Common Athlete Injuries: Fractures

A fracture can happen to anyone. But athletes are especially susceptible. In fact, 10% of all athlete injuries are fractures—and they can take up to nine weeks to heal.

A fracture occurs when a bone cracks or breaks. A fracture is typically either an open or closed fracture. The difference? An open fracture is a clean break that only affects the bone; a closed fracture affects the tissue and skin around the bone¹.

There are many types of fractures, including hairline, compression, spiral, stress, and many others.

Fracture Types¹

Avulsion fracture: caused by a muscle or ligament pulling on the bone

Comminuted fracture: when the bone is shattered into many pieces

Compression fracture: caused by a collapse typically in the spine

Fracture dislocation: when a bone connected to a joint fractures and the joint dislocates

Greenstick fracture: more common among children because their bones are soft and elastic. Occurs when the bone does not break all the way because the rest of the bone is bendable.

Hairline fracture: sometimes difficult to detect, this is a partial fracture.

Impacted fracture: when a fragment of bone goes into another

Intraarticular fracture: when the break or crack reaches the surface of the joint

Longitudinal fracture: the break extends the length of the bone

Oblique fracture: a diagonal fracture

Pathological fracture: when a disease or condition weakens the bone, causing a fracture. An example is osteoporosis.

Spiral fracture: one or multiple parts of the bone has been twisted

Stress fracture: caused by repeated stress or strain

Torus fracture: another fracture common in children. The bone becomes deformed but does not break

Transverse fracture: a straight break that goes directly across the bone

Athlete Fractures

The most common fractures for athletes are stress fractures and fractures of the wrist, hands, collarbone, and ankles/feet. Stress fractures are especially common. A stress fracture occurs when repeated stress on the bone which causes increased pressure on the bone. Due to this stress, the bone will either crack or severely bruised. Why are these fractures more common in athletes? Stress fractures are caused by overuse and most athletes perform the same movements day in and day out, thereby causing stress on the bone. The problem begins when muscles become overused and tired. Eventually, the wear is passed onto the bone causing a fracture.

A stress fracture can also be caused by a few other factors:

• An increase in physical activity in a short period of time
• Unfamiliar surfaces i.e. going from running on pavement to a dirt path
• Poor or improper equipment such as poor shoes

Where do stress fractures occur? Typically, stress fractures occur in the foot and lower leg. Around 50% of stress fractures happen in the lower leg. Certain sports increase susceptibility to stress fractures, including tennis, basketball, gymnastics, and track and field.

No matter what type of fracture an athlete might sustain, the recovery takes time. To help support not only recovery but possible prevention, be aware of the following information.

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Possible Symptoms

Most fractures are quite painful so pain will be a major indicator of a fracture. Fractures also often involve swelling and redness. Depending on the type of fracture, the skin may or may not be broken. Additionally, a fracture will often limit movement of the affected area. Other symptoms may include

• Bleeding
• Bruising
• Deformity
• Tenderness
• Discolored skin
• Cannot bear weight
• Cannot move the fracture site
• Nausea and dizziness

The symptoms of a full break will be more obvious that the symptoms of a stress fracture. In the case of a stress fracture, you may only notice some soreness or tenderness that gets worse with continual use.

Possible Treatments

Before you treat a fracture, you need to make sure it is a fracture. In order to diagnose a fracture, your doctor will need to do a physical examination. An x-ray will be taken, maybe even an MRI or CT scan.

An MRI stands for Magnetic Resonance Imaging and is used to take detailed images of your body and is a powerful diagnostic procedure. A CT scan, or a Computer Tomography scan, is similar, allowing your physician to take a closer look at your bone and tissue.

When it comes to treating a fracture, the main objective is to reduce the weight-bearing load on the fractured bone. This is usually done by using

• crutches,
• a walking boot,
• a brace,
• a scooter,
• a cast,
• a splint, or
• even a wheelchair if needed.

Depending on the severity of the fracture, surgery or metal rods may be used or required. The type of surgery will depend on the type of fracture. Surgery is often used to reconnect or stabilize broken bones. Any treatment options or techniques should be done under the care of a physician, whether that be an orthopedic surgeon, physical therapist, or your primary care provider.

Rest is a key part of fracture recovery. Giving the bone adequate time to heal will help determine the overall success of the recovery. Once the bone is mostly healed, physical therapy is often the next step, especially for athletes.

Your Nutritional Needs

In addition to rest, your body will need an increased amount of nutrition to heal. Below are some nutrients that are essential for bone healing:

Calcium and Vitamin D: These minerals help repair and remodel the broken bone. Calcium helps increase the strength of the bone while vitamin D helps make calcium available to the body

Protein: By volume, protein compromises around half of bone makeup. When a fracture occurs, your body needs amino acids to rebuild new bone. When healing from a fracture, you need to form a rigid callus. Protein deficiency leads to a rubbery callus. Proper protein intake can help accelerate fracture healing.

Antioxidants: When a fracture occurs, your body releases free radicals that come from the damaged tissue. Free radicals cause cell damage which can lead to inflammation and poor bone healing. Antioxidants, such as vitamin C and E, help suppress free radicals thus preventing further damage^2,3.

Zinc: A must-have during fracture healing. Zinc aids in the formation of callus and bone protein. During fracture healing, your body will create a soft callus that will eventually harden. Zinc promotes hard callus in the final stages of fracture healing.

Vitamin K: Shown to have positive effects on bone healing. Vitamin K can be considered the sidekick to calcium. It helps bind calcium to bone and helps preserve the calcium in your body.

Vitamin B6: A B-complex vitamin that has been positively linked to improved fracture healing. If vitamin K is calcium’s sidekick, vitamin B6 is the sidekick to vitamin K. B6 helps support the benefits of vitamin K. Further, a deficiency in B6 has been linked to more fractures.

Copper: Collagen is an abundant protein in the body and makes up bones, tissue, tendons, cartilage, and skin. Copper is needed for the formation of collagen. And your need for copper drastically increases after a trauma such as a fracture.

Silicon: Essential for collagen and bone formation.

Multi-Nutrients Approach

You will need ALL of these nutrients during fracture recovery. Bone is a complex tissue which means bone healing is also complex—which means one nutrient alone won’t do it. You will need sufficient stores of many nutrients. Receiving a wide variety of nutrients that support bone healing will provide better support during recovery. There have been studies that found multi-nutrient support is more effective. 

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Possible Prevention

In general, a healthy diet and regular exercise help prevent fractures. Being overweight or smoking are factors that increase the likelihood of fractures. However, when it comes to athletes, nutrition and proper care play a vital role in fracture prevention.

Everyone knows that calcium supports stronger bones. Calcium will not only help restore broken bones but ward off potential injuries. The same goes for vitamin D and adequate protein. The more nutritionally supported your bones are, the less likely you are to suffer a fracture and the better prepared you will be to recover if you do.

Safe and regular exercise is also key, which typically isn’t a problem for athletes. While remaining active, make sure to rest any existing injuries and do not push your body past its limits. Seek advice from your trainer or a physical therapist if you have questions or concerns about how to nurture your bones.

Potential Complications

Non-unions

This is a fracture that fails to heal and will require more corrective work such as bone grafts or stem cell therapy.

Infections

In cases where the skin breaks, bacteria can enter and cause an infection. This will require antibiotics and even surgical drainage.

Incorrect position

Sometimes, the bone can heal in the wrong position. When it does, it is called a malunion.

Bone death

In severe cases, the bone can die from a loss of blood supply.

The best things you can do to prevent complications are

• strictly follow the directions of your surgeon
• Follow a plan of optimal nutrition and appropriate exercise
• Give your recovery time and adequate rest

 

 

Bonjour JP, Schurch MA, Rizzoli R. Nutritional aspects of hip fractures. Bone 1996; 18:139S-144S.

Schurch MA, et al. Protein supplements increase serum insulin-like growth factor-1 levels and attenuate proximal femur bone loss in patients with recent hip fracture. Ann Intern Med 1998;128(10):801-809.