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Fractures Q&As

Published by Bupa's health information team, November 2008.

Answers to questions about fractures

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

 

Is there anything I need to know about looking after my cast?

With any cast, whether it's plaster or synthetic, you are aiming to keep it in good condition and prevent it from being damaged. If it becomes damaged then it's less likely to provide you with the support that you need. It's also less likely to keep the broken bones still and in the right place so that they can heal properly. So, it's important for you to know when the cast might be causing problems and when to seek help.

Explanation

There are two main types of cast used to treat fractures: plaster of Paris casts and synthetic casts. When a plaster of Paris cast is put on it can take around two days to dry out fully and can be quite heavy. Some people have backslab plaster casts put on when the fracture is new. This is a kind of 'half plaster', which supports the broken bone with bandaging instead of a full plaster. This lets the area around the fracture swell.

These are the things you need to be aware of with a plaster cast.

  • While the plaster is damp it's easy to damage it, so make sure that the cast is resting on a soft surface like a pillow for the first couple of days.
  • If the cast is on your foot and leg, don't put any weight on the plaster until it has dried out.
  • Once the plaster has dried out, don't get it wet as this will permanently damage it.
  • When you have a shower or bath, cover the plaster cast completely to stop it getting wet. You can buy special covers for this or use a plastic bag.
  • Don't keep the plaster covered with plastic for long periods of time, as it can become damp from condensation.
  • If the plaster cast comes right up to the top of your thigh, you will also need to be careful when you go to the toilet to make sure it doesn't get wet or become soiled.

There are a number of different types of synthetic cast, including ones made from fibreglass. They weigh much less than plaster casts and are harder and less likely to be damaged. They also dry out much more quickly than plaster casts and are usually set within 20 or 30 minutes.

Because synthetic casts are harder, they don't have any 'give' in them to allow for swelling. For this reason they aren't usually used as the first cast after you have had your accident, but are more likely to be used once the initial swelling has gone down. You are also more likely to be given a synthetic cast if you are elderly because the cast is lighter, which makes it easier for you to keep active.

Some synthetic casts can get wet. Ask your doctor or nurse if this is the case for your cast. If you need to keep the cast dry, follow the instructions for a plaster of Paris cast. Casts that can get wet can take some time to dry out again.

Whether you have a plaster or a synthetic cast, you also need to know the following.

  • Keeping your arm or leg elevated as often as you can will help to reduce the amount of swelling you get, which can help to reduce your pain. If you have a cast on your arm, wear a sling to support it and if you have a cast on your leg, keep it raised as much as you can. For example, don't stand up for long periods of time and when you are sitting down put your leg up on a chair or stool.
  • Exercise the joints around your fracture that aren't broken. For example, if you have a cast on your arm for a broken wrist, make sure you exercise your fingers, elbow and shoulders at least four times a day. This helps to prevent other joints from becoming stiff and painful.
  • Don't put any sharp objects down inside the plaster to scratch your skin. It's easy to break the skin doing this and it can lead to an infection.

Go back to the accident and emergency department if:

  • you have pain that goes on for more than a few days after the cast is put on, or if you develop severe pain that gets worse
  • the cast becomes cracked or uncomfortable
  • your fingers or toes, or any other areas, become very swollen, pale or blue in colour, or become numb and hard to move
  • you notice any discoloured areas on the plaster or any discharge

Sources

  • Alexander M, Fawcett J, Runciman P. Nursing practice hospital and home: the Adult. 3rd ed. Edinburgh: Churchill Livingstone, 2006: 451-452
  • Altizer L. Casting for immobilization. Orthop Nurs 2004; 23 (2):136-142
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Is there anything I can do to prevent a broken bone in later life?

To prevent broken bones in later life you need to do two things - build strong and healthy bones and prevent accidents or falls that might cause a fracture. Eating the right foods, being active and following a healthy lifestyle can all help to build strong and healthy bones. Being aware of hazards that could cause an accident and keeping active can help you to prevent a fall.

Explanation

Over the age of 35 we start to lose bone quicker than our bodies can grow new bone. This happens much more quickly in some people and can lead to a condition called osteoporosis. Half of women and one in five men over the age of 50 will break a bone at some time, usually because of osteoporosis. Women are more at risk from broken bones than men once they have been through the menopause. This is because bone loss speeds up when your ovaries stop producing the hormone oestrogen.

Broken bones can be very dangerous as you get older. A broken hip is one of the most common fractures to happen to older women, for example, and it can be very serious. After a hip fracture you are more likely to develop a chest infection or a blood clot in a vein, which can cause serious illness. A broken hip can also affect how independent you are. Half of all women who had been independent before a broken hip become more dependent after it.

There are many things you can do to help develop strong and healthy bones. Here are some examples.

  • Eat a healthy diet, including foods that contain calcium and vitamin D. Foods that contain a lot of calcium are dairy products such as milk and cheese and foods that contain vitamin D are oily fish, egg yolks, liver and butter and margarine.
  • Get out in the sunshine. We get most of our vitamin D from sunlight on our skin and the best source is sunlight during the summer months. If you do go out in the sun protect yourself from burning.
  • Be active. Leading an active lifestyle can halve your chances of breaking a bone. This means doing a range of different activities to help build up strength, flexibility and balance. For example, tai chi and dance can help you to be more flexible, and walking and cycling can improve your muscle strength. Wear comfortable and well fitting clothes and shoes and build up the amount you do gradually.
  • Be the right weight. Osteoporosis is more common in people who are underweight so try to eat well and stay at a healthy weight for your height.
  • Don't smoke. Smoking also has an effect on your bones, so it's another good reason to give up.

If you think you might be likely to have an accident or fall over, talk to your GP. He or she can help you to get the right treatment and services that may help to prevent an accident.

These could include the following.

  • Strength and balance training. This is a programme of exercises designed to strengthen your muscles and improve your balance.
  • A home hazard assessment. An occupational therapist comes to your home to check for hazards that might cause a fall, for example, loose carpet or flooring. They may make changes to rooms such as the bathroom, to make sure you can get to the toilet and wash safely.
  • Having your eyesight tested.
  • Reviewing your medicines and checking for any medical conditions that might cause you to lose your balance or fall.
  • Reading information about how to prevent falls from happening, what to do if you fall and where to go for more help.
  • Having an assessment for an alarm system, which you can use to get help if you do fall.

The following practical day-to-day tips can also help to prevent you from having an accident at home.

  • Keep your home free of clutter and tuck away any cables that you could trip over.
  • Take care with any pets to make sure they don't get under your feet.
  • Store the things that you use every day at the right height for you to reach easily, so that you don't have to do too much bending or stretching.
  • Make sure your home is lit well so that you can see where you are going properly.
  • Wear well-fitting shoes with laces or a strap.
  • Put a rubber mat in the bath and have a grab rail installed to help you get in and out of the bath.

Further information

Sources

  • Fracture prevention in postmenopausal women. BMJ Clinical Evidence. http://clinicalevidence.bmj.com, accessed 31 March 2008
  • Bone and joint health. British Nutrition Foundation. www.nutrition.org.uk, accessed 31 March 2008
  • What is osteoporosis? National Osteoporosis Society. www.nos.org.uk, accessed 31 March 2008
  • Prevention and management of hip fracture in older people. Scottish Intercollegiate Guidelines Network, 2002. Guideline no. 56. www.sign.ac.uk
  • Clinical practice guideline for the assessment and prevention of falls in older people. National Institute for Health and Clinical Excellence (NICE), 2004. www.nice.org.uk
  • Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007:162-163
  • Caring for your bones: advice for older people. Help the Aged. www.helptheaged.org.uk, accessed 31 March 2008
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Could I have a sprain rather than a break?

Yes, you could have a sprain. A sprain is an injury to ligaments, which are the strong fibres that hold your joints together. It's possible to tear ligaments and this can give the same symptoms as a broken bone. How you injured yourself, how much movement and pain you have and investigations like an X-ray will help your doctor to decide whether you have sprained or broken something. If you are in any doubt, always get medical help.

Explanation

It can sometimes be very difficult to tell a sprain from a broken bone, particularly if the sprain is severe. A severe sprain has similar symptoms to a break:

  • swelling and bruising
  • pain
  • movement of the joint which isn't normal, and which may get worse as time goes on, until you can't move the joint at all
  • a snapping or breaking sound at the time of the accident, if the ligament has broken

If you have broken a bone, you are likely to have tenderness over the affected bone, which you wouldn't usually have with a sprain. It's not possible for you to be sure whether you have broken a bone or whether you have sprained a joint, so always get medical advice. See your GP or go to the accident and emergency department. Your doctor may need to take an X-ray to be sure. If you have sprained your ankle, the following is the recommended treatment.

  • As soon as you have injured yourself, apply an ice pack. You can use a bag of frozen peas wrapped in a damp towel. Leave this on for 15 minutes and keep the injured area elevated if you can. You can keep using an ice pack for a few days, three or four times a day, to help the swelling go down.
  • Rest the sprained area for a couple of days. Then start to move the joint to stop it becoming stiff. Take pain killers if you need to, to help you do this.
  • Use a support bandage to help reduce the swelling. If you have torn a ligament you may need to have a cast on for six weeks to allow it to heal properly
  • Gradually increase the amount of activity you do as the pain gets better and the swelling goes down. If you play sports, make sure you are fully fit before you play again.

Further information

Sources

  • Sprain and strains: background information. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 3 March 2008
  • Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007:564
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Related topics

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This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: November 2008

 

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