Fracture

Baoheng
Definition of fracture
 A fracture is present when there
is loss of continuity in the
substance of a bone

 A fracture is defined as a linear

deformation or discontinuity of
bone produced by forces that
exceed the ultimate strength of
the material
Causes of fractures
 Direct force
In these instances a force which the bone
cannot resist applied at or near the site of
fracture.
 Indirect force
Most fractures result when force is
transmitted from a distant point of impact
to a site where the bone fails.
 Fatigue fractures
Stresses,repeated with excessive
frequency to a bone, may result in
fracture
Classification of
fractures
 Closed fracture. Fracture that
does not communicate with the
outside.

 Open fracture. Fracture that

communicates with the external
environment.
Incomplete fractures

 Hairline fractures: result from minimal

trauma which is just great enough to produce a
fracture but not severe enough to produce any
significant displacement of the fragments.
 Greenstick fractures: occur in children.
The less brittle bone of the child tends to buckle
on the side opposite the causal force. Tearing of
the periosteum and of the surrounding soft
tissues is often minimal.
Greenstick fractures
Complete fractures

 Transverse fractures: The fractures run

either at right angles to the long axis of a
bone, or with an obliquity of less than 30°.
 Oblique fractures: The fractures run at an
obliquity angle of 30° or more.
 Spiral fractures: The line of the fracture
curves round the bone in a spiral.
 Comminuted fractures: there are more
than two fragments.
Complete fractures
 Impacted fractures: A fracture is impacted
when one fragment is driven into the other.
 Compression fractures: occur in cancellous
bone which is compressed beyond the limits of
tolerance.
 Depressed fractures: occur when a sharply
localised blow depresses a segment
 Epiphyseal Separation: a break in the region
of the epiphyseal plate (physis, growth plate)
of the child. This may damage the growing
bone and result in angular and/or length
discrepancy.
 Pathological Fracture

 a break in a bone
weakened by disease
such as osteoporosis,
infection, or a bone cyst.
Less force is required to
produce these fractures
than to produce one in a
normal bone.
 Stable fractures: Hairline fractures,
greenstick fractures, impacted
fractures, compression fractures,et al.

 Unstable fractures: Oblique fractures,

spiral fractures, comminuted fractures
Displacement
 Angulation

 Shortening

 Seperation

 Axial rotation

 Lateral displacement
The clinical
manifestations
 General:

 Shock

 Fever
 Local:
 Pain, swelling, difficulty using or
moving the injured area in a normal
manner

 Deformity,abnormal
movement,crepitus
Radiographic
examination

 Two plane: AP and lateral

 Two side: Comparison
 Two times
 Two joints:
SCT
MRI
 Introsseous fracture

This 39 y/o female fell off a ladder. Approximately two weeks

after the injury she presented with heel pain. Selected plain x-
ray and MRI images are shown above. The decreased T1 signal
and increased T2 signal within the calcaneus are consistent with
an occult intraosseous fracture. The suspected basic pathology is
trabecular disruption with edema and hemorrhage.
 Complications
 Immediate complications
 shock
 Hemorrhage,
 Damage to arteries and nerves
 Damage to surrounding soft
tissues
Christopher Reeve
Early complications

 Wound infection
 Fat embolism: FES results when embolic marrow
fat macroglobules damage small vessel
perfusion leading to endothelial damage in
pulmonary capillary beds leading to respiratory
failure and ARDS like picture
 DIC( Disseminated intravascular coagulation )
 Exacerbation of general illness.
 Compartment syndrome
Compartment
syndrome
 The cardinal signs of pain, pallor,
pulselessness, and paresthesias are
present to variable degrees. Pain with
passive stretch of muscles is one of the
more reliable indicators of
compartment syndrome, and accurate
diagnosis is readily made by
measurement of intracompartmental
pressures using a slit catheter.
Pressures in the range of 30 to 40
mmHg constitute an indication for
fasciotomy.
In patients with prolonged
ischemia due to arterial
compromise, prophylactic
fasciotomies of all
compartments distal to the
vascular injury should be
done concomitantly with
reestablishment of
perfusion, regardless of
whether signs of
compartment syndrome are
present.
 Late complications,

 Bed sores
 Deformity,
 Anchylosis
 Osteoarthritis
 Aseptic necrosis
 Ischemic contracture
 Hypostatic pneumonia
 Traumatic chondromalacia
 Reflex sympathetic dystrophy
Bone healing process
 Bone is a dynamic biological
tissue composed of metabolically
active cells that are integrated
into a rigid framework.
Bone healing process
 Healing occurs in three distinct
but overlapping stages:
 1) the early inflammatory stage;
 2) the repair stage;
 3) the late remodeling stage.
 In the inflammatory stage, a hematoma develops within the fracture site
during the first few hours and days. Inflammatory cells (macrophages,
monocytes, lymphocytes, and polymorphonuclear cells) and fibroblasts
infiltrate the bone under prostaglandin mediation.

 This results in the formation of granulation tissue, ingrowth of vascular

tissue, and migration of mesenchymal cells.

 The primary nutrient and oxygen supply of this early process is provided
by the exposed cancellous bone and muscle.

 The use of antiinflammatory or cytotoxic medication during this 1st

 week may alter the inflammatory response and inhibit bone healing.
 As vascular ingrowth progresses, a collagen matrix is
laid down while osteoid is secreted and subsequently
mineralized,which leads to the formation of a soft
callusaround the repair site.

 Eventually, the callus ossifies, forming a bridge of woven
bone between the fracture fragments. Alternatively, if
proper immobilization is not used, ossification of the
callus may not occur,and an unstable fibrous union may
develop instead.

 Fracture healing is completed during the remodeling

stage in which the healing bone is restored to its original
shape, structure, and mechanical strength. Remodeling
of the bone occurs slowly over months to years and is
facilitated by mechanical stress placed on the bone.
 As the fracture site is exposed to an
axial loading force, bone is
generallylaid down where it is
needed and resorbed from where it
is not needed. Adequate strength is
typically achieved in 3 to 6 months.