Professional Documents
Culture Documents
INTRODUCTION
Fracture
A fracture is a break in the continuity of bone and is defined according to its type
and extent. Fractures occur when the bone is subjected to stress greater than it can
absorb. Fractures are caused by direct blows, crushing forces, sudden twisting motions
and even extreme muscle contractions. When the bone is broken, adjacent structures
are also affected, resulting in soft tissue edema, hemorrhage into the muscle and joints,
joint dislocations, ruptured tendons, severed nerves and damaged blood vessels. Body
organ maybe injured by the force that caused the fracture or by fracture fragments.
A Complete fracture involves a break across the entire cross-section of the bone
and is frequently displaced (removed from normal position). In an incomplete fracture,
the break occurs through only part of the cross-section of the bone. A comminuted
fracture is one that produces several bone fragments. A closed fracture (simple fracture)
is one that does not cause a break in the skin. An open fracture (compound or complex
fracture) is one in which the skin or mucous membrane wound extends to the fracture
bone. Open fractures are graded according to the criteria:
Grade III is highly contaminated, has extensive soft tissue damage, and is the
most severe.
Clinical Manifestations
Pain
The pain is continous and increase in severity until the bone fragments are
immobilized. The muscle spasm that accompanies fracture is a type of natural splinting
designed to minimize further movement of the fracture movement.
Loss of Function
After a fracture, the extremity cannot function properly because normal functions
of the muscles depend on the integrity of the bones to which they are atteched. Pain
contributes to the loss of the function. In addition, abnormal movement (false
movement) may be present.
Deformity
Shortening
Shortening
In fractures of the long bones, there is actual shortening of the extremity because
of the contraction of the muscles that are attached above and below the site of the
fracture. The fragments aften overlap by as much as 2.5 to 5cm (1 to 2 inches).
Crepitus
When the extremity is examined with the hands grating sensation called crepitus
can be felt. It is caused by the rubbing of the bone fragments against each other.
There are 206 bones in the human body, divided into four categories:
Long bones (femur)
Short bones (metacarpals)
Flat bones (sternum)
Irregular bones (vertebrae)
Bone Formation
Bone begins to form long before birth. Ossification is the process in which bone
matrix (collagen fibers and ground substance) is formed and hardening minerals (e.g
calcium salts) are deposited on the collagen fibers. The collagen fibers give tensile
streght to the bone and the calcium provides compressional streght. The two basic
process of ossification: endochondral and intramembranous. Most bones in the body
are formed by endochondral ossification in which cartilage-like tissue (osteoid) is
formed, resorbed and replaced bybthe bone. Intramembranous ossification occurs
when bonr develops within the membrane as in the bones of the face and skull.
Local Stress (weight bearing) acts to stimulate bone formation and remodeling. Weight-
bearing bones are thick and strong. Without weight-bearing or stress as in prolong bed
rest, the bone loses calcium (resorption) and becomes osteopenic and weak. The weak
bone may fracture easily. Biologically active vitamin D (calcitriol) functions to increase
the amount of calcium in the blood by promoting absorption of calcium from the
gastrointestinal tract. It laso facilitates mineralization of osteoid tissue. A deficiency af
vitamin D results in the bone mineralization deficit, deformity and fracture.
Parathyroid hormone and calcitonin are the major hormonal regulators of calcium
homeostasis. Parathyroid hormone regulates the concentration of calcium in the blood
in part by promoting movement of calcium from the bone. In response to low calcium
levels in the blood, increased levels of parathyroid hormone prompt the mobilization of
calcium the demineralization of the bone and the formation of the bone cysts. Calcitonin
secreted by the thyroid gland in response to elevated blood calcium levels, inhibits bone
resorption and increase the deposit of calcium in the bone.
Blood supply to the bone also affects bone formstion. With diminished blood supply and
hyperemia (congestion), osteogenesis (bone formation) and bone density decrease.
Bone necrosis occurs when the bone deprived of blood.
Bone Healing
Buckwalter (2000) summarized the process of fracture healing into six stages stimulated
by the release and activation of biologic regulators and signaling molecules:
1. Hematoma and inflammation: The body response is similar to that after injury
elsewhere in the body. There is bleeding into the injured tissue and formation of
a fracture hematoma. The hematoma is the source of signaling molecules such
as cytokenis, transforming growth factor (PDGF) which initiates the fracture
healing process. The fracture fragments ends become devitalized because of the
interrupted blood supply. Thhe injured area is invaded by macrophages which
debrie the area. Inflammation, swelling, and pain are present. The inflammatory
stage last several days and resolves with decrease in pain and swelling.
2. Angiogenesis and Cartilage formation: Under the influence of signaling
molecules, cell proliferation and differentiation occur. Blood vessels and cartilage
overlie the fracture.
3. Cartilage Calcification: Chondrocytes in the cartilage callus form matrix vesicles
which regulate calcification of the cartilage. Enzymes within these matrix vesicles
prepare the cartilage for calcium release and deposit.
4. Cartilage Removal: The calcified cartilage is invaded by blood vessels and
becomes resorbed by chondroblasts and osteoblasts. It is replaced by woven
bone similar to that growth pllate.
5. Bone Formation: Minerals continue to be deposited until the bone is firmly
reunited. With major adult long bone fractures, ossification takes 3-4 months.
6. Remodeling: The final stage of fracture repair consist of remodeling the new
bone into its former structural arrangement. Remodeling may take months to
years depending on the extent of bone modification needed, the function of the
bone and fuctional stresses of the bone. Cancelous bone heals and remodels
more rapidly than does compact cortical bones.
Serial x-ray films are used to monitor the progress of bone healing. The type of bone
fractured the adequacy of blood supply, the surface contact of the fragments and
genera health of a person influence the rate of fracture healing. Adequate
immobilization is essential until there is x-ray evidence of bone formation with
ossification.
1. Ball and socket joints, best exemplified by the hip and the shoulder permit full
freedom movement.
2. Hinge joints permit bending in one direction only and are best exemplified by
elbow and knee.
3. Saddle joints allow movement in two planes at right angles at each other. The
joint at the base of the thumb is a saddle, biaxial joint.
4. Pivot joints are characterized by the articulation between the radius and ulna.
They permit rotation for such activity as turning a doorknob.
5. Gidding joints allow for limited movement in all directions and are represented by
joints of the carpal bones in the wrist.
The ends of the articulating bones of a typical movable joint are covered with
smooth hyaline cartilage. The tough fibrous sheath called the joint capsule
surrounds articulating bones. The capsule is lined with a membrane, the synovium
which secretes the lubricating and shock-absorbing synovial fluid into the joint
capsule. Therefore, the bone surfaces are not direct contact. In some synovial joints
such as knee, fibrocartilage disks such as medial meniscus are located between the
articular cartilage surfaces. These disks provide shock absorption.
Ligaments bind the articulating bone together. A bursa is a sac filled with synovial
fluid that cushions the movement of tendons, ligaments and bones at point of
friction. Bursae are found at the elbow, shoulder, knee and some other joints.
Fracture First-aid
Depends on type & location of fracture
DO NOT