Fractures | Types of Fractures | Fracture Treatment

Fractures Key Points

  • Usually break in bone called Fracture
  • Most Fractures are caused by accidents
  • Bone Fractures due to underlying cause are called pathological fractures
  • Fractures that cause injury to overlying skin are called compound fractures
  • Different types of fracture usually include avulsion, comminuted and hairlineBone healing is usually a natural process.

Definition:


It is a condition in which there is partial or complete break in the continuity of bone.it usually result from accidents, high force impact stress or underlying medical conditions such as osteoporosis, osteopenia, or bone cancer. Fracture can be crosswise, lengthwise, in several pieces or into many pieces. Broken bone and fracture bone are the same things.

Types of Fractures:

CLOSED FRACTURE

If the skin does not break or open with the fracture.

OPEN FRACTURE

If the skin break or open with the fracture.

COMPLETE FRACTURE

In this fracture bone break into two pieces.

DISPLACED FRACTURE

There is usually a gap where the bone breaks.

STRESS FRACTURE

There is only a crack on the bone.

Medical terms

COMMINUTED FRACTURE

The bone break into several different pieces.

AVULSION FRACTURE

A muscle, tendon or ligament pull on the bone.

COMPRESSION (CRUSH) FRACTURE

The bones gets flattened or crushed it usually occur in spongy bone in spine.

FRACTURE DISLOCATION

It usually involves joint dislocation in which one of the bones of the joint has fracture.

GREENSTICK FRACTURE

They are incomplete fractures and occur when a bone bends and crack.it is usually more common in children.

HAIRLINE FRACTURE

A small crack or severe bruise within a bone due to stress.

IMPACTED FRACTURE

It is usually a break where the ends are driven into each other.

INTRAARTICULAR FRACTURE

These fractures usually crosses the joint surface they also involve some cartilage damage.

LONGITUDINAL FRACTURE

The fracture happen along the length of the bone.

OBLIQUE FRACTURE

Fracture that happen diagonally to bone axis.

PATHOLOGICAL FRACTURE

Fracture due to some underling medical condition conditions in which bone already weaken.

SPIRAL FRACTURE

Bone fracture due to twisting force.

STRESS FRACTURE

Tiny cracks in bone due to stress or overuse most common in athletes.

TORUS (BUCKLE) FRACTURE

Can occur in any soft or compressible bone but most preferably. Used in context of radius and ulna fracture.

TRANSVERSE FRACTURE

Perpendicular or straight break along the axis of bone.

Sign and symptoms

The sign and symptoms depend on the patients health condition, age and severity of injury.

Some of the common sign and symptoms include;

  • Pain
  • Swelling
  • Bruising
  • Discoloration of skin around the bone break
  • Patient unable to carry weight
  • Movement restriction

When facture occur in large bones it usually have;

  • The patient may look pale
  • Patient may have feeling of dizziness
  • Patient may have feeling of nausea

Causes of Fractures:

Bone break usually occur when your bone come in contact with greater force than usually it can support. Some common causes include;

  • Automobile accidents
  • Sports injuries
  • More stress
  • Fall

Who is at increase risk of fracture?

  • Old age people
  • People having osteoporosis
  • People suffering from endocrine or intestinal disorders
  • Most prone to fractures are those who are physically inactive, drink alcohol and smoke

Pathophysiology of Fractures:

The natural action of healing a fracture starts when the injured bone and surrounding tissues bleed, forming a fracture hematoma. The blood coagulates to make a embolus situated between the broken fragments. Within a couple of days, blood vessels grow into the jelly-like matrix of the embolus. The new blood vessels bring phagocytes to the world , which gradually removes the non-viable material. The blood vessels also bring fibroblasts within the walls of the vessels and these multiply and produce collagen fibers. In this way, the embolus is replaced by a matrix of collagen. Collagen’s rubbery consistency allows bone fragments to maneuver only a little amount unless severe or persistent force is applied. At this stage, a number of the fibroblasts begin to get down bone matrix within the sort of collagen monomers. These monomers spontaneously assemble to make the bone matrix, that bone crystals (calcium hydroxyapatite) are deposited in amongst, within the sort of insoluble crystals. In fact, bone may be a mineralized collagen matrix; if the mineral is dissolved out of bone, it becomes rubbery. Healing bone callus on the average is sufficiently mineralized to point out abreast of X-ray within 6 weeks in adults and fewer in children. This initial “woven” bone doesn’t have the strong mechanical properties of mature bone. The whole process may take up to 18 months, but in adults, the strength of the healing bone is typically 80% of normal by 3 months after the injury.

Diagnosis of Fractures:

  • Doctor will do physical examination ,identify the signs and will make diagnosis
  • Doctor will also ask for X-ray, MRI or CT scan

Treatment:

Bone healing is usually a natural process which will occur automatically. Treatment usually focuses on providing suitable circumstances for optimum healing. For natural healing ends of broken bone need to lined up this is known as reducing the fracture. It usually done by surgery, manipulation, or closed reduction.

Immobilization

It is usually done so bones stay aligned while healing, It includes;

PLASTER OF PARIS OR PLASTER CASTS:

This hold the bone in position until healing.

METAL PLATES AND SCREW PLATES

Plates usually use to hold the broken pieces of bone together while screws are used to attached the plates with bones. They may be left in place or they may be removed in some cases.

INTRA MEDULLARY NAILS

Mostly closed fractures are treated through internal fixation with medullary or interlocking nails. They do not provide rigid fixation so some movements exist at fracture site.

EXTERNAL FIXATORS

This is usually a type of scaffolding in which steel pins like plates and screws go into the bone directly through small incisions into skin and muscles the pins, plates and screws are usually attached to a bar outside the skin.

Usually fractured area is immobilized for 2-8 weeks. But duration depend on site of fracture and underlying conditions.

Healing:

Healing is usually a natural process. If a broken bone has been aligned properly and kept immobilize the healing process is usually fast.

  • Osteoclast remove dead cells
  • Osteoblasts are bone forming cells
  • Callus is a newly formed structure it forms on either side and grows toward each side until gap is filled. EvenTually the excess bone smooths off as the bone before.

Healing depend on type of fracture age of patient and which bone is affected.

Smoking has direct relation with healing. Those who smoke while require greater time for healing as compared to non smoker.

Physical therapy for Fractures:

After healing it is necessary to restore movement and muscle strength of the fractured site. If fracture occur on a joint or near a joint there are chances of arthritis or stiffness the patient may not be able to move the affected area as before

Surgery:

As in open fracture with bone skin, muscles and soft tissues also damage.in this situation plastic surgery may be required.

Delayed and NON Unions:

Delayed unions are those that take greater time to heal than usually required for healing. Non-Union fracture are those which unable to heal due to several reasons

In delayed healing usually low intensity ultrasound therapy is given on daily basis to increase the process of healing

Bone graft:

In non unions natural synthetic bones are grafted for stimulation of fracture bone.

Doctor may also prescribe some medications to treat pain, infection or to manage other complications

Complications:

Infection

If there is break in a skin bacteria can get in and affect the bone which can lead to a persistent fracture.

Mal union

Healing in wrong position is one of the most common complication.

Avascular necrosis

If due to some conditions bone loses its blood supply result bone death.

Prevention:

Sunlight

Our body needs vitamin D to absorb calcium. Sunlight is one of the natural source of vitamin D.

Nutrition

Human body need adequate nutrients for healthy bone. Vitamin C is essential for healthy bone. Sources of vitamin C include dairy products dark green vegetables ETC.

Physical activity:

Weight bearing exercises make the bones more stronger and denser.

Menopause

On menopause estrogen level decrease which require for calcium regulation. Consequently, women should be more careful after menopause for bone health.

The following indications may help reduce post menopausal osteoporosis;

  • Stop smoking or drinking alcohol or reduce its amount
  • Do weight bearing exercises on weekly basis
  • Get adequate exposure to sunlight
  • Take food enrich wit calcium

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