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  Arthritis Fracture Osteoporosis   ·  Orthopedic Surgery  

Fractures

Your skeleton is composed of 206 bones and functions to maintain your body form. The skeleton holds the body erect, but not fixed in one position. Where bone meets bone, joints make the skeleton flexible and allow it to move. In addition, your skeleton acts as armor, protecting its vital organs. For instance, the vertebrae in your back encase your spinal cord, your skull protects your brain, and your rib cage protects vital organs, namely your heart, lungs, liver and kidneys.
Bone Cell
Bones do more than just lend your body structure, support and protection. They also play a critical role in your body's metabolism. Metabolism is the process by which your body maintains the chemical balance vital to life. Blood cells are formed in the bone marrow. Lymphocytes, which are involved in the body's immune response, are also produced there.

What is Bone?

Our bones are made of calcium, phosphate, collagen, and water. Bone is among the strongest materials created by nature. Prior to birth and for several months after birth, the skeleton has very little bone. Many bones start out as cartilage and as a child grows, cartilage transforms into true bone (a process called endochondral ossification). Early in life, more bone tissue is added than is taken away. Maximum bone density and strength is reached between ages 25 and 30. 

In addition, bones are surprisingly light, accounting for only 14% of total body weight, or maybe 20 pounds. Bones are a storehouse of minerals. They hold 99% of the body’s calcium, 86% of its phosphate, and 54% of our magnesium. These minerals are stored in the bones and are continually released into the bloodstream to maintain the body's chemical balance within the cells. 

Fracture Figure 2
Fracture Facts

Fractures, or broken bones, are extremely common. Approximately 6.8 million Americans break a bone each year. On average, every person in the United States will experience two broken bones over the course of a lifetime. 

How Do Bones Break?

Bones are made up of bone cells, proteins, and minerals. Although your bones are amazingly tough - one cubic inch can withstand loads of almost 19,000 pounds, about four times the strength of concrete – they can still break. Like a wooden pencil, bones can bend to a certain extent, however, once the pressure is too much or too sudden, your bone might break, or fracture. 

There's more than one type of fracture. A fracture can be anything from a hairline fracture (a very thin break in the bone) to the bone being broken into two or more pieces.
Fractures occur in the following ways:

Fracture Types Oblique Fracture: 
The break occurs diagonally across the bone.

Communited Fracture: 
A fracture in which bone is broken, splintered or 
crushed into a number of pieces.

Spiral Fracture Bone:
A fracture in which the break travels around 
the bone.

Compound Fracture: 
Fracture Types A fracture in which the bone is sticking through 
the skin, also called an open fracture.

Greenstick Fracture: 
The bone cracks one side only, not all the way 
through (like when trying to bend a living stick 
on a tree), usually only seen in children due to 
the softness of their bones.

Transverse Fracture: 
A complete fracture in which the break is straight 
across the bone.

Simple Fracture: 
A fracture in which the bone is only partially fractured. 

How Do Broken Bones Heal?

If a fractured bone is to resume its normal function, it must be repaired. Your bones are natural healers. At the location of the fracture, your bones will produce many new cells and tiny blood vessels that rebuild the bone. Fragments of broken bone are removed from the site by osteoclasts, specialized bone cells that dissolve and reabsorb the calcium salts of nonliving bone matter. Then special bone cells, called osteoblasts, activate to produce new material which “knits” the ends of the bone together. Most fractures repair themselves within six weeks. Some bones, however, have a poor blood supply and repair takes longer. These include the neck of the femur and the lower portion of the tibia.

One of the most important influences on fracture healing is nutrition. The healing time for broken bones is influenced by a number of variables that are impacted by the availability of key nutrients to support bone healing and a healthy blood supply.
 

Calcium: With vitamin D, essential combination for the production and maintenance of healthy bones and prevention of osteoporosis. Supplementation may reduce fracture rates by as much as 50%.
Vitamin D: Facilitates the absorption of calcium in the intestinal tract; can increase calcium absorption by 65%. Vitamin D deficiency is present in 40% of those admitted to the hospital for a hip fracture. Systemic vitamin D production decreases in the elderly, in people who are house bound, and during the winter.
Vitamin A: Helps promote the growth of strong bone and, along with beta carotene, is also an antioxidant and excellent free radical quencher. Deficiency has been linked with an increase in wound healing time.
Vitamin C: Important in repair of bones and connective tissue. Vitamin C plays a crucial role in the manufacture of collagen, which forms the connective tissue in skin, bones, teeth, cartilage, ligaments, vertebral discs, joint linings and capillary walls. If you are deficient in vitamin C, you may not have sufficient collagen production, meaning your fracture may not heal properly.
Vitamin E: Antioxidant that preserves essential cellular constituents. Deficiency of vitamin E can result in impaired vitamin A absorption.
Vitamin K: Plays an important role in the synthesis of a key bone protein, osteocalcin. Osteocalcin improves the attachment of bone-resorbing cells to bone and supports bone remodeling. Women with hip fractures have decreased levels of vitamin K. Numerous studies indicate that vitamin K plays a role in preventing osteoporosis.
Vitamin B12: Vitamin B12 and folic acid combine with iron, copper and vitamin C to improve hematopoiesis (production of blood cells in the bone marrow). There is evidence of the close folic acid - vitamin B12 inter-relationship and how they work in tandem to produce healthy red blood cells. It is especially important for surgically repaired fractures. 
Folic Acid: Folic acid and vitamin B12 combine with iron, copper and vitamin C to improve hematopoiesis. Works closely with vitamin B12 to produce healthy red blood cells; especially important for people who require surgical repair of fractures.
Zinc: Required for proper functioning of enzyme systems in the body and can help reduce healing time; important for tissue renewal and skeletal development. Zinc levels in the body are decreased following surgery. 
Magnesium: Necessary for the metabolism of calcium into bone. Has shown to be effective in increasing bone density. Deficiency can result in an imbalance in calcium metabolism. 
Iron: Is an essential part of red blood cell production, particularly important for people recovering from surgical repair of fractures. 
Copper: Important for collagen formation. Part of proteins and enzymes linked with red blood cell function. Co-factor of enzymes involved in wound healing. 
As a fracture heals, it may be helpful to take a bone health supplement in order to ensure availability of key nutrients and provide for extra nutritional support during the healing process. 
Smoking and Fracture Healing

Many studies have shown that broken bones tend to take longer to heal if the injured person has been smoking. Cigarettes can also increase the risk of blood clotting, which may further reduce blood flow. Breakdown products of cigarette smoke include carbon monoxide, formaldehyde, nitrosamines and benzenes which can damage the cells that form the bone itself and can interrupt the healing process after a fracture or bone injury. 

Multiple studies have shown a significant difference in the healing time of bone between groups of smokers and non-smokers. For example, a study from the Northwestern University Medical School in Chicago, Illinois was performed on 54 patients who were surgically treated for a specific wrist injury. Of these patients, 95% of the non-smokers healed completely, while only 68% of the smokers healed completely. The average time until complete healing was over 2 months longer in the smokers. Numerous other studies on patients with different injuries have shown a similar effect. 

Bone CellWhy are bones affected by smoking? 

Bones are nourished by blood much like the other organs and tissues in your body. Nutrients, minerals, and oxygen are all supplied to the bones through the blood stream. Smoking elevates the levels of nicotine in your blood and this causes the blood vessels to constrict or become narrower. Nicotine constricts blood vessels approximately 25% of their normal diameter. Because of the constriction of the vessels, decreased levels of nutrients are supplied to the bones. It is thought that this is the reason for the effect on bone healing. 

If you sustain a fracture, it is of utmost importance that you do not smoke. Doing so will decrease your chances of recovering completely, lengthen the time you spend healing, and make it less likely that you will be satisfied with your outcome. 

How Can You Minimize Your Risk For Fractures? 

A healthy diet, high in vitamins and minerals will help keep your bones strong. In addition to proper nutrition, weight bearing exercise will help keep your bones strong and improve your balance and coordination. One of every three adults 65 years or older falls each year and over 500,000 fractures or other serious injuries occur as a result of these falls. About half of all falls occur at home. The consequences of falls can be death, injuries, fractures, hospitalization, and permanent disability. The three most predictive factors for falling are muscle weakness around the hip joint, increased unsteadiness and intake of more than three medications.

Steps you can take to avoid risk:
• Engage in walking or other weight bearing activities to improve both muscle and bone. Exercise also improves balance and coordination.
• Make sure your stairways and hallways at home have bright lights.
• Maintain a healthy diet with lots of vitamins and minerals, especially calcium and vitamin D.
• Eliminate all tripping hazards at home, such as loose rugs; repair any loose carpeting or floorboards; install non-slip tread on stairs.
• Remove loose electrical cords.
• Use sturdy hand rails when walking down steps.
• Provide enough light to see each step at both the top and bottom of stairways.
• Arrange household furniture in ways that provide plenty of walking room.
• Install slip resistant strips on floor of shower or bathtub.
• Wear properly fitting shoes with nonskid soles; tie shoelaces.
• In the kitchen, place a rubber mat in front of your sink so you will not slip on water.
• Store items on shelves and in cabinets that are at waist level. Avoid reaching for things that are too high.
• Be aware of the medications you are taking and their possible side effects, such as dizziness.
• Since vision is particularly important for balance and steadiness, you should have your vision checked regularly.
• Minimize alcohol consumption.

Following the tips listed above will help you avoid fractures and keep your bones healthy for life!

Note: All information on this website is intended for your general knowledge only and is not a substitute for medical advice or treatment for a specific medical condition. Please consult your physician if you have questions or concerns regarding your health.
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