A bone fracture is a disruption in the integrity of the bone structure, ranging from a hairline crack to a complete break. For individuals with a fracture, the prospect of flying introduces anxieties concerning pain and safety. Air travel can intensify discomfort at the injury site due to a combination of physical forces and physiological responses, making it important to understand these mechanisms for a safer journey.
The Impact of Cabin Pressure on Fractures
The primary reason a fracture may hurt more during a flight is the change in atmospheric pressure inside the airplane cabin. Commercial aircraft are pressurized to an altitude equivalent of 6,000 to 8,000 feet, which is lower than ground pressure. This reduced external pressure causes gases trapped within the body to expand, a phenomenon explained by Boyle’s Law. As the volume of these trapped gases increases, they exert internal pressure on nearby nerves and the already compromised tissue, leading to increased pain and discomfort around the break.
The effect is most pronounced with new fractures where inflammation is still high and tiny pockets of gas may be present. This pressure change is similar to the discomfort people sometimes feel in their ears or sinuses during altitude changes, but it is localized to the injured area.
Addressing Swelling and Circulation Risks
Flying with a fracture introduces significant risk related to swelling. Swelling is a natural response to injury, but it can be exacerbated by reduced cabin pressure and prolonged immobility in a seated position. Gravity causes fluids to pool in the lower extremities, which is particularly concerning with a fracture.
If the injured limb is immobilized in a rigid, non-flexible cast, swelling can become dangerous. The expanding tissue has nowhere to go within the fixed confines of the cast, leading to increased pressure on blood vessels and nerves. This restriction can compromise circulation and potentially lead to a serious condition called compartment syndrome, which requires immediate medical attention.
Because of this risk, especially when the cast was applied within 24 to 48 hours of the flight, airlines often require that a full plaster or fiberglass cast be split down its entire length. A split, or bivalve, cast allows the rigid material to open slightly, accommodating any swelling that occurs during the flight and preventing dangerous pressure buildup.
Necessary Steps Before Boarding
Medical Clearance
Before booking a flight, consultation with the treating orthopedic specialist is necessary to ensure it is safe to travel. The physician must provide medical clearance, often in the form of a “fit-to-fly” letter, which may be required by the airline. This clearance confirms the fracture is stable and that the patient is not at immediate risk of complications.
Immobilization Device Preparation
The medical team must also address the state of the immobilization device. If the cast is new or if the flight is long, the doctor should split the cast or apply a temporary splint to manage anticipated swelling.
Airline Arrangements
Travelers must contact the airline in advance to notify them of the injury and any special seating needs, such as the need to keep a leg elevated. For lower limb fractures, it may be necessary to purchase extra seats to allow the leg to be fully elevated along the row, which is a requirement for certain full-leg casts. Arranging for special assistance, such as wheelchair service and early boarding, is also recommended to minimize strain and the risk of re-injury while navigating the airport.
Strategies for In-Flight Comfort and Pain Relief
Once on board, the focus shifts to proactively managing pain and preventing further complications throughout the journey.
- The injured limb should be elevated as much as possible, using pillows, blankets, or the extra seat space to position the limb above the level of the heart, which helps counteract gravity’s effect on swelling.
- Strict adherence to a scheduled pain medication regimen is advisable, rather than waiting until the pain becomes severe.
- If permitted by the doctor, gently wiggling the toes or fingers of the injured limb every hour can stimulate circulation and help prevent blood pooling and stiffness.
- Staying adequately hydrated by drinking water is important, as dehydration can contribute to circulation issues and overall discomfort.