Introduction

A transverse fracture is one that is complete, meaning it goes all the way through the bone. The break is perpendicular to the direction of the bone. It may also involve displacement, where parts of the bone move and are no longer aligned. These fractures are most common in long bones, such as the femur (thigh bone) and the humerus (upper arm bone); however, they can occur in any bone in the body, including the patella (part of the knee). They can be either an open fracture, where the bone pierces your skin, or a closed fracture.¹ Transverse fractures are different to an oblique fracture, which is also through the bone but at an angle. They are also slightly different to comminuted fractures where the bone is broken into three or more pieces. Different types of fractures are shown in Figure 1 below.²

Figure 1 shows different types of fractures. The one we discuss in this article is on the left, the transverse fracture.² 

There are several common symptoms to look out for if you're concerned about a fracture, including swelling, pain, numbness or tingling, reduced ability to move, and an obvious deformity, which is where your leg or your arm, or other injured body part, doesn't look as it should.² There may be a lump or bend that shouldn't be there. If you experience any of these symptoms, especially after a slip, fall, or other accident, you should seek medical attention to check if you have a fracture.

Understanding the cause of the fracture is important as this can affect how it is treated, along with which bone is broken and if it is displaced. The cause is typically high force, and therefore, the risk of displacement is greater. Healing often takes months, and if there is no displacement and parts of the bone are still aligned with each other, treatment may simply be a cast to hold the bone in place while it heals. In more complex cases, surgery may be necessary. Surgical options may involve aligning the bone and using screws and rods to hold it together and allow it to heal correctly, because incorrect healing can cause future issues such as pain and mobility issues.³

There are three key causes of these fractures: high-impact injuries, falls, and repetitive stress. 

Key causes of transverse fractures

High-Impact Injuries

High-impact injuries include traumatic, sudden, and forceful collisions, such as car accidents, workplace accidents, and sports injuries (common sports include football and skiing). For example, in a car accident, your leg might hit the dashboard, and this direct impact can cause a transverse fracture. In the case of a workplace, if you drop something on your leg, this is another type of direct force that could cause a transverse fracture. In these injuries, force is transferred from an external source to the bone, and when this force exceeds the level of force that the bone can absorb, it causes a break.⁴ Prevention of these sorts of accidents can be limited, but you should always wear a seat belt when travelling in a vehicle to minimise any impact injuries in a car accident. Furthermore, risk assessments should be performed in a workplace to assess and prevent any potential risks that might arise. Proper protocols should be put in place and followed to prevent any workplace accidents. When playing sports, wear any recommended protective equipment and follow the rules of your sport.

Falls

Falls involve direct impact on a hard surface, and commonly affected bones include wrists, hips and pelvis. This is because of the mechanism of falls. Particularly, when you fall, you will probably try to protect yourself by putting out your hands, and this is known as falling on outstretched hands (FOOSH). This can result in wrist and forearm fractures. If you don't break your fall, you might fall onto your side or back, causing impact with your hip.⁵

Repetitive stress 

Any activity that causes repeated stress on the bone can lead to a fracture. This includes activities such as running, and can be particularly common in athletes who regularly overwork certain muscles and bones. Stress fractures are sometimes known as fatigue fractures, and they are small cracks in the bone caused by repetitive stress. While they are common in athletes, they can occur in anyone, particularly when increasing activity suddenly. This might include suddenly increasing physical activity, such as running, or even just increasing the amount of time spent standing, which might be for work. They are usually associated with less severe pain; however, without medical attention, treatment, and with continued stress, they can grow over time to become complete transverse fractures, making them more difficult to treat.⁸

Risk factors for fall-related fractures

There are several risk factors for fall-related fractures, including osteoporosis. This is more commonly found in elderly people, and it is where the bone is weakened and is more easily fractured. There are some symptoms to look out for, including height loss, slumped posture, and back pain, but the most obvious symptom is increased occurrence of fractures.⁶

Another risk factor for fall-related fractures is poor balance or coordination. There are several reasons someone might be experiencing poor balance and coordination, including but not limited to:

• Certain medications 
• Inner ear problems causing vertigo (feeling like everything is spinning)
• Alcohol
• Medical conditions
  • Cerebral palsy
  • Stroke
  • Vision problems⁷

Factors like these can make you feel dizzy and unsteady, or even give you blurred vision, making movement more difficult and increasing the likelihood of falls.⁷ 

Environmental factors can be a further risk for transverse fractures. For example, slippery or uneven floors can increase the risk of falls and, therefore, fractures. This can happen anywhere, from the workplace to at home, or even out and about. Health and safety in the workplace and public spaces are crucial in preventing injuries. 

Summary

Transverse fractures are a complete break through the bone, and can take a long time to heal depending on the complexity of the fracture. There are three main causes: high-impact injuries, falls, and repetitive stress. High-impact injuries typically involve car or workplace accidents or sports injuries and result from sudden force on the bone. Falls can occur due to a number of factors, both physical and environmental. Finally, repetitive stress can cause stress fractures, which, left untreated, can grow and become complete transverse fractures.

Prevention is crucial in trying to prevent transverse fractures. This includes proper safety measures, particularly in the workplace. There should be proper use of wet floor signs to prevent slips, and there should be protocols in place for the use of heavy machinery. If you have any balance issues or struggle with mobility, you should use mobility aids to prevent falls. Furthermore, elderly patients need to receive regular medical check-ups. This can help detect early signs of osteoporosis. In discovering this, doctors can prescribe treatment to strengthen the bones and can give advice on prevention. When undertaking physical activity, you should build up steadily rather than suddenly and significantly increase activity to prevent stress fractures. 

Preventing osteoporosis can include eating a healthy diet and taking vitamin D supplements, which is good advice for anyone hoping to minimise their chances of osteoporosis and fractures.⁶ To further improve bone strength and prevent fractures, regular exercise is key. This includes weight-bearing and muscle-strengthening exercise, such as running, where you are upright with your body weight pulling down on your bones, adding extra force by the motion of running. Muscle-strengthening is effective because the muscles pull on the bones, making them stronger. It is typically recommended you do this type of exercise 2-3 times a week, with rest in between to prevent stress fractures and other injuries.⁹ 

The most important takeaway message from this is to seek medical attention if you are experiencing any potential symptoms of a fracture. Early treatment will prevent it from being made worse and will allow it to heal better.

These symptoms include:

• Pain
• Swelling
• Bruising 
• Deformities 
• Numbness or tingling
• Reduced movement 

You should also see a doctor if you experience any of the symptoms of osteoporosis to minimise the risk of fractures. These include:

• Height loss
• Back pain
• Hunched posture