BONE FRACTURE

Fracture is a break in the continuity of any bone in the body.
CAUSES OF FRACTURE
TYPES OF FRACTURE
  • Complete fracture: a break across the entire cross section of the bone
  • Incomplete fracture: break occurs through only part of the cross section of the bone
  • Closed (simple) fracture: is one that does not cause a break in the skin
  • Open (compound/complex) fracture: is the one in which the skin or mucous membrane wound extends to the fractured bone
CLASSIFICATION ACCORDING TI THE ANATOMICAL PLACEMENT
  • Greenstick fracture: a fracture in which one side of the bone is broken while the other is bent
  • Spiral fracture: a fracture in which a bone has been twisted apart
  • Comminuted fracture: a fracture in which the bone is broken, splintered or crushed into number of pieces.
  • Transverse fracture: a fracture in which the break is across the bone at right angle to the long axis of the bone
  • Compression fracture: a fracture caused by compression, the act of pressing together (commonly seen in vertebrae)
OTHER FRACTURE:
  • Avulsion: fracture which occurs when a fragment of bone tears away from the main mass of bone
  • Depressed: a fracture in which fragments are driven inward (seen frequently in fractures of skull and facial bones)
  • Pathologic: it occurs through an area of diseased bone. Eg bony tumor
  • Stress: fracture that results from repeated loading
CLINICAL MANIFESTATIONS:
  • Pain
  • Loss of function
  • Deformity
  • Shortening
  • Crepitus
  • Swelling
  • Dislocation
DIAGNOSIS OF FRACTURE:
  • History
  • Physical examination
  • X ray
  • CT scan
  • MRI scan
MANAGEMENT:
  1. REDUCTION: refers to restoration of the fracture fragments to anatomic alignment and rotation
    • Open reduction: it is a surgical approach.
    • External/internal fixation devices lie pins, wires, plates,nails, rods may be used to hold the bone fragments in position until solid bone healing occurs.
    • Closed reduction: it is accomplished by bringing the bone fragments into apposition i.e placing the ends in contact through manipulation and manual traction.
  2. IMMOBILIZATION: this may be accomplished by external fixation lie bandages, splints, casts, continuous traction or external fixators. Metal implants are used for internal fixation which serves as internal splint to immobilize the fracture.
  3. MAINTAINING AND RESTORING FUNCTION:
    • Exercises are encouraged to minimize disuse atrophy of the muscles and to promote circulation.
    • Participation in activities of daily living (ADLs) is encouraged to promote independent functioning.
COMPLICATIONS OF FRATURE:
    1. Early complications-
      • Shock
      • Fat embolism
      • Compartment syndrome
      • Deep vein thrombosis
      • Infection
    1. Delayed complications-
      • Delayed union and non-union
      • Avascular necrosis of bone
You can prevent fractures by avoiding falls, staying fit and eating nutritious food
  1. Avoiding falls
    • Following certain tips can help one stay upright indoors and out
    • Balance-consider balance training and physiotherapy. Elders can use a cane or walker if needed.Shoes/slippers- use skid free shoe with good soles which offer good support
    • Lights-make sure the room is well lit
    • Clutter removal- make sure your room has no clutter on floor and wires and cords don’t cross your way
    • Rugs-use skid free mats/doormats
    • Vision-make sure to check eyesight (necessary for elders)
    • Bathrooms-install grab bars beside shower and toilet area
    • Staircase- install sturdy handrails on both sides
  2. Staying fit
    • Weight bearing exercises and balance exercises help to build and maintain muscles and improve balance.
    • Many studies have shown positive results of exercise in prevention of bone fracture and improved strength in post-menopausal women and elderly population preventing early osteoporosis.
  3. Eating right
    • Eat food rich promotes bone strength. Consult your doctor to get correct dose of calcium and vitamin D supplements.
      • Certain food like almonds, chickpeas, dairy such as milk and curd, eggs, vegetables like broccoli, spinach provide good sources of these nutrients.