Bones are essential to a person’s form and structure. They are the main weight-bearing parts of the body and carry us through various activities that are essential for everyday living. They also protect several organs from the soft lungs inside the rib cage to the spine that relays impulses from the brain to the tips of our toes.
However, even the strongest have their breaking point, and bones often break.
What is the easiest bone to break?
Honestly? It depends on who you ask.
A critical review article published in 2016 purports that the clavicle or the collar bone is the most commonly broken bone in the human body, comprising as much as 10% of all fractures seen in emergency admissions.
In a study of an orthopedic trauma unit in Edinburgh last 2000, researchers found that fractures of the hip, ankles, wrists, hands, and fingers make up as much as 60% of fractures for that year. A number of these were considered fragility fractures that were due to osteoporosis seen in older individuals. A follow-up study in Edinburgh last 2014 reported similar common fracture sites but with increasing incidences.
The most recent study done in 2020 using the Swedish Fracture Register revealed that, like the study in Edinburgh, more than 50% of all fractures can be attributed to fractures of the wrist, the hand, fingers, hip, and ankle-- with the addition of fractures in the upper arm.
If you imagine where in the body those are, the most common cause of fractures now makes sense.
Fragility fractures and low energy trauma
One thing that the studies above found in common were that these fractures tended to be age-related. Research spanning from 2000 to 2020 shows that fracture incidence is highest in older individuals and may be due to changes in bone structure as people age.[2,4]
While more force may be required for younger bones to break, as with a high-impact vehicular collision, the same is not true for older individuals. Diseases like osteoporosis, in which a patient would have low bone mass make them more susceptible to fragility fractures. These are specific fractures that only require ‘low-energy’ trauma, such as falling from a standing height. Perhaps, even less.
Picture this: an old grandmother is walking down the stairs, swaying unsteadily because her prescription glasses need updating and the floor looks further than it is. If she falls and trips on her ankle, this could lead to a fracture. If she falls and lands on her hip, the force could cause the long bone connecting to the hip to break. If she falls and attempts to stop it by extending her hand, the wrist could break. Depending on the angle, perhaps also the fingers. Or the force could travel up the arm and to the part that connects to the shoulder.
These coincide with the most commonly broken bones in the human body.
How do you treat a broken bone?
There is no one-size-fits-all treatment for fractures. Each would be handled differently depending on where they are, how much damage there is, or whether the bone has moved from its original alignment. Nevertheless, some general principles inform how broken bones are treated.
Keeping the fracture stable and immobilizing the affected limb is essential in supporting the normal healing process. Now, not all fractures heal perfectly. Excessive instability in a fracture, especially one that isn’t internally fixed through surgery or wrapped in a cast, may get in the way of the normal healing process. Cartilage formation and the creation of a bony callus are essential in treating several types of fractures.
The treatment depends on where the fracture is and what it looks like for hip fractures. Since these are fractures that are common in the elderly, their other comorbidities or sickness may also factor in the healing time. The general goal of this treatment is to get the patient up and about as soon as possible. Thus, surgery is often recommended within 48 hours of being admitted to the emergency room.
For wrist or distal radius fractures, bone mineral density plays a significant role, especially since this is more common in the elderly. While casting or closed reduction is enough for stable fractures, there is a higher risk for the fracture to be displaced in unstable fractures. While many elderly patients have a good prognosis for their wrist fractures, this type of fracture is known to portend more future fractures. Thus, it’s best to revisit whether older adults are at risk for falls in the home.
Unlike fractures of the hip or the wrist, fractures of the fingers and hand have a different demographic. Also known as metacarpal and phalangeal fractures, these are often seen in athletes who engage in ball-handling sports. It’s when the ball comes hurtling towards them and they fail to catch it properly that these injuries can happen. Other contact sports such as boxing may also be causes for these injuries.
As with wrist injuries, unstable fractures may need an operation. However, most of these fractures are only minimally displaced and require a shorter time of non-movement before exercise therapy can be started.
The last most commonly broken bone relates to an ankle fracture. The common recommendation for most patients is surgical fixation to stabilize the area. Once stability has been achieved, weight-bearing or putting your weight on the affected foot as tolerated is known to improve short-term functional status. With this, there’s often an earlier return to work and, compared to those who put their full weight on the joint later, there was no significant increase in complications.
Of course, this weight-bearing is “as tolerated” and thus dependent on how comfortable one is. Until then, there are wheeled knee walkers or scooters for a broken foot that are available for that transition period. A scooter for a broken foot may help with ambulation and in doing everyday tasks that may be challenging with a broken foot. A study conducted in 2021 showed that, despite half of the participants not having experience with these wheeled knee walkers, there was still a high satisfaction rate for the knee walker.
Just make sure you keep your balance in the scooter to prevent falls.
Bones are both strong support systems for the body as well as fragile and breakable, especially with increasing age. Knowledge of which bones are most commonly broken, why this is so, and how to treat them helps us prevent these accidents.
- Burnham JM, Kim DC, Kamineni S. Midshaft Clavicle Fractures: A Critical Review. Orthopedics. 2016;39(5):e814-e821. doi:10.3928/01477447-20160517-06
- Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-697. doi:10.1016/j.injury.2006.04.130
- Court-Brown CM, Biant L, Bugler KE, McQueen MM. Changing epidemiology of adult fractures in Scotland. Scott Med J. 2014;59(1):30-34. doi:10.1177/0036933013518148
- Bergh C, Wennergren D, Möller M, Brisby H. Fracture incidence in adults in relation to age and gender: A study of 27,169 fractures in the Swedish Fracture Register in a well-defined catchment area. PLoS One. 2020;15(12):e0244291. Published 2020 Dec 21. doi:10.1371/journal.pone.0244291
- Osteoporosis: assessing the risk of fragility fracture. London: National Institute for Health and Care Excellence (NICE); February 2017.
- Einhorn TA, Gerstenfeld LC. Fracture healing: mechanisms and interventions. Nat Rev Rheumatol. 2015;11(1):45-54. doi:10.1038/nrrheum.2014.164
- Emmerson BR, Varacallo M, Inman D. Hip Fracture Overview. [Updated 2021 Nov 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557514/
- Mauck BM, Swigler CW. Evidence-Based Review of Distal Radius Fractures. Orthop Clin North Am. 2018;49(2):211-222. doi:10.1016/j.ocl.2017.12.001
- Wahl EP, Richard MJ. Management of Metacarpal and Phalangeal Fractures in the Athlete. Clin Sports Med. 2020;39(2):401-422. doi:10.1016/j.csm.2019.12.002
- Smeeing DPJ, Houwert RM, Briet JP, et al. Weight-bearing or non-weight-bearing after surgical treatment of ankle fractures: a multicenter randomized controlled trial. Eur J Trauma Emerg Surg. 2020;46(1):121-130. doi:10.1007/s00068-018-1016-6
- Yeoh JC, Ruta DJ, Murphy GA, et al. Analysis of Wheeled Knee Walker Use following Foot and Ankle Surgery or Injury. J Foot Ankle Surg. 2021;60(5):946-949. doi:10.1053/j.jfas.2021.04.001