You don’t need a break this winter

It is not just slippery icy weather that can lead to bone fractures in winter. Inactivity can lead to weakened muscles, making falls more likely among older people, and low vitamin D levels have been linked with weak muscles and brittle bones.

Whatever the cause, a large number of breaks do occur in the winter months.

Fractures, or a break or a crack in a bone, can occur in any bone in our body. They can also occur in different ways. A simple fracture is a clean break to the bone that doesn’t cause any damage to surrounding tissue or break through the skin. A compound fracture is when the surrounding soft tissue and possibly the skin is also damaged and this is a more serious type of fracture because there is a higher risk of infection.

Doctors have various names for different fractures such as a hairline fracture, when the bone is only partially broken, and a compression fracture when the bone collapses. There are also stress fractures, when a bone breaks not because of an accident but because of repeated stress and strain. This is mainly a problem with the lower leg or foot and affects athletes with heavy training programmes far more than others. Bones can also fracture when they are weakened by diseases such as osteoporosis.

If you have had a fall, it is not always clear cut whether a bone is broken or not. The symptoms can vary depending on the bone that has been injured and also the severity of the break. There are some obvious indications of course: pain; part of the body being bent at an unusual angle; inability to move or put weight on the injured limb; or a grinding or grating sensation in the bone. Swelling, bruising and discoloured skin around the bone or lower joint are also indications that a bone might be broken.

Often, immediately after you have suffered a break, you may become pale and feel faint, dizzy or sick. A fracture is a severe shock for the body.

If you feel you might have broken something, do not move; medical help should be called immediately as moving a person with a fractured limb can cause more damage.

Treatment for fractures can involve a general anaesthetic while surgery takes place to realign the bones. Sometimes a metal place or screws are needed to ensure the bones are kept together in the correct positions. Once the broken bones are back in place, then the ends have to be held still while they grow and knit together. This is done by immobilising the limb, usually with a plaster cast but sometimes with other methods such as plastic braces.

As the area heals, the osteoblasts and osteoclasts in our body get hard at work. Osteoclasts are bone cells that absorb old and damaged bone, while osteoblasts build up new bone. The new bone built by the osteoblasts around a fracture is called callus. This callus forms on either side of a fracture and grows towards each end until the fracture gap is closed. Over time any excess bone is smoothed off and the bone returns to normal.

Most fractures are kept around eight weeks in plaster or similar immobilisation material, but healing a broken bone can take shorter or longer periods of time depending on natural physiology, the age of the patient, any infection and other aspects.

Some fractures simply refuse to heal completely and then there are various additional treatments that can help. Ultrasound therapy can be used, done on a daily basis for a few days; or a bone graft may be recommended. Research is currently taking place on the use of stem cells to help heal fractures that are failing to heal properly.

But of course as with so many things, prevention is better than cure. Diet has a major roll to play here – having enough calcium in your diet (from foods such as milk, cheese and green leafy vegetables) and ensuring adequate levels of vitamin D (from sunshine, eggs and oily fish) are important. Exercise can also help, bones become stronger and denser with regular weight-bearing exercise such as walking and aerobics.

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