Fracture in Terms of Biology

The biology and biomechanics of fracture and soft tissue healing are no different among athletes. Athletes do not heal any quicker because they seek the advice and treatment of a ‘sports doctor’. In general, fracture union in the upper limb occurs in about six weeks among the adults and about half of this duration in a child, while its consolidation takes twice as long.

What is different among the patients is the attitude to injury. The demands of competition, especially at the elite level, may result in the athlete returning to training and competition too early, increasing the risk of further injury after sustaining fractured bones. Financial concerns may bear on this decision to return too early. Still, it is the athlete who will make the ultimate decision. It is the role of the sports medical team to advise what the risks are and how they may be minimized.

The clinical signs of fracture are important - pain, swelling, deformity and loss of function. Diagnosis is confirmed by x-ray. Early movement is the key for a swift return to full function so the fracture must be of a stable pattern, or be rendered stable by splinting or surgical fixation. Outcomes deteriorate if active range of motion is delayed beyond three weeks.

A fractured bone is reduced under appropriate anesthetic by closed or open means and rendered stable. Confirm by x-ray and repeat one week post injury and later as necessary.

If the fractured bone cannot be made stable by splinting, surgical fixation is necessary.

In general, displaced fractures involving joint surfaces will require reduction and surgical fixation. Note the called ‘clip’ or avulsion’ types of fractured bones, the bony equivalent of a tendon or ligament rupture, will usually require surgical repair.