What is a spiral fracture? Causes and treatment

A spiral fracture is a bone fracture that occurs when a long bone is broken by a twisting force.

It usually takes a combination of surgery, rest, and physical therapy to recover from spiral fractures.

What is a spiral fracture?

A spiral fracture is usually treated right away with surgery. After the surgery, a cast may be worn.

A spiral fracture happens when a long bone is torn in half by a twisting force or impact.

The long bones are the bones of the body that are longer than they are wide. Most spiral fractures involve the long bones of the legs, such as the femur, tibia, and fibula.

The injury can also involve the long bones of the arms, including the humerus, ulna, and radius.

Spiral fractures are usually serious injuries and carry the risk of complications.

When long bones are broken on an angle, they often separate into two parts that do not align and have rough, uneven edges. This fracture can make it difficult to put the bone back together. 

Spiral fractures are sometimes called torsion or twisting fractures.

Causes

Anything that puts a lot of twisting stress or force on a long bone can cause a spiral fracture. But a few specific motions, activities, and circumstances tend to be associated with the injury.

Causes of spiral fractures include:

·         Skiing or snowboarding injuries, when the leg is twisted by being stuck in a ski or snowboarding boot while the rest of the leg continues to move.

·         Soccer injuries, especially when two players run into one another and become entangled or twisted.

·         American football injuries, especially when one player runs into another, one player is held or restrained by another, or a player twists to get free.

·         Wrestling injuries to the legs or arms caused by twists.

·         Motor vehicle and motorcycle accidents.

·         Bicycle accidents, typically those involving a motor vehicle as well.

·         Falling after trying to compensate for a loss in balance by putting out an arm or quickly repositioning the leg.

·         Child abuse, if a child's arm or leg has been jerked aggressively.

·         Falling down the stairs or a slope with fixed obstacles, such as rocks or trees that can twist an arm or leg away from the rest of the body.

·         Physical violence, when a person's arm or leg has been twisted forcibly.

·         Machinery injuries that involve someone's limbs.

Symptoms

Spiral fractures can be extremely painful. Other symptoms commonly associated with the injury include:

·         fainting or losing consciousness

·         inability to put weight on the affected bone

·         loss of feeling and control in the lower leg or arm, especially in the feet and hands

·         bone tenting, where the fractured bone is ready to break through the skin

·         inability to straighten or fully extend the leg or arm

·         signs of bruising

·         inflammation or redness and swelling

·         loss of pulse in the ankle or wrist

Diagnosis

A doctor will usually begin by examining the injury, potentially trying to straighten or bend the affected bone. They will also ask questions about when and how the injury happened and how it has been treated so far.

X-rays are often used to diagnose spiral fractures.

Other tests used to diagnosis spiral fractures include:

·         X-rays

·         CT scans

·         radiographs

·         blood tests

Without proper imaging, a spiral fracture can be mistaken for another type of fracture, such as an oblique fracture.

On scans and X-rays, a spiral fracture is identifiable because it looks like a corkscrew.

Treatment

Treatment for a spiral fracture depends on the severity of the breakage and damage to the surrounding tissues and blood vessels.

Immediately after the injury takes place, it is important to make sure no weight is put on the fracture. If possible, it should be splinted to prevent further damage.

The affected limb should be elevated to heart level and iced to reduce blood flow and limit inflammation. Ice should be applied for no longer than 10 minutes at a time.

Acetaminophen is the only over-the-counter medication recommended during initial treatment for a fracture. Anti-inflammatory medications weaken the blood's ability to clot and may make internal bleeding worse. 

A person should not eat or drink anything immediately after the fracture, as surgery may be required.

All fractures require immediate medical care. Calling 911 or an emergency hotline to request an ambulance may be the best way to get to a hospital without further injury.

Surgery

Most spiral fractures require surgery and general anesthesia. Less severe cases, where the bone is not fully separated, may be operated on using local anesthesia.

If the two ends of the bone are separated then an open reduction surgery will be necessary.

For this procedure, surgeons will usually cut the skin to expose the fracture. They will then examine the entire area, looking for stray pieces of bone, broken blood vessels, and tissue damage before realigning or reducing the broken parts of the bone.

If necessary, the bone is then reinforced using pins, screws, or rods to ensure the bone stays aligned while healing. If the surgery involves reinforcement, it is called open reduction with internal fixation surgery.

If the bone is not separated, a doctor may perform closed reduction surgery. Surgeons will guide the bone into proper alignment from the outside, manipulating the bone through the skin.

Post-surgical treatment

After surgery, or with clean breaks, a splint is frequently used to reinforce the proper positioning of the bone ends. A splint can be easily adjusted to allow for inflammation.

For the first few weeks of healing, the broken bones need to be completely immobilized or prevented from moving. Once the swelling has gone down, a cast is usually applied.

A brace may replace the cast after a few weeks, as a brace can be removed for cleaning, physical therapy, and examination. A wheelchair, crutches, or a walker may also be necessary to limit the weight put on the limb.

For the first 48 hours after the splint and cast are applied, the limb should be elevated to heart level. Icing and elevation should be used periodically throughout the day as needed or directed by a doctor.

Medications will be prescribed to help manage pain. A doctor will typically also prescribe antibiotics to prevent infection.

Gradual weight-bearing activities may be appropriate 4 to 6 weeks after the injury. However, for severe cases, it often takes 12 or more weeks before the bone can begin to bear weight. Reinforcing devices like rods and pins are usually removed between 3 and 6 months after surgery.

Even after the cast or brace is removed, most people still need to limit movement in the affected limb. In the case of leg injuries, a walker or crutches may be used for a few weeks or months after casts or braces are removed.

In total, it often takes between 4 and 6 months for a full recovery from a spiral fracture. Severe injuries may take as long as 18 months to heal properly.

Complications

If left untreated, a fracture can be life-threatening. Spiral fractures also increase the risk of developing additional health conditions. Complications can also occur during surgery.

Common complications associated with spiral fractures include:

·         compartment syndrome, where blood to the leg is stopped by inflammation or swelling

·         blood vessel and nerve damage

·         muscle damage

·         infection, including osteomyelitis or a chronic infection of the deep bone

·         sepsis, when the immune system begins to damage the tissues after being overstimulated by a severe infection

·         non-union or malunion, when the bone does not heal or heals incorrectly

·         pulmonary emboli, when a blood clot breaks loose and goes into the lungs

Prevention and risk factors

A sedentary lifestyle may cause muscle ache and weak bones, which may increase the risk of experiencing a spiral fracture.

There is no real way to prevent a spiral fracture. Most people experience the injury due to an accident or during sporting activities.

However, there are factors considered to increase the likelihood of bone fractures.

Known risk factors for fractures include:

·         prior history of bone injury

·         bone disease

·         chronic malnutrition

·         age

·         low physical activity level

·         exposure to violence or abuse

·         failure to wear protective gear, such as wrist guards for football, rugby, and snowboarding

·         tobacco smoking

·         nerve injury or disease

·         muscle damage

·         neurological conditions

·         genetic conditions that affect bone formation and stability, such as osteogenesis imperfecta

·         preterm birth

·         osteomyelitis or bone infection

·         vitamin C deficiency (scurvy)

·         vitamin D deficiency (rickets)

·         copper deficiency or Menkes disease, a congenital condition present at birth that impairs copper metabolism

·         alcoholism

Avoiding, preventing, or reducing these factors can, in turn, reduce the risk of a spiral fracture.