Session 10: Fracture Basics

What is a fracture (#)

A break or discontinuity in bone (or cartilage) resulting from mechanical forces which exceed bone's ability to withstand them

Primary bone healing vs secondary bone healing

Secondary bone healing

Endochondral ossification

The repair process that is characterized by the formation of fracture callus, which then remodels to form new bone

Approximate healing times for bones in upper limb

Child = 3 weeks

Adult = 6 weeks

Approximate healing times for bones in lower limb

Child = 6 weeks

Adult = 12 weeks

Union

How well the broken bone is aligned

Direct fracture

Break occurs at point of impact

Direct trauma to fracture site

Due to high energy trauma (e.g., comminuted fracture)

Indirect fracture

No direct trauma to fracture site e.g., spiral fracture

Pathological fracture

Fracture through abnormally weak bone (due to disease) e.g., osteoporosis, cancer, infections

Fragility fracture

Fall from standing height or less

Osteoporotic fracture

Bone fracture that occurs in individuals with compromised bone mass density; most common at the spine, hip, and wrist.

Fragility due to osteoporosis

Examples

- Neck of femur fracture

- Colles (distal radius fracture)

- Vertebral fracture

Fracture classification

Three "either/or" fracture classifications

Position of bone ends after fracture

Nondisplaced—ends retain normal position

Displaced—ends out of normal alignment

Completeness of break

Complete—broken all the way through

Incomplete—not broken all the way through

Whether skin is penetrated

Open (compound) - skin is penetrated

Closed (simple) - skin is not penetrated

Open fractures

A fracture in which the bone is broken and there is an open wound in the skin.

Direct communication between fracture site & external environment

- Skin & soft tissue damage

- Neurovascular injury

- Infection

Often fractures classified based on soft tissue damage and vascular damage (Gustillo-Anderson classification)

Complete fractures

Bone fragments are completely separate

Fracture all the way through the bone with complete separation of the cortex

Incomplete fractures

Go through only part of the bone

Whole cortex is not broken

Types of complete fractures

Transverse

- Straight across the bone

Oblique

- Oblique line across the bone

Comminuted

- More than 2 parts to the fracture

Spiral

- Twisting motion

- Fracture like looks like a corkscrew

Types of incomplete fractures

Buckle (torus) fracture

- Most common in children

- Due to axial loading e.g., compression

Greenstick fracture

- Most common in children

- Due to tension

Displacement fracture

Movement of distal fragment in relation to the proximal component

Rotation

Angulation

Translation

Longitudinal

What is the most appropriate description for this fracture?

Oblique fracture

How would you describe the displacement of this fracture?

Translation

Systemic trauma assessment (ATLS) in major trauma

Airway maintenance & C-spine protection

Breathing and ventilation

Circulation and haemorrhage control

Disability

Exposure

Fracture complications can be classified as...

- Immediate: within few hours

- Early: within few weeks

- Late: months-years later

AND

Local vs. systemic

Give some examples of systemic complications of fracture

Hypovolaemic shock

Pulmonary embolism

Give some examples of local complications of fracture

Injury to blood vessels

Injury to soft tissues

Compartment syndrome

Wound infection

Fractures are managed in three steps...

1) Reduce

Restore anatomical alignment of fracture/dislocation

2) Hold

Immobilisation of fracture e.g., splints, slings, braches, internal/external fixation

3) Rehabilitate

Intensive physiotherapy

What are the benefits of the reduction step of fracture management?

- Reduce pressure & traction on surrounding soft tissues

- Tamponade bleeding