Introduction

As an athlete, injuries are unavoidable. The injuries themselves can range from minor sprains to complications that require surgery to correct them.

It is a well known fact that the training undergone by athletes can cause immense stress on the body in order for the athlete to perform to the best of their ability whilst also maintaining their body at peak physical condition. However, the recovery from an injury, such as a transverse fracture, can make or break an athlete’s career. This article will explore transverse fractures in athletes and the best way they can be managed to ensure a smooth transition back to physical exercise. 

What are transverse fractures?

Transverse fractures are a type of break to the bone that can occur following a significant physical trauma. The fracture typically runs perpendicular (at a right angle) to the bone’s length¹. This type of fracture is also known as a ‘complete’ fracture as the bone cleanly breaks into two or more pieces.²

They typically occur in the longer bones of the body which include:¹

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

How does someone get a transverse fracture? 

Bones are known to be incredibly strong and can withstand a lot of force, which is why bone fractures do not happen often. It takes an extreme amount of stress and pressure that is more than what the bone can handle in order for it to break. 

They often occur when a person has:³

• Undergone high-impact trauma e.g. falls, car accidents, or playing sports
• Overused their muscles
• Has weakened bones due to pre-existing conditions or diseases (such as osteoporosis or cancer)
• Is ageing (as bone density and strength decreases as you age)

Although bone fractures can easily be preventable, athletes are at a higher risk of fracturing their bones due to their profession. Since athletes have to train much more compared to the average person, and in a way that is a lot more physically demanding, their bodies are under a higher amount of stress. In addition, they are constantly overusing their muscles or doing repetitive motions that also increases the stress applied to bones.

Some athletes are at a higher risk of breaking their bones due to the sport that they play. These sports include:

• Contact sports such as rugby, football, American football, and mixed martial arts (MMA)
• High-speed sports such as cycling and skiing
• High-impact sports such as running and gymnastics

What all of these sports have in common is that there is a risk of the athlete receiving a large amount of force in one go whether it be through a tackle from another person, crashing and landing on hard surfaces, or overusing their muscles to a degree at which a minor injury progresses into a more complicated one. Therefore, preventative measures (how to prevent an injury) are extremely important in the world of athletics in order to reduce the risk of a severe injury.⁷

How are transverse fractures diagnosed?

Symptoms of a bone fracture include:^1,3

• Sudden pain
• Swelling
• Tenderness
• Bruising or discolouration around the area of injury
• An unusual bump or deformation that is usually not there
• Warmth around the area
• Unable to move or bear weight on the affected body part 

Alongside the doctor checking the symptoms of the bone fracture (also known as a physical exam), they will also perform a series of tests to identify what type of fracture it is. These are called ‘Imaging tests’. The imaging tests that are performed are:⁴

• X-rays
• Magnetic Resonance Imaging (MRI)
• Computed Tomography (CT Scan) 

Usually a simple X-ray will be enough to figure out the type of fracture the bone has, however, MRIs and CT scans can also be done to visualise the severity of the fracture or to reveal any hidden fractures which were not picked up by the initial X-ray.⁴

How are transverse fractures treated?

There are various types of treatments available depending on the severity of the fracture. The options mainly break down into non-surgical and surgical options. Rehabilitation strategies are typically offered if the fracture is severe. 

For athletes, there is a heavy focus on rehabilitation in order to get their body back to their peak condition whilst also focusing on preventing the same injury from happening again. 

Non-surgical treatment

Immobilisation is the typical non-surgical treatment if the bones have not moved far out of place. You will be given a cast or splint to help keep the bones aligned for it to naturally heal. A splint will need to be worn for three to five weeks, whereas a cast may need to be worn for six to eight weeks. Medications can be prescribed to help control the pain and it is usually recommended you rest the affected body part to help with the healing process.¹

If the break is more severe, the doctor will have to perform a closed reduction to realign the bones before putting you into a cast or splint. An anaesthetic will be given to prevent you from feeling any pain during this procedure.¹

Surgical treatment

In more severe cases, surgery may be needed to help with realigning the bones. Surgical options include either internal (inside the body) fixation or external (outside the body) fixation techniques to help with holding the bone fragments in place whilst the bone heals, which in turn limits your movement.³

These techniques include:³

• Rods which are inserted through the center of the bone
• Metal plates and screws which are screwed into the bone, holding the pieces together
• Pins and wires which are usually used to hold smaller bone fragments and used alongside the rods or plates

With these types of treatments, the inserted surgical you either live with these pieces inside of you for the rest of your life or will have a follow-up surgery to remove them after you have healed. However, this is dependent on the severity of the break, and how the bone heals. Recovery time of these fractures are typically six to twelve weeks, however, this is also dependent on the severity of the break.³

Rehabilitation strategies

Rehabilitation strategies for the general public that are usually offered are physiotherapy and progressive weight-bearing exercises. This will help you gain strength and flexibility in the affected area to help you gradually get back to everyday life. Inevitably, this will take time and you must make sure you get a lot of rest to prevent the same injury from happening again⁵.

However for athletes, the same cannot be said. Athletes will work closely with their healthcare providers and trainers in order for them to get back to playing sports as quickly as possible with the lowest side effects possible⁵.The rehabilitation strategies are extremely similar to what is offered to the general public, however, they are usually done at an accelerated rate. The general recovery time needed for the fracture to heal is the same, placing an importance on resting as much as possible in order for the bone to heal quickly⁵. 

Return-to-play protocols

There are a lot of variables that need to be considered when creating a return-to-play protocol. A general guideline, created by the Center of Disease and Control, outlines is typically followed for this.⁶ Let’s have a look at some of these protocols. 

Return to participation

After the athlete has followed the general recovery time, they may be allowed to participate in rehabilitation. This could include exercises that gradually increase their strength, mobility of the affected area, flexibility, and their stamina. The athlete will be more physically active, however, will not be considered for returning to their sport just yet.⁶

Return to sport

The athlete will be allowed to return to their sport, but they will not be performing at their desired performance level just yet. The difficulty of their exercises will increase, and they will be doing more sport-specific exercises to help them refine their skills than what they have done during their initial rehabilitation period. Some athletes may consider this stage as the final stage of their rehabilitation.⁶

Return to performance

At this stage of rehabilitation, the athlete will have fully recovered from their injury and has returned to or are performing above their level before the injury. They will experience no pain whilst performing exercises and during training. After an examination from a medical professional, they will be allowed to return to playing their sport. The medical professional and trainer will also create prevention strategies to prevent further injury from occurring.⁶

Summary

Transverse fractures are a type of fracture that runs perpendicular to the bone’s length and cleanly breaks the bone into two or more pieces. These fractures occur when a force is exerted onto the bone which is more than what it can usually withstand. Athletes are at a higher risk of getting a bone fracture due to the nature of their profession and training program. However, for both an athlete and a member of the general public, there is an extreme importance placed on the recovery period after the fracture is treated. It is important to follow the recommended recovery instructions in order for the bone to heal and for you to return to your everyday life as quickly as possible. The key recovery tip – rest. If any complications arise, contact your healthcare provider for further advice or treatment.