Introduction

Bone fractures are one of the most common injuries that the global population experiences. Around 178 million cases¹ were reported by the World Health Organisation (WHO) in 2019, and the number has steadily increased in the past few years.

What are transverse fractures?

Transverse fractures are a type of bone fracture where the break occurs perpendicular to its length.³ These types of fractures tend to occur after a person has undergone physical trauma such as a fall or accident. They are typically found in the longer bones of the body, which include:

• Femur (thigh)
• Tibia (shin)
• Fibula (calf)
• Humerus (upper arm)
• Radius and ulna (forearm)
• Clavicle (collarbone)³

Why is resting during recovery important?

When a fracture occurs, it is recommended to rest the affected area from a couple weeks to a few months. The required recovery period is dependent on the severity of the fracture, the location of fracture, and the patient’s medical history (occupation, age, sex). Rest ensures the bones heal in the correct position. Treatment often involves immobilising the fracture to maintain proper alignment and prevent complications. However, in some cases, complications may still arise.

Complications that can occur

Nonunion

A nonunion fracture occurs when the bone does not heal within the expected timeframe. The general timeframe that is used is when the bone doesn’t heal within 9 months after 3 months of it showing no signs of healing.⁴ There are different types of nonunion fractures, which include:

• Hypertrophic nonunion: the new bone growth does not meet and join together^4,5
• Atrophic nonunion: there is no new bone growth due to a lack of blood supply at the fracture⁴,⁵
• Oligotrophic nonunion: there is incomplete bone growth, but the bones are in the incorrect position^4,5 
• Septic nonunion: there is no new bone growth due to an infection at the site of the fracture⁴

Malunion

A malunion fracture occurs when the bone does not heal in the right place. This may lead to a bone deformity and the affected limb not working properly. A malunion fracture occurs when the bones are moved during the healing process, which may be caused by:

• The bones were initially not being aligned
• The affected area not being immobilised enough to prevent the bones from moving out of place
• The patient is prematurely placing weight on the affected limb

How are nonunion and malunion fractures diagnosed?

A nonunion and malunion fracture is diagnosed by performing a series of tests. Firstly, the patient’s medical history is collected. This includes:

• General information: age, sex, pre-existing conditions, current medications, and family medical history
• History of initial fracture: the severity and the affected area
• Recovery period

A physical examination is then given to assess the patient’s symptoms.

In the final stage of assessment, imaging tests such as x-rays, MRIs or CT scans are performed to evaluate the fracture. 

Once these steps are completed, the healthcare provider will deliver a diagnosis and recommend a recovery plan. The treatment approach will vary depending on the fracture’s severity and the patient’s overall health. 

Infections

Fracture-related infections (FRIs) are a type of infection that occur during either the process of the fracture or the treatment method used.⁶ The common scenarios in which FRIs can happen are:

• Open fractures: These types of fractures are at a higher risk of becoming infected as they are exposed to bacteria
• Surgical treatment: surgical methods introduce ‘foreign’ material into the body, which increases the risk of infection as they expose the body to bacteria⁶

The types of infections that can occur are:

• Superficial infections which affect the surrounding soft tissue around the fracture
• Bone infections (osteomyelitis), which is a serious infection that is difficult to treat

When an infection occurs, this is usually a cause of high concern. An infection may delay or even stop the healing process of the fracture, causing further complications that could be life-threatening. If any of these symptoms occur, you should seek out medical assistance as soon as possible:

• Fever (may be high when osteomyelitis occurs as the result of a blood infection)
• Pain and tenderness in the affected area
• Irritability in infants who can’t express pain
• Feeling ill
• Swelling of the affected area
• Redness in the affected area
• Warmth in the affected area
• Difficulty moving joints near the affected area
• Difficulty bearing weight or walking
• A new limp
• A stiff back (with vertebral involvement)⁸

Similarly to a nonunion and malunion fracture, the same tests to help diagnose the infection will occur, however, the final step involves a bone aspiration or biopsies to help in the diagnosis process and in determining treatment.⁸

Summary

While most transverse fractures heal well with proper care, complications can arise during any point of the recovery period. Therefore, it is of utmost importance to follow your healthcare provider’s instructions. Doing so helps ensure the best possible healing and reduces risks like nonunion, malunion, or infection If these complications do occur, it is crucial that you address the symptoms and seek medical assistance as soon as possible.