a bone fracture... zarate

8/8/2019 A Bone Fracture... Zarate

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A bone fracture (sometimes abbreviated FRX orFx, Fx, or#) is a medical condition inwhich there is a break in the continuity of the bone. A bone fracture can be the result of high

force impact or stress, or trivial injury as a result of certain medical conditions that weaken thebones, such as osteoporosis, bone cancer, or osteogenesis imperfecta, where the fracture is then

properly termed a pathological fracture.

Although broken bone and bone breakare common colloquialisms for a bone fracture,breakis not a formal orthopedic term.

Orthopedic

In orthopedic medicine, fractures are classified in various ways. Historically they are named afterthe doctor who first described the fracture conditions. However, there are more systematic

classifications in place currently.

All fractures can be broadly described as:

y Closed (simple) fractures are those in which the skin is intact, while open (compound)fractures involve wounds that communicate with the fracture, or where fracture

hematoma is exposed, and may thus expose bone to contamination. Open injuries carry ahigher risk of infection.

Other considerations in fracture care are displacement (fracture gap) and angulation. Ifangulation or displacement is large, reduction (manipulation) of the bone may be required and, in

adults, frequently requires surgical care. These injuries may take longer to heal than injurieswithout displacement or angulation.

Another type of bone fracture is a compression fracture.It usually occurs in the vertebrae, forexample when the front portion of a vertebra in the spine collapses due to osteoporosis (a

medical condition which causes bones to become brittle and susceptible to fracture, with or

without trauma).

Other types of fracture are:

y Complete fracture: A fracture in which bone fragments separate completely.y Incomplete fracture: A fracture in which the bone fragments are still partially joined.y Linear fracture: A fracture that is parallel to the bone's long axis.y Transverse fracture: A fracture that is at a right angle to the bone's long axis.y

Oblique fracture: A fracture that is diagonal to a bone's long axis.y Spiral fracture: A fracture where at least one part of the bone has been twisted.y Comminuted fracture: A fracture in which the bone has broken into a number of pieces.y Impacted fracture: A fracture caused when bone fragments are driven into each other.


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OTA classification

The Orthopedic Trauma Association, an association for orthopaedic surgeons, adopted and thenextended the classification of Mller and the AO foundation ("The Comprehensive

Classification of the Long Bones") an elaborate classification system to describe the injury

accurately and guide treatment.

[2][3]

There are five parts to the code:

y Bone: Description of a fracture starts by coding for the bone involved:}}(1) Humerus, (2) Radius/Ulna, (3) Femur, (4) Tibia/Fibula, (5) Spine, (6) Pelvis, (24) Carpus,(25) Metacarpals, (26) Phalanx (Hand), (72) Talus, (73) Calcaneus, (74) Navicular, (75)

Cuneiform, (76) Cuboid, (80) LisFranc, (81) Metatarsals, (82) Phalanx (Foot), (45) Patella, (06)

Clavicle, (09) Scapula

y Location: a code for the part of the bone involved (e.g. shaft of the femur): proximal=1,diaphyseal=2, distal=3 (at the ankle the malleolar region is considered separately due to

the pre-existing Weber classification and coded as 4[4]

). Except at the proximal femurthe distal and proximal regions of the bone are defined by a square that is as wide as the

as the distance between the condyles. The diaphysis is considered to be the rest of the

bone between these two squares.

y Type: It is important to note whether the fracture is simple or multifragmentary andwhether it is closed or open: A=simple fracture, B=wedge fracture, C=complex fracture

y Group: The geometry of the fracture is also described by terms such as transverse,oblique, spiral, or segmental.

y Subgroup: Other features of the fracture are described in terms of displacement,angulation and shortening. A stable fracture is one which is likely to stay in a good

(functional) position while it heals; an unstable one is likely to shorten, angulate or

rotate before healing and lead to poor function in the long term.

Other classification systems

There are other systems used to classify different types of bone fractures:

y "Denis classification": spiney "Frykman classification": radius and ulnay "G

ustilo open fracture classification"

y "Letournel and Judet Classification": Acetabular Fracturesy "Neer classification": humerusy "Seinsheimer's Classification": femur


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Signs and symptoms

Although bone tissue itself contains no nociceptors, bone fracture is very painful for several

reasons:

y Breaking in the continuity of the periosteum, with or without similar discontinuity inendosteum, as both contain multiple nociceptors.

y Edema of nearby soft tissues caused by bleeding of torn periosteal blood vessels evokespressure pain.

y Muscle spasms trying to hold bone fragments in placePathophysiology

Main article: Bone healing

The natural process of healing a fracture starts when the injured bone and surrounding tissuesbleed, forming a fracture Hematoma. The blood coagulates to form a blood clot situatedbetween the broken fragments. Within a few days blood vessels grow into the jelly-like matrix of

the blood clot. The new blood vessels bring phagocytes to the area, which gradually remove thenon-viable material. The blood vessels also bring fibroblasts in the walls of the vessels and these

multiply and produce collagen fibres. In this way the blood clot is replaced by a matrix ofcollagen. Collagen's rubbery consistency allows bone fragments to move only a small amount

unless severe or persistent force is applied.

At this stage, some of the fibroblasts begin to lay down bone matrix (calcium hydroxyapatite) in

the form of insoluble crystals. This mineralization of the collagen matrix stiffens it andtransforms it into bone. In fact, bone is a mineralized collagen matrix; if the mineral is dissolved

out of bone, it becomes rubbery. Healing bone callus is on average sufficiently mineralized toshow up on X-ray within 6 weeks in adults and less in children. This initial "woven" bone does

not have the strong mechanical properties of mature bone. By a process of remodeling, thewoven bone is replaced by mature "lamellar" bone. The whole process can take up to 18 months,

but in adults the strength of the healing bone is usually 80% of normal by 3 months after theinjury.

Several factors can help or hinder the bone healing process. For example, any form of nicotine

hinders the process of bone healing, and adequate nutrition (including calcium intake) will helpthe bone healing process. Weight-bearing stress on bone, after the bone has healed sufficiently to

bear the weight, also builds bone strength. The bone shards can also embed in the muscle causinggreat pain. Although there are theoretical concerns about NSAIDs slowing the rate of healing,

there is not enough evidence to warrant withholding the use of this type analgesic in simplefractures.


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Diagnosis

A bone fracture can be diagnosed clinically, based on the history given and the physical

examination performed by a healthcare professional. Usually there will be an area of swelling,

abrasion, bruising and/or tenderness at the suspected fracture site.

Open fractures may be obvious if bone is exposed but small wounds may need surgicalexploration to determine if they are only superficial or connected to the fracture.

X-ray radiographs can be requested to view the bone suspected of being fractured.

In situations where x-ray alone is insufficient, a computed tomograph (CT scan) may beperformed.

Treatment

X-ray showing the proximal portion of a fractured tibia with an intramedullary nail.

X-ray showing the distal portion of a fractured tibia and intramedular nail.


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Pain management

In arm fractures in children, ibuprofen has been found to be equally effective as the combinationof acetaminophen and codeine.

[13]

Immobilization

Since bone healing is a natural process which will most often occur, fracture treatment aims toensure the best possiblefunction of the injured part after healing. Bone fractures are typically

treated by restoring the fractured pieces of bone to their natural positions (if necessary), andmaintaining those positions while the bone heals. Often, aligning the bone, called reduction, in

good position and verifying the improved alignment with an X-ray is all that is needed. Thisprocess is extremely painful without anesthesia, about as painful as breaking the bone itself. To

this end, a fractured limb is usually immobilized with a plaster or fiberglass cast or splint whichholds the bones in position and immobilizes the joints above and below the fracture. When the

initial post-fracture edema or swelling goes down, the fracture may be placed in a removable

brace or orthosis.If being treated with surgery, surgical nails, screws, plates and wires are usedto hold the fractured bone together more directly. Alternatively, fractured bones may be treated

by the Ilizarov method which is a form of external fixator.

Occasionally smaller bones, such as phalanges of the toes and fingers, may be treated without the

cast, by buddy wrapping them, which serves a similar function to making a cast. By allowingonly limited movement, fixation helps preserve anatomical alignment while enabling callus

formation, towards the target of achieving union.

Surgery

Surgical methods of treating fractures have their own risks and benefits, but usually surgery isdone only if conservative treatment has failed or is very likely to fail. With some fractures such

as hip fractures (usually caused by osteoporosis or osteogenesis Imperfecta), surgery is offered

routinely, because the complications of non-operative treatment include deep vein thrombosis(DVT) and pulmonary embolism, which are more dangerous than surgery. When a joint surface

is damaged by a fracture, surgery is also commonly recommended to make an accurateanatomical reduction and restore the smoothness of the joint. Infection is especially dangerous in

bones, due to their limited blood flow. Bone tissue is predominantly extracellular matrix, ratherthan living cells, and the few blood vessels needed to support this low metabolism are only able

to bring a limited number of immune cells to an injury to fight infection. For this reason, openfractures and osteotomies call for very careful antiseptic procedures and prophylactic antibiotics.

Occasionally bone grafting is used to treat a fracture.

Sometimes bones are reinforced with metal. These implants must be designed and installed with

care. Stress shieldingoccurs when plates or screws carry too large of a portion of the bone's load,causing atrophy. This problem is reduced, but not eliminated, by the use of low-modulusmaterials, including titanium and its alloys. The heat generated by the friction of installing

hardware can easily accumulate and damage bone tissue, reducing the strength of the


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connections. If dissimilar metals are installed in contact with one another (i.e., a titanium platewith cobalt-chromium alloy or stainless steel screws), galvanic corrosion will result. The metal

ions produced can damage the bone locally and may cause systemic effects as well.

Electrical bone growth stimulation or osteostimulation has been attempted to speed or improve

bone healing. Results however do not support its effectiveness.

[14]

Complications

An old fracture with nonunion of the fracture fragments.

Some fractures can lead to serious complications including a condition known as compartmentsyndrome. If not treated, compartment syndrome can result in amputation of the affected limb.

Other complications may include non-union, where the fractured bone fails to heal or mal-union,where the fractured bone heals in a deformed manner.

In children

Main article: Child bone fracture

In children, whose bones are still developing, there are risks of either a growth plate injury or agreenstick fracture.

y A greenstick fracture occurs due to mechanical failure on the tension side. That is, sincethe bone is not as brittle as it would be in an adult, it does not completely fracture, but

rather exhibits bowing without complete disruption of the bone's cortex in the surface

opposite the applied force.


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y Growth plate injuries, as in Salter-Harris fractures, require careful treatment andaccurate reduction to make sure that the bone continues to grow normally.

y Plastic deformation of the bone, in which the bone permanently bends but does notbreak, is also possible in children. These injuries may require an osteotomy (bone cut) to

realign the bone if it is fixed and cannot be realigned by closed methods.

y Certain fractures are known to occur mainly in the pediatric age group, such as fractureof the clavicle & supracondylar fracture of the humerus.


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CENTRAL LUZON DOCTORS HOSPITAL

EDUCATIONAL INSTITUTION

S.Y.2010-2011

FRACTURE

PREPARED BY:

ZARATE,DARYL JANE A.

BSN III-C

a bone fracture... zarate

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