Fracture equals broken equals cracked

Monday, June 29, 2015

Words matter, especially in medicine. There are unique terms that help describe anatomy, physiology, disease and injury and it’s important that doctors speak the same language with their colleagues. It’s just as important that doctors translate medical speak into regular English, so that patients and families can understand their situation. For that reason, it is not terribly helpful when the media and press misuse medical terms that might confuse and mislead their audience.

This diatribe starts with the Sports Illustrated article that discussed the ability of hockey players to neglect injuries during their quest for the Stanley Cup:

  • Montreal’s Nathan Beaulieu – fractured sternum
  • Rangers’ Mats Zuccarello – fractured skull
  • Tampa’s Tyler Johnson – broken wrist
  • Ottawa’s Mark Stone – fractured wrist
  • Minnesota’s Jason Zucker – broken bone in his thumb
  • Ranger’s Marc Steel – hairline fracture in the ankle
  • Red Wings’ Jonathan Ericksson – broken big toe

At the bedside, patients and families seem to have the same concept when it comes to bone injuries. Routinely, there are questions. “I hope it’s only cracked and not broken” or “is it fractured or just broken?”

Let us be clear with the words… fractured, broken and cracked all mean the same thing. The integrity of the bone has been disrupted. One term does not imply a more severe injury and another does not presume that healing will be quicker or that surgery might not be needed.

When talking about fractures (the same thing as broken or cracked), there are other descriptive terms that are helpful in explaining the injury:

Is the fracture open or closed? The skin protects the body from the outside world. If the skin over a fracture is broken and the dirty outside work can communicate with the broken bone fragments and the risk of a bacterial infection increases dramatically. Often, this requires a trip to the operating room for the orthopedic surgeon to clean out the wound and prevent osteomyelitis, an infection of the bone.

Is the fracture comminuted? A bone can brake into two parts, it can shatter into multiple fragments or the fracture is somewhere in between. Comminuted equals more than two pieces and may signal a more complicated healing process…or not. Every injury is distinct and needs to be individually assessed.

Is the fracture aligned or is it displaced? If the bone fragments appear to be in reasonable position, they may heal nicely without much intervention. Sometimes, though, the fracture needs to be reduced or realigned to make it heal as close to abnormal anatomic position as possible. Knowing anatomy helps. Even though a fracture may appear to be normally aligned initially, the pull of muscles or gravity may cause the pieces to move.

Is the neurovascular status intact? Arteries, veins and nerves may be located near the fracture site and it’s important to know whether there is good blood flow and sensation beyond the injury. Looking for complications is the first step in potentially finding them.

And there are special terms used for certain bone injuries. Fractures may enter joints. Skull fractures may be depressed. The Salter Harris classification system is used to describe fractures that involve growth plate fractures in children. Compression fractures may occur in the vertebrae of the neck or back.

Each fracture has its own healing potential and treatment need. The goal for treatment is to return the bone to anatomic alignment and allow it to heal so that the body can be returned to normal function. If an ankle fracture heals poorly or is misaligned, arthritis may set in and cause problems to develop years later. Bones in the hand and finger cannot be allowed to have any rotation issue; otherwise the hand might not be able to form a fist. Bones that support the eye cannot trap muscle otherwise, the eye will not move properly and double vision might result.

The language of bone is important so that an injury can be described and explained in words. For that reason, it’s important that the doctor, patient and family know what words mean, so that they have the same game plan for care and the same expectation for healing. For that reason, the writers and editors of Sports Illustrated need to learn medical terminology, just like they learned the words used to describe the action on the field that caused the broken, fractured, cracked bone.

 

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