2Statistics • Fractures of extremities most common • More common in men up to 45 years of age• More common in women over 45 years ofageBefore 75 years wrist fractures (Colles’) most common• After 75 years hip fractures most common
3Types of fractures Magnitude and direction of force Closed – Bone fragments do not pierce skinOpen/compound– Bone fragments pierce skinDisplaced or undisplaced
4Transverse fractureUsually caused by directly applied force to fracture site
5Spiral or ObliqueCaused by violence transmitted through limb from a distance (twisting movements)
6GreenstickOccurs in children: bones soft and bend without fracturing completely
7Crush fracturesFracture in cancellous bone: result of compression (osteoporosis)
8Burst fractureOccurs in short bones, e.g. vertebra from strong direct pressure such as impaction of disc.
9Avulsion fractureCaused by traction, bony fragment usually torn off by a tendon or ligament.What muscle group attaches to this bony prominence and what nerve also runs in close proximity?Forearm flexors (common flexor origin) ulnar nerve
10Fracture dislocation/subluxation Fracture involves a joint: results in malalignment of joint surfaces.
11Impacted fractureBone fragments are impacted into each other.
12Comminuated fractureTwo or more bone pieces - high energy trauma
13Comminuated fractures can require serious hardware to repair.
14Stress fractureAbnormal stress on normal bone (fatigue fracture) or normal stress on abnormal bone (insufficiency fracture).
15Functions of the X-ray Localises fracture and number of fragments Indicates degree of displacementEvidence of pre-existing disease in boneForeign bodies or air in tissuesMay show other fracturesMRI, CT or ultrasound to reveal soft tissue damage
16How to Handle Fractures ReductionOpen reduction– Allows very accurate reduction– Risk of infection– Usually when internal fixation is neededManipulation– Usually with anaesthesiaTraction– Fractures or dislocation requiring slo
21Bone Healing 1. Fracture hematoma – blood from broken vessels forms a clot.– 6-8 hours after injury– swelling and inflammation to dead bone cells at fracture site
222. Fibrocartilaginous callus (lasts about 3 weeks (up to 1st May))– new capillaries organise fracture hematoma into granulation tissue - ‘procallus’– Fibroblasts and osteogenic cells invade procallus.– Make collagen fibres which connect ends together– Chondroblasts begin to produce fibrocatilage,
233. Bony callus (after 3 weeks and lasts about 3-4 months) – osteoblasts make woven bone.
244. Bone RemodelingOsteoclasts remodel woven bone into compact bone and trabecular bone– Often no trace of fracture line on X-rays.