Borsa_Module_Bone Common Fractures

Course Information

  • Course Title: Human Pathophysiology for the Exercise Sciences

  • Instructor: Paul A. Borsa, PhD, ATC

  • Institution: UF Department of Applied Physiology and Kinesiology

Module Overview

Bone & Joint: Bone Structure & Fracture Healing (Regeneration)

  • Focuses on:

    • Joint structure and function

    • The effects of joint injury on structure and function

    • Bone composition and the process of fracture healing

Learning Objectives

  • Upon module completion, students will be able to:

    1. Identify and describe joint structure & function

    2. Understand the extent and effects of joint injury on structure and function

    3. Describe bone composition and the mechanisms of fracture healing

Types of Fractures

Classification of fractures:

  • Linear Fracture: A straight break in the bone

  • Oblique, nondisplaced: Diagonal fracture that does not move out of alignment

  • Oblique, displaced: Fracture that is diagonal and the ends are out of alignment

  • Spiral Fracture: Caused by twisting forces

  • Greenstick Fracture: Incomplete fracture seen more commonly in children

  • Comminuted Fracture: Bone is shattered into multiple pieces

Stress Reactions & Fractures

  • Causes and characteristics:

    • Result of repetitive stress with insufficient recovery, particularly in lower extremities

    • Bone dynamics: Osteoclastic activity (resorption) exceeds osteoblastic activity (replacement) leading to fatigue fractures

    • Muscular fatigue may lead to overloading of the bone

    • Linear fissures can compromise bone strength, increasing the risk for complete fractures

Stress Fractures

Common Areas:

  • Tibia (50%)

    • Anterior aspect, proximal third (common in children), distal third (common in adults)

  • Metatarsals (25%)

    • Commonly distal 2nd and 3rd

  • Tarsal and Fibula (10%)

    • Includes navicular and calcaneus

  • Femoral (5%)

    • Affecting shaft and neck of the femur

Diagnosis of Bone Injuries

  • Bone scan (scintigraphy)

    • Involves radioactive tracers (technetium) to visualize bone metabolism and remodeling

Base of 5th Metatarsal Fractures

Fracture Zones:

  1. Avulsion fracture - at the proximal zone

    • Caused by traction force from peroneus brevis attachment

  2. Jones fracture - at the middle zone

    • Involves inter-metatarsal joint, usually from inversion or twisting forces

  3. Stress fracture - at the distal zone

    • Resulting from compression and overuse (fatigue)

Common Types of Hand Fractures

Bennett's Fracture

  • Location: Base of the 1st metacarpal (thumb)

  • Characteristics:

    • Caused by axial load with slight flexion

    • Fracture-dislocation at the carpometacarpal joint

Boxer's Fracture

  • Location: 4th or 5th metacarpal neck/head

  • Characteristics:

    • Results from compression after punching with a closed fist

    • Classified as an oblique fracture

Tibial and Fibular Fractures

  • Tibial Shaft Fracture:

    • Treatment may involve intramedullary (IM) rod placement

  • Fibula Fracture:

    • May require use of Kirschner wire or Steinmann pins for stabilization

Spinal Fractures & Spondylolisthesis

  • Jefferson or Burst fractures are categorized as comminuted spinal injuries

  • Spondylolisthesis is characterized by the forward displacement of one vertebra over another

Growth Plate Fractures (Salter-Harris Classification)

Types of Fractures:

  • Type I: Physis (growth plate) fracture - 6%

  • Type II: Metaphysis and physis fracture - 75%

  • Type III: Epiphysis and physis fracture - 8%

  • Type IV: Through epiphysis, plate, and metaphysis - 10%

  • Type V: Crush fracture - 1%

Salter-Harris Type Descriptions:

  • Type I: Straight across - Separation/displacement of growth plate

  • Type II: Above - Involves metaphysis and growth plate

  • Type III: Lower - Through epiphysis and growth plate

  • Type IV: Through all three sections - epiphysis, plate, and metaphysis

  • Type V: Rammed - Compression fracture of growth plate

Prognosis and Outcomes of Salter-Harris Fractures

  • Type II: Most common, favorable outcome

  • Types III & IV: Increased risk of chronic disability

  • Type V: Associated with growth disturbances and poor prognosis

  • Only 2% of Salter-Harris fractures result in significant functional disturbance

Contact Information

  • Instructor: Paul A. Borsa

  • Email: pborsa@ufl.edu