Recovering from a Fracture (Broken Bone)
ContentsSigns And Symptoms Of A Fracture Types Of Fractures Common Causes Of Fractures Osteoporosis And Fractures Diagnosis And Treatment Of Fractures Medical Specialists Who Treat Fractures Care Needs For A Fracture After Discharge From Hospital Care Provider Options During Recovery From A Fracture Selecting A Care Provider When Recovering From A Fracture Effects Of Fracture Recovery On Caregivers Financial Considerations When Recovering From A Fracture Legal Considerations When Recovering From A Fracture FAQs About Recovering From A Fracture (Broken Bone)
A broken bone is also called a fracture. A fracture occurs when a force is applied to a bone causing it to break. Fractures may be a small crack in the bone or a complete shattering of the bone in cases of extreme trauma such as a car accident.
Fractures are a very common injury with the average person sustaining 2 fractures over the course of their lives. Fractures are even more common among seniors due to bone loss. Throughout this guide, you will become more familiar with broken bones and the impact they may have on a person’s functional ability and quality of life.
Signs And Symptoms Of A Fracture
The symptoms of a fractured bone may vary depending on the type of bone breaks and on the individual. Some common signs and symptoms include:
- Pain in the affected area
- Inability to move the affected bone or limb
- Bruising of the affected area
- Deformity of the affected area
- Discoloration of the skin around the area
- Swelling and tenderness of the area
- Inability to put weight on the limb or area
- Grating or grinding sensation in the affected area
- Nausea or a “sick feeling”
- Dizziness or lightheadedness
- Pale or clammy complexion
Symptoms such as nausea and dizziness are most commonly felt with the fracture of a large bone such as the pelvis or femur. If an individual feels they have broken a bone, they should seek medical attention as soon as possible to avoid aggravating the injury.
Types Of Fractures
Bones may break in different ways depending on the type of force that caused the break and on a person's overall bone health. Some common types of broken bones include:
- Open fracture - In an open fracture, the broken ends of the bone pierce through the skin. This causes a wound in addition to the broken bone. Sometimes the bone is visible in the wound, but that is not always the case.
- Stable fracture - In a stable fracture, the broken ends of the bone line up next to each other and are not out of place. These fractures generally heal without a surgical procedure.
- Transverse fracture - A transverse fracture is fracture line at approximately a 90 degree angle to the length of the injured bone.
- Oblique fracture - An oblique bone fracture has a fracture line that angles through the injured bone.
- Comminuted fracture - In a comminuted fracture, the affected bone shatters into pieces.
Common Causes Of Fractures
Anyone may break a bone at any time if there is pressure applied to the bone. However, the most common causes of fractures are:
- Trauma - This includes trauma such as an accident or a fall which may result in a broken bone.
- Overuse - Muscles that are fatigued from overuse may place more force on bones resulting in a fractured bone.
- Osteoporosis - Osteoporosis weakens bones making it easier for them to break.
Osteoporosis And Fractures
Osteoporosis is an age-related condition that causes bones to lose bone mass. This weakens bones and makes them brittle and significantly more likely to break. Osteoporosis is common among seniors. The International Osteoporosis Foundation estimates that 55% of people over 50 in the U.S. have osteoporosis.
The most common types of fractures for people with osteoporosis are fractures of the spine, wrist, or hip. For people with osteoporosis, even minor falls or accidents may result in a broken bone. For example, a person with osteoporosis may sustain a fracture from tripping or from bumping against a wall, while a person who does not have osteoporosis might sustain a slight bruise or no injury at all from the same incident. These fractures are referred to as fragility fractures.
Osteoporosis should not affect the bone healing process. Fractures typically heal in about 6 to 12 weeks, although this process may take much longer in some cases. Some fractures will heal on their own while others may require more invasive treatments such as surgery.
Diagnosis And Treatment Of Fractures
The treatment that an individual receives for a broken bone will depend on the type of fracture they sustained and on their overall health. Diagnosing a fracture is generally a fairly simple process. A doctor will perform a physical examination and ask the patient about their symptoms and the circumstances that led to the fracture. They will examine the affected area and often order an x-ray. Depending on the type of fracture, an MRI or CT scan may also be ordered.
Treatment of a fracture will vary depending on the severity of the fracture, however, the focus of treatment is always to allow the bone to heal properly and safely.
Some common treatments for fractures include:
- Immobilization - Keeping the injured bone immobilized may assist in the fracture healing process. The bone may be able to fuse back into a solid piece and not sustain further injury if it is immobilized. Fractures are immobilized using plaster casts and plastic braces.
- Bone realignment or fracture reduction - A bone will not heal properly if it is not aligned correctly. Depending on the type of fracture, the broken ends of the bone may need to be physically lined up in order for the bone to heal. This is sometimes done by physically manipulating the limb to reset it. In other cases, fracture reduction requires a surgical procedure.
- Metal plates and screws - In some cases, metal plates, screws, or wires may need to be placed to properly align the bone and help it heal.
- External fixators - An external fixator is placed on the outside of the affected limb with metal pins going into the broken bone through the skin. This is done to provide structure and support.
- Surgery - In cases where tissue or skin around the bone was injured, surgery may be required to correct the damage.
Medical Specialists Who Treat Fractures
Treatment of a broken bone may require the assistance of specialists. An individual’s primary care doctor or emergency room doctor may make different recommendations depending on the injury and the individual. Some specialists who help treat fractures include:
- An orthopedic doctor or surgeon - Orthopedic specialists may need to construct a cast or perform procedures to reduce the fracture.
- A physiatrist - A physiatrist treats problems that affect movement such as pain in the muscles, bones, or nerves.
- A physical or occupational therapist - Therapists may work with an individual to improve strength, range of motion (ROM), and one’s ability to provide self-care.
Care Needs For A Fracture After Discharge From Hospital
After sustaining a broken bone, an individual may have difficulty performing daily tasks. They may be unable to care for themselves and perform activities of daily living (ADLs). They may need help to bathe, get dressed, toilet, or walk.
With help from physical and occupational therapists, an individual may regain these abilities. However, in the case of a severe fracture, an individual may not be able to perform at their prior level of functioning. They may have acute pain or have chronic pain as a result of the fracture.
Chronic pain may lead to depression and to an overall decreased ability to provide self-care. An individual who has broken a bone may be overwhelmed during recovery time and unable to perform tasks they could perform prior to their injury. These tasks, such as cooking, housekeeping, and financial management, are referred to as instrumental activities of daily living (IADLs).
Medication Changes After A Fracture
After a broken bone, an individual may require some changes to their medication routine. They may require medication for pain or to strengthen bones and protect against additional breaks.
The medications prescribed for an individual after a fracture will depend on how much pain they are having, what other medications they are taking, and their overall health. Some commonly-prescribed medications for pain include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) - NSAIDs include anti-inflammatory drugs such as ibuprofen and naproxen. NSAIDs may be purchased over- the-counter (OTC) or through a prescription. Prescription NSAIDs are generally stronger than OTC NSAIDs.
- Narcotic pain relievers - Narcotic medications include codeine and morphine. Narcotics are available by prescription only. They are very strong and may have side effects. They are generally intended for short-term use.
- Calcitonin medications - Calcitonin is a man-made medication that may be used for pain relief in some cases. Examples of calcitonin medications include Calcimar or Miacalcin.
If an individual has osteoporosis, they may also be prescribed medication to strengthen their bones and protect them from future fractures. Some common medications for osteoporosis include:
- Bisphosphonates - Bisphosphonates are used to slow down bone loss. They include medications such as alendronate and risedronate.
- Denosumab and teriparatide - These medications are used to increase bone density and reduce fracture risk in people with osteoporosis.
- Calcitonin - In addition to being used for pain relief, calcitonin may be used to regulate calcium in the body and strengthen bones.
Adaptive Equipment Required After A Fracture
After sustaining a fracture, an individual may need to use adaptive equipment to complete daily tasks. Some examples of adaptive equipment that may be needed include:
- Shower chairs or benches - Having a bench in the shower allows a person to sit while showering. This can be useful for an individual who is still having trouble bearing weight or who has a plaster cast.
- Raised chair cushions - Sitting and standing up from a chair is easier when the chair seat is raised to a higher level. For a person who has broken a bone in their hip, pelvis, or legs, raised chair cushions may help with this.
- Raised toilet seats - Raised toilet seats may help reduce one’s difficulty with sitting and standing when using the toilet. As with raised chair cushions, this may assist people who have broken bones in their lower body.
- Walkers or canes - For an individual who is having trouble bearing weight on their injured limb, a walker or cane may be a good solution. Walkers and canes are used to help individuals support themselves while walking.
Physical and occupational therapists will be able to recommend the specific equipment an individual will need. They will also be able to teach the individual how to safely use the equipment and work with caregivers to ensure it is being used correctly and effectively.
Rehabilitation For A Fracture
After breaking a bone, an individual may need rehabilitation with physical and occupational therapists. In the case of significant breaks such as a hip fracture, this rehabilitation will be started as soon as possible. Often, therapy will begin when an individual is still in the hospital.
A physical therapist will work with the individual in their room to ensure they do not begin losing the ability to move. Moving around while in hospital as the doctor and nursing staff recommend also reduces the risk of bed sores and blood clots, particularly after surgery.
In hospital, the individual will be led through exercises to strengthen the injured area and surrounding muscle. Therapists will assist the person with tasks such as sitting up, walking, and washing at the sink. Occupational therapists will assist the person in safely performing ADLs. A physical therapist will also teach them how to use a walker or cane if use of this aid is required.
Depending on an individual’s circumstances and the type of fracture they sustained, more intensive rehabilitation after discharge from hospital may be needed. The hospital team may recommend an acute rehabilitation center if more rehabilitation is required after discharge.
In an acute rehabilitation center, the individual will receive intensive therapy for up to six weeks. Acute rehabilitation centers are generally recommended for significant fractures to the lower body. For example, a person who has sustained a hip fracture will require much more intense therapy than someone who has fractured their wrist.
Care Provider Options During Recovery From A Fracture
In many cases, an individual who has broken a bone will be able to return home. However, since a fracture sometimes leads to significant physical decline, this is not possible in all cases. When an individual is recovering from a broken bone, it is important that they and their family select the most appropriate type of care that is required.
When considering what type of care provider is needed, some questions an individual and their caregiver may want to consider include:
- How severe was the fracture?
Fractures may heal differently depending on the type of fracture. An open or comminuted fracture will likely take longer to heal than other types of fractures. An individual with these kind of fractures may require more help for an extended period of time.
- Where was the fracture?
A fracture to the lower body may limit an individual’s ability to care for themselves more than a fracture to the wrist or arms. For example, an individual who has a fractured wrist may still need assistance with ADLs such as showering during recovery time, but may be able to walk around their home on their own.
- Does the individual have any memory loss or cognitive concerns?
For people with cognitive impairment such as dementia, it may not be safe for them to remain at home while recovering from a broken bone. Dementia may be may worse with delirium or pain following a serious injury such as a severe fracture.
- Is their home safe?
Home hazards such as stairs, carpeting, poor lighting, large furniture, and other obstacles may increase the risk of another fracture. Ensuring the home environment is as safe as possible is an important part of recovery.
- Is the individual able to manage their medications?
Newly prescribed medications following a broken bone may overwhelming for an individual, particularly if they have started taking a medication with significant side effects. Pain medications may cause dizziness and confusion resulting in a person not taking their other medications as ordered.
- Does the individual have any other health conditions that may need monitoring?
While recovering from a broken bone, any other health condition a person may have will still need monitoring. This may become overwhelming if a person has new medications, therapies, and treatments following a fracture.
- Does the individual live alone?
If an individual lives with a spouse, adult child, or other caregiver, they may be able to stay in their own home longer. Caregivers may be able to assist with ADLs and IADLs and help a person during their recovery. If an individual lives alone, it may not be safe for them to return home until they are able to perform some tasks on their own.
Home Health Care For Recovery From A Fracture
If an individual would not feel safe or comfortable alone in their home after sustaining a fracture, home health care may be the best option. A home health care agency will help an individual recover from a fracture. A home health care agency will be able to monitor a person’s progress, help manage medications, assist in cooking meals, and help manage any other conditions. This may provide a sense of security and peace of mind for the individual and their family.
A home health care agency will also provide physical and occupational therapy in the individual’s home. They will work with the person and ensure the home is safe and free from hazards. They will work with the individual on the tasks they need to be able to do to live in their home such as climb stairs for example.
The home health care agency will also have nurses come to the home. Nurses will assist with treatments, medications, pain management and any post-surgical care such as wound care and assessment. Home health aides will assist with ADLs such as dressing, toileting and showering.
Some home health care agencies are able to provide additional services such as meal preparation or housekeeping. If an individual is in need of these kinds of services, they should ensure that the agency they select offers these kinds of services and inquire about any additional costs that may be associated with these services.
When recovering from a fracture, an individual and their family should meet with several home health care agencies to assess which one best suits their needs.
Medicare will pay for 100% of the costs of the home health care as long as the agency is Medicare-certified and as long as the doctor ordering the care certifies that there is a skilled need. Medicare will cover the costs for services needed on a part-time and temporary basis.
However, Medicare will not pay for services from a home health care agency to assist with IADLs such as housekeeping, transportation, and meal preparation. Different agencies will accept different payment forms, but common payment options include Medicaid, private pay, and long-term care insurance.
Inpatient Facilities For Recovery From A Fracture
If it is not safe for an individual to return to their home after sustaining a fracture, the individual may need to consider inpatient facilities such as skilled nursing facilities (SNFs) or assisted living facilities (ALFs). SNFs are usually intended for short-term and acute needs.
In a SNF, a doctor will oversee the person’s care and set specific goals for them to meet before returning home. After sustaining a severe fracture, an individual may stay at a SNF until their cast is removed and they are able to walk safely with a walker.
At a SNF, healthcare professionals will work with the individual to help them recover from their fracture. Occupational and physical therapists will work with the person at their bedside and in therapy rooms. They will ask questions about the individual’s home setup so they know what exercises and skills to focus on with the individual so they may return home safely.
Physical and occupational therapists will also teach the person how to use any needed adaptive equipment and report progress back to the doctor. Nurses will assist with any needed treatments, pain medications, and wound care. Nursing assistants will assist with ADLs and monitor vital signs.
Hospital staff will discuss with the individual and their family if they do not feel it is safe for them to return home during their recovery. Hospital staff should be able to provide a list of local SNFs with beds available that can meet the individual’s needs.
It may help in the selection process to have a family member visit several SNFs before hospital discharge. If this is not possible, reviewing SNF options online may help the individual and their family get a better idea of what each facility offers and if they would feel comfortable there.
Medicare will cover 100% of the costs for care in a SNF for 20 days as long as there has been a qualifying hospital stay. On days 21 through 100, Medicare will pay a portion of the costs and the individual will be responsible for a copay amount. After 100 days, Medicare will no longer cover the costs of care in a SNF and the individual will be responsible for the entire amount. Most SNFs accept payments such as long-term care insurance, Medicaid, and private pay.
Assisted Living Needs After A Fracture
If an individual does not need the skilled level of care provided by a SNF but is not able to live at home safely, they may consider moving to an assisted living facility (ALF). In an ALF, care staff are present 24-hours a day to assist an individual with care needs and medication management. ALF facilities generally also include services such as housekeeping, meals, activities, and laundry.
While most ALFs do not have physical therapists or occupational therapists on staff, home health agencies may be able to work with an ALF to come into the facility to provide physical therapy as needed.
If an individual lived in an ALF prior to sustaining a fracture, they may be able to use the services of a home health agency when they return to the ALF. Home health care staff will work with the individual in the ALF and report their progress to the doctor.
Some ALFs and SNFs are part of communities known as continuing care retirement communities (CCRCs). In these communities, multiple levels of care are offered on one campus. A CCRC allows a person to stay in a familiar environment even if their care needs change. A person may start in an ALF, sustain a fracture, receive physical therapy and skilled care in the SNF, and then return to their room in the ALF all in the same general location. This allows for continuity of care and familiarity which may help in the recovery process.
ALFs and CCRCs are considered custodial care and not medical care, so they are not covered by Medicare. The cost of these facilities will need to be paid in another way. Staff at an ALF or CCRC may be able to assist an individual and their family to determine the best payment option for them.
Selecting A Care Provider When Recovering From A Fracture
Once an individual and their family have chosen the appropriate level of care, it is important to select the most appropriate provider for that level of care. Different home health care agencies, SNFs, ALFs, and CCRCs provide different services. An individual and their family will want to ensure they chose the provider that best suits their needs.
If possible, an individual and their family should visit multiple facilities or talk with several home health care agencies before making a choice. Some important considerations when choosing a care provider after a fracture include:
- How do former residents or clients rate the provider?
This information may often be found online or by asking others in one’s local community. It may help to see if the provider is well regarded by past clients or if there have been numerous complaints.
- Are staff members well trained and certified?
All staff should be CPR-certified and trained to provide care for individuals with various health conditions. Staff should also be aware of and should use best practices when caring for individuals with various health conditions. Providers should be able to show proof of this training.
- Is the facility or agency office clean and welcoming?
An individual and their family should ensure the residential facility or the office of the home health agency is clean and feels like a safe and welcoming environment. This should help ensure that they would feel comfortable living in the facility or having home health care staff in their home.
- Does the provider have a fall prevention plan in place?
Preventing falls may help an individual avoid another another fracture which may occur due to a fall. Many facilities have specialized plans in place for individuals who are at a high risk of falling. In addition to a fall prevention plan, staff should be trained on how to respond quickly to any fall or potential injury.
Choosing the right care provider can significantly hasten a person’s recovery as well as improve their quality of life as they heal. It is important to be well-informed before choosing a care provider. It may be helpful to bring a list of questions when meeting agency or facility staff and to talk with current residents or clients of the provider about their satisfaction with the care provided.
Effects Of Fracture Recovery On Caregivers
An individual’s fracture may have significant effects on their caregiver. The caregiver may blame themselves for the incident that caused the fracture or become overwhelmed by the increased care needs of the person who sustained the fracture.
The caregiver may also be concerned if the recovery process seems to be moving slowly or worry that the individual will never regain previous abilities. They may feel stressed, anxious, or depressed or experience burnout.
While fractures may be caused by any injury, individuals with osteoporosis are at a higher risk of sustaining a fracture. Some best practice tips for caregivers of individuals with osteoporosis who have sustained a fracture include:
- Make sure the person takes all prescribed medication.
- Provide a balanced diet - With the approval of a doctor or dietician, consider adding foods with extra vitamin D and calcium to meals.
- Take steps to prevent falls and ensure safety.
- Exercise with the person to help them regain their strength.
- Advocate for the person with doctors and other healthcare providers.
Financial Considerations When Recovering From A Fracture
All forms of long-term care have associated costs. Home care providers, SNFs, ALFs, and CCRCs may accept different forms of payment. Factors such as the level of care needed may increase costs in certain facilities. More detailed information on financial options for covering long-term care costs may be found here, however, some payment options include:
- Medicare - Medicare usually only covers short-term skilled care.
- Long-term care insurance
- Home equity loans
- Reverse mortgages
- Immediate annuities
- Veterans Aid and Attendance Benefits
An individual’s financial situation and the level of care they need will help determine which option, or combination of options, is right for them.
Legal Considerations When Recovering From A Fracture
When an individual begins transitioning into long-term care, it may helpful to have some legal protections and documents in place. One form of legal documents are known as healthcare directives and include:
- Power of attorney (POA) - A POA is able to make financial and healthcare decisions for an individual if they become unable to do so for themselves. These decisions may be very overwhelming for a person so having a POA assist with or make these decisions may allow an individual to focus more on their recovery.
- Living will - A living will is a document that protects an individual’s wishes for medical care in the event of a medical emergency. The document tells care providers what steps the person wants taken in the provision of their medical care if they become unable unable to communicate their care preferences.
FAQs About Recovering From A Fracture (Broken Bone)
1. What is a hip protector?
Hip protectors are undergarments that are designed with padding or plastic that rests over the hip joint. Hip protectors may minimize the impact of falling and prevent hip fractures. They are often used with older adults with dementia and in long-term care facilities.
It is important that hip protectors are placed appropriately and that they are monitored throughout the day. Hip protectors that are improperly placed or broken may cause skin irritation or wounds.
2. Can broken bones be prevented?
Broken bones can happen at any time and may be the result of unexpected trauma which may not be preventable. However, a person may reduce their risk of osteoporosis and broken bones by doing the following:
- Exercise - Moderate exercise such as walking has bone health benefits. Exercise may also improve balance which may reduce the risk of falls.
- Quit smoking - Smoking may increase a person’s risk for osteoporosis and may cause damage to bones and muscles.
- Increase calcium and vitamin D - These nutrients may help an individual retain bone mass and improve their overall health.
- Ensure the home is safe from falls - Home hazards such as poor lighting or loose rugs may increase the risk of falling and bone breaks.
- Ensure adaptive equipment is used as needed - Sometimes seniors are uncomfortable using adaptive devices such as walkers. They may feel embarrassed using them or think they only need them to walk long distances. Using these devices as recommended by a doctor or therapist may prevent falls and fractures.
- Ensure glasses or hearing aids are worn when needed - Poor vision and/or poor hearing may lead to dizziness, confusion, and falls.
- Report medication side effects to one’s doctor - If an individual is taking a medication that makes them feel dizzy or weak, they should report this to their doctor as soon as possible to prevent an accident that could lead to a broken bone.
- Limit alcohol - Alcohol consumption may increase dizziness and depression and is associated with an increased risk of falls. It may also make someone who has injured themselves unaware of the extent of their injury which may lead to increased damage and delayed fracture healing time.
3. What are the risk factors for osteoporosis?
- Gender (females have an increased risk)
- Age (those over 50 have an increased risk)
- Low body weight or having a small frame
- Broken bones
- Loss of height
- Family history of osteoporosis
Some risk factors that may be controlled include:
- Exercise or activity level
- Excess alcohol consumption
- Adequate Intake of fruits and vegetables
- Adequate intake of vitamin D and calcium
- Consuming too much caffeine, protein, and/or sodium
- Excessive weight loss
Being underweight is a risk factor for osteoporosis. People who are underweight have a low body mass index (BMI) and are at risk for other health concerns as well. This is due to decreased muscle mass and a person may not be taking in adequate calories and nutrients for bone health. A doctor or dietician may be help to set up a meal plan to help a person achieve and maintain a healthy weight.
4. What are the complications of an open fracture?
An open fracture may present more complications than other types of fractures. This is because with an open fracture, the broken bone pierces the skin. This causes a wound in addition to the broken bone.
Any wound increases a person’s risk of infection. If a person has a wound and is inactive or immobile due to their fracture, the risk of infection increases. It may be difficult for an open wound to heal properly. The broken bone may require surgery, screws, casts, or other treatments that may delay bone healing time.
A person with an open fracture will likely need significant monitoring and follow-up care. They may be prescribed antibiotics in addition to pain medications during their recovery.
Proximity of care is very important when considering options
Research care options that are nearby when thinking about the next step for your loved ones.
Leona J. Werezak RN, BSN, MN is a registered nurse and adjunct nursing professor. She has 24 years experience working in a variety of healthcare settings including such remote locations as the Arctic Circle. Her research in early stage dementia was published in the Canadian Journal of Nursing Research and re-published in their 40th anniversary issue which showcased exceptional research published since the journal began. Her work in dementia care has also been published in the Journal of Gerontological Nursing. She currently teaches surgical nursing care on a thoracic/vascular unit to baccalaureate nursing students. Her clinical work with nursing students involves extensive work with older adults who have multiple chronic health conditions.