geneal principle of fracture
TRANSCRIPT
GENERAL
PRINCIPLE
OF
FRACTURE
Fracture :is an interruption of bone continuity.
Dislocation : disruption of the continuity of a joint .
Fracture dislocation : dislocation together with a
fracture of one or more of the bones forming the joint.
Mechanism of injury
1- Direct trauma
A direct trauma usually causes a fracture
at the
site of impact . The fracture is most often
transverse or comminuted and the
associated soft tissue damage is more
because of its crushing effect .
2- Indirect trauma
An indirect trauma causes fracture at a
site which is situated at a distance from
where the force is applied . Such a force
usually causes an oblique , spiral or
transverse fracture . The associated soft
tissue damage is less . This indirect force
is transmitted along the bone or the limb .
3- Repeated trauma
A fracture caused by repeated minor
trauma over a period of time is called
fatigue fracture.
Certain weight bearing bones fracture
because
of repeated stress and strain applied to
them ,
like during walking .
TYPES OF FRACTURE
According to etiology:
1 - Traumatic fracture : this is a
fracture due to sustained trauma.
E.g. fractures caused by a fall , road
traffic accident , fight etc…
2-PATHOLOGICAL fracture
A- Aminor trauma to already weakened bone by
pre-existing disease , by a degree of stress or
trauma .
B-the disease maybe generalized e.g.
osteoporosis,
or localized e.g. osteomyelitis , bone tumors.
fatigue fracture ))3-Stress fracture
- fracture that occur when a bone is repeatedly
exposed to unaccustomed stresses , it may
crack under their summated effects .
- Usually in young adult .
SITES: stress fracture commonly involves
the metatarsal , the fibula
and the tibia .
According to soft tissue involvement :
are those in which the 1-closed
(simple)fracture :
overlying skin is intact .
2-open (compound) fracture : involve wounds
that
communicate with the fracture , or where
fracture hematoma is exposed , and may thus
expose bone
to contamination . Open injuries carry a higher
risk of infection .
.- clean fracturecontaminated
fracture.-
3- complicated fracture : there is associated
damage
.to nerve , blood vessels or internal structure
According to shape of fracture line
:
1- Transverse ( angle < 30 )
2- oblique ( angle > 30 )
3- spiral
4- comminuted
5- segmental
According to extent
1- complete
fracture
2- incomplete fracture
:
- Fissure fracture : incomplete fracture in adult
bone.
- Greenstick fracture : incomplete fracture in
child
(soft bones & thick periosteum
)
According to impaction
1- Non-
impacted
2- impacted
:
- A fragment is driven into the other
fragment .
- Mainly occurs in epiphyseal
areas.
Fracture displacement
Displacement of fracture is defined in terms of
the abnormal position of the distal fracture
fragment in relation to the proximal bone .
Types of displacement
1- Overlap
2-Side displacement
3- Angulation
4- Rotation
DIAGNOSIS OF FRACTURE
The diagnosis of a fracture is both
clinical and radiographic
.
Clinical diagnosis :
The patient presents because of pain and
inability to use the injured part,(loss of
function) .
History : description of the accident is known
from the patient or the attendants .
General examination : for shock , head ,
visceral
and other skeletal injuries .
Local examination : the signs of a fracture are :
1. Tenderness : localized tenderness over a
bone after an injury is sufficient for making the
provisional diagnosis of a fracture until x-ray
is taken .
Tenderness may be a sign of a fissure fracture
.
2. swelling : the swelling is evident in one
hour, maximum in one day , then
gradually disappears after few days .
3.Deformity : deformity is present when the
fracture is
displaced ; not marked when one bone only of
the
forearm or the leg is fractured ; and is absent in
a fissure fracture .
4. Abnormal mobility : abnormal mobility can be
elicited
when the fracture is complete .
5.Crepitus : crepitus is the friction sound between
the
fractured surfaces . The examiner need not elicit
this
sign because it is painful, can be harmful, and
isn’t
essential for reaching the diagnosis of a fracture
RADIOGRAPHIC EXAMINATION
The x-ray shows the particulars of the fracture,
and
is also a documentary record of the injury :
1. The injured part must be examined in at
least two
views, anteroposterior and lateral views . More
views
are often required in special cases ,e.g. carpal
scaphoid.
2. The x-ray must include the joint adjacent to
the fracture . In case of forearm , both the
elbow and wrist joints are to be included .