It was a usual Bengaluru summer day when Kumar K C was riding his motorcycle towards his workplace for his evening shift. He was moving at a moderate speed when suddenly, a man on a bicycle cut across the road at a turning. Kumar applied the brakes to avoid hitting him. The impact threw him off the bike and he crashed into the median, shoulder and arm first.
The sudden, stabbing pain through his arms almost knocked him out. Observing the way his right wrist started swelling, he knew it was bad news.
Once at the hospital, the X-rays showed that Kumar had a crack in his left shoulder and a fracture in his wrist. Doctors at the hospital stabilised his wrist. While one arm had to be put in a plaster cast, the other one was in a sling to help the shoulder heal.
The sharp pain (acute pain) turned into a dull one (sub-acute pain) after a week and as the bone and muscles started healing, the pain subsided.
“It’s a decade since the accident, but occasionally while doing vigorous exercise or in chilly weather, I get a niggling pain (chronic pain) in my shoulder,” says the 47-year-old media professional.
Bone fractures are not just painful; they adversely affect the quality of life and have an economic impact on an individual, till the fractures heal completely. Pain management depends on the intensity of the pain, type of fracture and the bone that is affected. Prompt and effective treatment ensures the bones and connective tissues regenerate, lessening the pain.
Causes of bone fractures
According to the American Academy of Orthopaedic Surgeons, the most common causes of fractures are:
- Trauma – Injury from a road accident or a fall; or while playing a sport
- Overuse – This type of fracture is more common in sportspersons because of repetitive motions that put pressure on the muscles and bones
- Osteoporosis – Ageing results in the bones becoming weakened; osteoporosis in the elderly can cause broken bones
Types of bone fractures
Closed: When the injury does not result in an opening in the skin and the broken bone stays inside.
Open: When the skin breaks open and the broken bone comes out through the skin.
Comminuted: When the bone breaks into many fragments.
Stress: When there is a crack in the bone due to overuse.
Displaced: When the fracture results in a gap between the bones.
The ‘Global, regional, and national burden of bone fractures in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019’ published in the journal Lancet, reveals that the majority of the fractures were seen in older people (above 54 years) and researchers have recommended that better screening and treatment of osteoporosis in the elderly is necessary.
The areas of the body where fractures are more common are the bones of the lower limb (patella or the kneecap, tibia, fibula and ankle), the forearm (radius and ulna) followed by the shoulder and upper arm (clavicle, scapula and humerus).
Doctors say that fractures of the ribs, spine, ankle and long bones are the most painful, as even a slight movement increases the agony.
“The first thing to do when a person with a fracture comes to the emergency room is to immobilise the area with splinting. This reduces pain and swelling and prevents further damage. Then, an X-ray will be done to check the nature of the fracture and decide the further line of treatment.
“The most common fractures that we see are of the hip and wrist (in the elderly) and the shoulder. Fractures that happen because of extreme impact such as vehicle accidents or falls from a height and where the bone has moved quite a bit, tend to be more painful than others because there is considerable trauma to the adjoining muscles. In osteoporotic fractures, where the bone is already quite weak and a trivial fall may cause a break, the pain is not so intense,” Dr M S Somanna, consultant, joint replacement and arthroscopic surgery, Aster CMI Hospital, Bengaluru, tells Happiest Health.
Treatment for bone fracture pain
- Splint or cast: A splint is a device used to support a broken bone while immobilising that part of the body. A cast made of plaster/fibre and gauze serves the same function. An arm pouch may be used to immobilise a fracture in the arm.
- Medications: Painkillers and anaesthetics may be administered to give immediate relief from pain after a fracture.
- Mechanism-based therapy: Studies have shown that certain antibodies used to inhibit nerve growth factors and minimise skeletal pain also help in bone formation.
- Hot and cold compress: Ice packs are used to decrease swelling in the event of a fracture and hot compress can give relief from pain.
- Traction: This treatment method is mostly used for long bone fractures; it uses pulleys and weights to align the bone and stretch the muscles around it. Traction aims to reduce pain, muscle spasms and inflammation.
- Physical/occupational therapy: Once the pain and inflammation reduce and the person is in the fracture recovery process, the doctor may advise physical therapy in the form of exercises to strengthen the muscles and prevent chronic pain.
- For major fractures, surgery may be the only treatment option to set right the bones and reduce pain.
Other methods to reduce pain
- Electrical stimulation: In this method, a mild current is passed through the affected area by placing electrodes on the skin. The current stimulates nerves and muscles and brings down the pain and facilitates healing.
- Traditional medicine: In many countries, indigenous populations may use certain medicinal herbs and traditional therapies such as bone setting to treat fractures. While few studies show that these methods help, more research is needed to prove their efficacy.