutrients

The following nutrients are important to your bone health. Most can be obtained naturally through your diet.

Phosphorus

— an important mineral for your bones, phosphorus is found in dairy  and meat products. Absorption in the intestine and kidney also aided by Vitamin D.

Recommended Daily Intake (RDI) is 1000 mg for anyone over 19 years. Between 9 and 18 years, 1,250 mg is recommended. 4–8 years, 500mg and 1–3 years, 460 mg/day.

Magnesium

— improves bone strength and found, like Phosphorous, in bone crystals. Older adults are often deficient in magnesium. Some calcium supplements contain magnesium.

RDI for magnesium is 310 mg for women 19–30 years; 400 mg for men 19–30 years; 320 mg for women 31–70 years and older; 420 mg for men 31–70 years and older.

Vitamin K

— needed for bone formation and mineralisation, also important for blood clotting. Available from green leafy vegetables (eg kale, spinach, salad greens, cabbage, broccoli, brussel sprouts) and some plant oils (eg soybean, canola and, to a lesser extent, cottonseed and olive oils).

Vitamin K is thought to assist in channeling calcium directly to the bone rather than via the blood vessels. Women over 19 years should get 60 µg/day of vitamin K. For men the same age, 70 µg/day.  RDI for ages 1–3 years, 25 µg/day; 4–8 years, 35 µg/day; 9–13 years, 45 µg/day; 14–18 years, 55 µg/day.

Vitamin C

— needed for synthesis of Collagen, the main protein in bone. Vitamin C is present in citrus fruits and tomatoes as well as in many vegetables.

RDI for vitamin C is 45 mg/day for everyone over the age of 19 years. For ages 1–8 years, 35 mg/day; and from 9–18years, 40 mg/day.

Vitamin A

— necessary for normal skeletal growth and for cells to differentiate normally. It comes in a number of forms — as retinol, retinal, retinoic acid or retinyl ester— and is present in liver, eggs, butter, green leafy vegetables and carrots.

Vitamin A deficiency is a major cause of blindness. Too much can cause bone loss and increase the risk of hip fracture. Animal source supplements (retinols) may cause toxicity but plant sources (B carotene) do not.

RDI for retinols is 700 µg/day for women over 14 years, 900 µg/day for men over 14 years. For 1–3 year olds, 300 µg/day; 4–8 years, 400 µg/day; 9–13 years 600 µg/day. During pregnancy, women over 19 years are recommended to take 800 µg/day.