Fractures and sprains

Also called Broken bone, Sprain, Strain, Soft tissue injury

A broken bone in an older person is rarely just an accident. The fracture gets treated; the reason for it usually does not.

What it is

A fracture is a broken bone. A sprain is a stretched or torn ligament, a strain a stretched or torn muscle or tendon. All three follow the same pattern of pain, swelling and loss of use, and they are frequently hard to tell apart without an X-ray.

The important distinction in this library is not which one it is. It is whether the injury made sense.

A bone that breaks from a fall at standing height or less is a fragility fracture, and it is a diagnosis in its own right: it means osteoporosis until proven otherwise. Wrist, upper arm, hip and spine are the classic sites. Around half the people who suffer a hip fracture had an earlier fragility fracture that was treated as an accident and never investigated. That is the single largest missed prevention opportunity in older people's health.

The other question a fracture should raise is why the person fell at all. See falls.

And in a child or a dependent adult, an injury that does not fit the explanation given, or bruising and fractures at different stages of healing, is a safeguarding matter that must be raised rather than wondered about.

Signs you might notice

Pain, swelling, bruising, and being unable to use or bear weight on the limb.

Deformity, an odd angle, or a grating feeling.

A snap or crack heard at the time.

999 or A and E immediately: bone visible through the skin; a limb that is numb, cold, pale or blue; severe deformity; a suspected hip, spine, neck or skull fracture; or a person who cannot get up after a fall.

Sudden severe back pain in an older person, with loss of height or a new stoop, can be a spinal compression fracture and needs assessment even without a fall.

Ongoing pain and swelling that has not settled after a few days deserves an X-ray, whatever it was called at the time.

How it can affect day-to-day life

The recovery is longer than the cast. Stiffness, weakness and loss of confidence outlast the bone healing by months, and in older people a wrist fracture is frequently the start of doing less, going out less, and a decline nobody connects back to it.

Fracture Liaison Services exist precisely to catch fragility fractures and start bone treatment. Coverage across the UK is patchy, and being referred is often something a person has to ask for.

Time in a cast or a sling means a real risk of deep vein thrombosis, pressure damage, constipation and deconditioning, especially in an older person.

For anybody who lives alone, the practical questions are the ones that determine whether they cope: washing, cooking, the stairs, and getting help if they fall again.

Supporting someone well

For any low-impact fracture in somebody over 50, ask directly for a bone health assessment and a referral to a Fracture Liaison Service. This is the step that prevents the next one.

Ask why they fell, and get that investigated too: medicines, blood pressure, eyesight, feet, and the home.

For the first 48 hours of a sprain: rest briefly, ice, compression, elevation. Then start moving it. Prolonged rest weakens and stiffens.

Ask for physiotherapy for anything not back to normal after a few weeks, and for any older person recovering from a fracture.

Ask for occupational therapy before discharge home if washing, dressing or the stairs will be a problem.

Keep moving what is not injured, keep fluids and protein up, and watch for constipation on painkillers.

Raise safeguarding concerns through the proper route if the injury does not fit the account given. That is not an accusation; it is a duty.

Where to get help

999 for an open fracture, a suspected hip or spinal fracture, or anybody who cannot get up.

An urgent treatment centre or minor injuries unit for suspected simple fractures and sprains.

A GP practice for pain that has not settled, and to ask about bone health assessment.

Royal Osteoporosis Society run a helpline and explain what a Fracture Liaison Service should offer.