What Are Spiral Fractures

Spiral fractures are visually distinctive fractures when looked at under an X-Ray. They are the result of painful twisting of an extremity that results in the bone breaking. 

Spiral fractures are corkscrew/spiral staircase-shaped fractures, often in the arms or the legs. They are extremely painful and can take longer than six months to heal. Also known as a ‘toddler's fracture’ or a ‘torsion fracture’ as they can often occur in young children and are the result of an extreme twist of the bone known as a torsion. 

Spiral fractures change from patient to patient, as they can occur in many different ways to wildly different groups of people. Read on to see the different types of spiral fractures, different groups affected, and more.

Overview 

Spiral fractures are common in athletes and toddlers alike. They are often caused by excessive rotation forces that lead to a spiral-shaped fracture on the bone. They can occur anywhere but mostly occur in long leg and arm bones. The variety of causes, locations, and age groups affected mean that the spiral fracture, the symptoms, and the recovery are different for everyone.

Introduction

A spiral fracture, also known as a torsion fracture, occurs when a long bone is damaged by a rotating force. This rotating force is often known as torque or torsion, with the fracture usually occurring when one extremity is planted still while the other is twisting. This means the fracture occurs in a corkscrew/spiral staircase shape on the bone. The severity of injury can vary depending on the type of spiral fracture.

Understanding spiral fractures is important as they are common in infants and sporting injuries (particularly skiing). Spiral fractures can also be a sign of child abuse caused by forceful twisting of limbs, though abuse isn’t always the case in young children.¹

This article goes through the different types of spiral fractures, their causes and their treatments.

Types of bone fractures

A fracture is a break or cracks in the bone that usually lead to pain or discomfort. Fractures can occur in any bone, and there are a variety of fractures.

Types of fractures:

• Transverse: a straight fracture across the bone.
• Slanting: a non-straight line fracture. 
• Longitudinal: a fracture across the shaft of the bone 
• Comminuted: a fracture where the bone shatters into many different pieces. 
• Spiral: where the fracture is not straight and spirals.

Spiral

These types of fractures also have sub-types. Spiral fractures have the sub-types of displaced or stable fractures. 

• Stable spiral fractures: where the bones are disconnected but still line up/are not out too much out of place. 
• Displaced spiral fractures: the bones along the break no longer line up correctly. 

Causes of spiral fractures

There are multiple causes of spiral fractures, they are mostly caused by an excessive external rotation force on an extremity such as your arms or legs. Though in rare instances they can happen without this external rotation force.² Falls, car collisions, violent incidents and sports can cause high-strength external rotation. 

Sports-related incidents

There are many sports that can cause spiral fractures. This includes: 

• Bowling a ball - known as ‘ball throwers fracture’, often occurs in the upper-arm/humerus bone in baseball players due to repeated tension caused by the frequent twisting of the bone when bowling.⁸
• Arm Wrestling - excessive force in arm wrestling can lead to a spiral fracture in the humerus.⁶
• Skiing - the most common type of fracture in skiers was found to be a spiral tibial shaft (lower leg) fracture.⁷ Frequently caused by one leg on one ski being planted in the ground while the other leg rotates freely. 

Abuse

An article from 1990 suggests that 9/10 spiral fractures in young children are accidental and are not a product of child abuse.³ More recently, it has been argued that transverse fractures are a better indicator of childhood abuse than spiral fractures in children under 3 years old.⁴ Still, childhood abuse can cause spiral fractures. One such sign is a spiral fracture of the leg in children who cannot walk yet. 

Overall, it is a potential warning sign of abuse, though is not proof of abuse by itself.¹

Characteristics of Spiral Fractures

Spiral fractures are often caused in the extremities of the body, particularly the large bones of the legs and arms. On an x-ray, a spiral fracture is distinct in the way it wraps around the bone like a spiral staircase.  

Diagnosis

Because of its unique spiral shape, the easiest way to diagnose a spiral fracture is through an x-ray. Therefore, an expert will have to diagnose the type of fracture. But there are signs of a fractured arm or leg to look out for:

• Severe pain or numbness (leg and arm). 
• Swollen or bruised (leg and arm). 
• Cracking sound when injured (leg and arm).
• Feeling faint, dizzy or sick (leg). 
• Difficulty moving (leg and arm). 
• Cannot walk (leg). 
• Bone sticking out of skin (leg and arm). 

Arms and legs aren't the only places a spiral fracture can occur, if concerned please seek medical help.

Visit A&E (or call emergency services if unable to reach A&E) when: 

• Bleeding from the wound. 
• Bone sticking out of the body. 
• The damaged area goes numb and has pins and needles sensations.
• Pain is extreme. 

If less severe, in the UK, it is still recommended that you call 111 and seek medical help as soon as possible. Medical professionals will give short-term advice that will stop the break from becoming worse and will start an immediate treatment plan that will increase the chance of a quick and effective recovery. 

Treatment options

Medical staff will find the best treatment option for the patient, with the style of treatment depending on the severity of the break. Often a plaster or a cast is used until the bone has healed. 

Reduction

A doctor or nurse will aim to set the bones back into the correct place after they have left through reduction, which is a non-surgical procedure. 

Surgery

Sometimes surgery will be needed to place the broken bones back together using rods, screws and wires. The screws and rods are left in the body permanently (unless there is a medical reason to remove them), while the wires are removed 4 - 6 weeks after the surgery. 

No matter the treatment, follow-up exercises and appointments are often necessary. Treatment may vary depending on location, severity, and age. 

In adults, spiral fractures in arms usually take around 4 - 6 weeks to heal, while spiral fractures in legs can range from 6 weeks to 6 months, depending on severity. 

Toddlers fracture treatment

For toddler fractures (a spiral fracture in the tibia in infants), a cast is usually used (but not always) for three weeks.

Complications and risks

Immediate medical attention is needed to minimise the risk of complications, including:

• Acute Compartment Syndrome (ACS): a buildup of pressure in the muscles near a fracture that leads to impaired blood flow to the damaged area. This can cause significant damage to the tissue and even death of the tissue if left untreated.
• Improper healing (malunion): when a fracture heals it may not realign with the bone like it did before the break. This can lead to limbs that are twisted, and havereduced functionality and pain at the site of the fracture and nearby joints. 
• Blood vessel, muscle and nerve damage: the impact that damages the bone, or the bone coming out of place, may also damage the blood vessels, muscles and nerves surrounding the site of fracture.
• Infection: whenever there is an open wound, there is a risk of infection. However, fractures have the added risk of the bone becoming infected (known as osteomyelitis).

Recovery and rehabilitation

Recovery and rehabilitation will be different for every fracture, depending on the age, severity, and location of the fracture. Often while recovering a cast, a sling, or crutches will be needed to aid with healing and mobility. Eating healthy, high-protein food and not smoking are two ways in which recovery can be sped up, but each injury will take its own time to heal. 

Rest

No matter the circumstances, rest is extremely important for recovery, especially for those who have had surgery. 

Physical therapy

Physical therapy will often be needed to restore previous strength and mobility to the damaged muscle and bone.

Toddlers fracture

A toddler often has a cast for around three weeks. It is normal for the toddler to start walking with the cast, but it is also common for the toddler to be hesitant about walking and putting pressure on the limb even when out of the cast. Their walk may be different from before the incident, but this again is normal, and they are expected to recover in a few weeks. 

Please see here or consult a healthcare professional for more guidance if you have a toddler with a toddler fracture.

Prevention

Preventing a spiral fracture may not always be possible as they are often the results of accidents. But there is a list of ways to increase bone health and so reduce the chance of the bone breaking:

• Vitamins - Magnesium, Vitamin D, Vitamin K, Calcium and more, can all help with bone health. 
• Exercise - exercise has been found to increase bone strength, with specific regimes being designed to directly increase the strength in your bones.⁵

When playing ANY physical sport you should always be careful of your surroundings and follow the safety measures put in place by officials or instructors.  

Summary

Spiral fractures are mostly caused by accidents that can happen to anyone. Eating a well-balanced diet, getting exercise, and being careful in sports can increase bone strength and lower the risk of a spiral fracture. However, even the most healthy and disciplined athletes can get a spiral fracture. Another group at risk is toddlers, which is why a spiral fracture is often referred to as a toddler’s fracture. Luckily, the condition is treatable. Seeing a medical professional as soon as possible is the best way to kickstart recovery. 

FAQs

How serious is a spiral fracture? 

A spiral fracture can be serious and poses the risk of complications.²

Is a spiral fracture the worst type of fracture?

Some spiral fractures can take longer than 6 months to heal, but as with all fractures, the location and severity changes upon injury. 

What is the most common cause of spinal fractures?

Spiral fractures can be the result of everyday injuries, as well as sporting injuries and abuse. In short, any incident that results in a sharp twist of the bone can cause a spiral fracture.¹