FRACTURE

DEFINITION

A fracture is any disruption in the normal continuity of a bone.

ETIOLOGY & RISK FACTORS Mechanical overload of bone

Metabolic bone disease Eg: Osteoporosis

Direct force.Eg: Moving object strikes body

Indirect force Eg: Muscle contraction Stress/ Fatigue

PREDISPOSING FACTORS Biologic conditions- Osteopenia

Neoplasms

Post menopausal estrogen loss & protein malnutrition

High risk recreation or employment related activity

PATHOPHYSIOLOGYFracture

Muscles attached to bone are disrupted

Muscle spasm- Pull fracture fragments out of position

Proximal portion of bone remains in place, distal displaced

Fracture fragments displaced sideways or overriding

Periosteum & blood vessels of fractured bone disrupted

Soft tissue damage

Bleeding from soft tissue & damaged bone ends

Hematoma between fracture fragments & beneath periosteum

Bone tissue surrounding fracture site dies

Intense inflamatory response

Vasodilation, edema, pain, loss of function, Infiltration of WBC

BONE HEALING

TYPES OF FRACTURE Appearance:

1.Burst fracture- Multiple pieces of bone

2. Comminuted fracture- More than one fracture line, more than 2

bone fragments, Fragments crushed

3.Complete fracture- Break across entire section of bone,

dividing into distinct fragments

4. Displaced fracture- Fragments out of normal position at

fracture site

5. Incomplete fracture- Fracture occurs through only one cortex

of bone, usually nondisplaced

6. Linear fracture- Fracture line is intact; Caused by minor-

moderate force

7. Longitudinal fracture- Fracture line extends in the directon of

bone’s longitudinal axis

8. Nondisplaced fracture- -Fragments aligned at fracture site

9. Oblique fracture- -Fracture line occurs at 45 degree angle

across longitudinal axis of bone

10. Spiral fracture- -Fracture line results from twisting force

11. Stellate fracture- -Fracture line radiate from one central

point

12. Transverse fracture- -Fracture line occurs at 90 degree angle

to longitudinal axis of bone

General Description

1. Avulsion- Bone fragments are torn away from

body of the bone at the site of attachment of ligaments or tendon

2. Compression fracture- Bone cracks as a result of loading forcee

applied to its longitudinal axis

3. Greenstick fracture- Incomplete fracture in which one side of

the cortex is broken & the other side is flexed but intact

4. Impacted fracture-One fragment driven to another

Anatomic Location1. Colle’s fracture-Fracture within last inch of distal radius

2. Pott’s fracture-Fracture of distal fibula

CLINICAL MANIFESTATIONS

Deformity

Swelling

Bruising ( Ecchymosis)

Muscle spasm

Pain Tenderness

Loss of function Abnormal mobility & Crepitus

Neurovascular changes

Shock

MANAGEMENTMedical managementGoals: Assessment of injury Reduction and stabilization of fracture Monitoring complications Eventual remobilization & rehabilitation

1. Thorough initial assessment:

Assessment

Emergency assistance

Stabilize

Neurologic assessment

Cover with sterile dressing( Open

fracture)

Antibiotic therapy

2. Fracture Reduction/ Bone setting:

Manipulation of fracture to restore

lignment, position and length by

bringing fragments

a. Closed reduction

b. Open reduction