Fracture

OR

BONE

Highly specialized connective tissue composed of branching cells calcified in an organic osteoid matrix

BONE

• Composed of cells, calcium, water, collagen and proteins

• Constantly undergoes destruction and regeneration

• Living tissue

Osteoblast

reproduce new bone formation

faster: leads to osteosclerosis

Osteoclast

bone resorption

faster: leads to osteoporosis

Osteocyte

Living element of bone 🡪 nutrients

Matured osteoblast

Regulates flow of minerals into and out of bone

Organic

Collagen type 1

20%

Inorganic

Hydroxyapatite: contains phosphates and carbonates

70%

Membranous Stage

• Gradual replacement of tissue into osteoid matrix

• Bones: head and face

Osteoid matrix

• Early stages of bone

• Structural framework

• Undergo calcification 🡪 deposition of calcium in the bones (solidify bones)

Endochondral Stage

• Cartilage

• Mesenchymal cells

Endochondral Stage

• Cartilage destroyed will turn into bone

• Bones:

  • Sternum

  • Ribs

  • Scapula

  • Spine

  • Pelvis

  • Long bones

Haversian System

• Aka: Osteones

• Long patent columns that are irregularly parallel along the axis of the shaft of bones

Haversian Canals

• surround the lamellae

• central spaces located in between haversian system

• blood vessels

Lamellae

concentric layers or intercellular substances that surrounds the canal

Lacunae

• spaces in between lamellae

• osteocytes

• processes of osteophytes

Canaliculi

• links the lacunae

• processes of osteocytes

Volkman’s Canal

• transverse/oblique channels connecting osteons

• blood supply into bone

Long bones

Type of bones

• Length is greater than width

• Cylinder-like

• Extremities

Short bones

Type of bones

• Cuboidal in shape

• Length and width are almost equal

• Carpals, tarsals

Sesamoid bones

Type of bones

• Sesame, small, round shape

• Patella, pisiform

Flat bones

Type of bones

• Flat, thin, curved

• 2 compact bones, spongey in between

• Sternum, scapula, cranial bones

Complex bones

Type of bones

• Irregular or no definite shape

• Facial bones, vertebrae, pelvis

Medullary canal

• Houses bone marrow (RBC) covered by endosteum

• Innermost

• Hollow space

• surrounded by diaphysis

Endosteum

Surrounds medullary canal

Diaphysis

Shaft/compact of bone

Periosteum

Covering of diaphysis

Metaphysis & Epiphysis

• Separated by epiphyseal plate (Cartilaginous/growth plate) at birth

• At the ends of long bones

• Cancellous bones

Salter Harris Classification

Classification system for log bones

Grade 1

Salter-Harris Grade

• Epiphyseal plate

• Incomplete fracture of EP

• Simple/Surrounding

Grade 2

Salter-Harris Grade

• Epiphyseal plate + Metaphysis

• Triangular segment of metaphysis

• Above

Grade 3

Salter-Harris Grade

• Epiphyseal plate + epiphysis

• Lower

Grade 4

Salter-Harris Grade

• Epiphyseal plate + epiphysis + metaphysis

• Through = growth arrest

Grade 5

Salter-Harris Grade

• Crushed epiphyseal plate

• Rammed comminuted

Fracture

Break/discontinuity of bone

Open Fracture

• Compound

• (+) wound 🡪 prone to infection

• Communicating with surrounding tissue

• Gustilo-Anderson Classification

Closed fracture

• Simple

• (-) wound / skin break

• (+) abrasion, contusions

• Tscherne Classification

Grade 1

Gustilo Anderson Classification

• <1 cm wound

• Transverse, oblique

Grade 2

Gustilo Anderson Classification

• 1 - 10 cm wound

• Comminuted type

Grade 3

Gustilo Anderson Classification

• >10 cm wound

• MVA, muscle, skin, blood vessel

Grade 3a

Gustilo Anderson Classification

• Periosteal stripping

• Soft tissue injury/laceration

Grade 3b

Gustilo Anderson Classification

• Soft tissue injury

• Bony coverage

• Require flap

Grade 3c

Gustilo Anderson Classification

• Blood vessel, circulatory

• No transmission of nutrients

Transverse

Type of Fracture

• horizontal

• forms right angle along axis of bone

Oblique

Type of Fracture

• diagonal / slanted

• transfixion screw

Spiral

Type of Fracture

• Secondary to torsional force (twist mechanism of injury)

• fastest to heal

Comminuted

Type of Fracture

• bones are broken into several fragments

Segmental

Type of Fracture

• bones are broken into several segments

• long bones

• multifracture

Impacted

Type of Fracture

• most stable

• GH & Hip joints

Stress

Type of Fracture

• secondary to microtrauma / repetitive trauma

Compression

Type of Fracture

• axial loading

avulsion

Type of Fracture

• strong pull of muscle

Pathological

Type of Fracture

• underlying disease

  • pott’s disease

  • osteomyelitis

  • dead bone: sequestrum

  • healthy bone: involucrum

Supracondylar fracture of Humerus

• mc complication: Volkman’s Ischemic contracture

• Myositis ossificans

• cubitus valgus* / varus deformities

Colle’s fracture

• dorsal of distal radius

• MOI: FOOSH

• Dinner / Silver fork

• Poteau’s fracture

Smith’s fracture

• ventral of distal radius

• MOI: FOBOTH / Fall on flexed hand

• Garden spade deformity

• Reverse Colle’s Fx

Montegia

Types 3, 2, 1, 4

• fracture of ulna with radial head dislocation

• types:

  • _ - lateral / anterolateral d/L

  • _ - posterior d/L

  • _ - anterior d/L

  • _ - ulna & radius

Galeazzi

• fracture of radius with ulnar head d/L

• Aka:

  • reverse montegia

  • piedmont fx

  • dupuytren’s fx

  • fx of necessity

Nightstick

fracture at the shaft of ulna

Greenstick

• common in children

• fracture at the bones of forearm

  • affects pronation/supination

Barton

fracture at the wrist

Chauffer’s fx

fracture at the radial styloid process

Bennet’s fx

• fracture at the 1st MCP

• avulsion

• Gutter splint = > 40 degrees

Rolando

• Comminuted fracture at the 1st MCP

• comminuted bennet

Boxer’s fx

• fracture at the neck of 5th MCP

• strip/fist fighter’s fx

Femoral neck fx

LE Fx

• crucial blood supply

• LCPD

Intertrochanteric

• fracture at the greater/ lesser trochanters

Subtrochanteric

• fracture proximal to the trochanter/s

Duverney’s fx

• fracture at the iliac wing

Straddle’s

• double vertical fx of the pubis

• horseback

Walther’s fx

• fracture at the ischioacetabular of pelvis

Cotton

• fracture at the transmalleolar of ankle

• inversion/eversion

Nutcracker

fracture at the nut-shaped tarsals → calcaneus & cuboid

March

stress at the 2nd metatarsal shaft

Jones fx

fracture at the 5th metatarsal base

sheperd’s

fracture at the lateral tubercle of talus

Grade 1

Garden classification

• Incomplete

• Femoral neck fx

Grade 2

Garden classification

• complete

• undisplaced

Grade 3

Garden classification

• complete

• partially displaced → <50%

Grade 4

Garden classification

• complete

• fully displaced → >50%

I

Le Fort Classification

• low maxillary / transverse fx of maxilla

II

Le Fort Classification

• Pyramidal fx

• (+) nasal bridge & maxilla

III

Le Fort Classification

• Craniofacial dysjunction/separation

• zygomatic arch + inferior orbital

C1: Jefferson Fx

Atypical

• compression → axial loading

• burst fx at the ring of atlas

C2: Hangman’s Fx

Atypical

• Neural arch of the axis

• Dens / Odontoid process → Teardrop fx

C7: Clay Shoveller’s Fx

Atypical

• vertebra prominence

• tip of spinous process of c7

Chance fx

Atypical

• secondary to tight seatbelts

• thoracic and lumbar

I. Inflammatory

Stages of bone healing

• directly occurring after injury

• hematoma formation → bruising

• prostaglandin mediation → pain

• activation of fibroblast

II. Reparative

Stages of bone healing

• bulk of fibroblastic activity → repair damages

• soft/hard callus formation

III. Remodelling

Stages of bone healing

• longest phase

1. Reversal

2. Quiescence

3. Activation

4. Formation

5. Resorption

Remodeling stage of bone healing

_ - osteoblast

_ - bone will undergo dormancy

_ - osteoclast

_ - osteoblast will form a new bone

_ - osteoclast will destroy the bone

Reduction

• replacement of bones to as near anatomic position as possible

• manipulation

Malunion

union of bones in a faulty position/posture

Delayed union

• union of bones beyond expected time

• UE: 3-12 wks healing

• LE: 12-18 wks healing

Non-union

failure of bones to unite

Achondroplasia

• mc form of dwarfism

• endochondral ossification retardation

• autosomal-dominant

• disproportionate limbs and trunk

• brachycephalic head

Achondroplasia

• < 4ft

• small face in relation to head

• flattened nose & depressed nose bridge

• prominent jaw

• short and pudgy fingers

• Main En Trident

Pseuodochrondoplasia

Metaphyseal chondroplasia

Achondroplasia variant/s

• _ - abnormality’s not obvious at birth

• _ - similar to ricket’s disease → vit. D deficiency

• diastrophic dwarfism

• hypochondroplasia

Achondroplasia variant/s

• _ - kyphoscoliosis, club foot deformity, proximal set hitchhiker’s thumb

• _ - small/milder form of Achondroplasia

chondroectodermal dysplasia

chondrodysplasia punctata

Achondroplasia variant/s

• _ - stippled epiphysis

• _ - displastic fingernails, polydactyly, distal shortening of legs and forearm

Osteoporosis

• silent disease

• -2.5 standard deviation of bone mass density