Fracture

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A fracture is defined as 'the separation of a body into two or more pieces under the action of stress'.

Medically speaking, the word 'fracture' is usually assumed to apply to fractures of the bone, although other organs such as the spleen or liver may be said to fracture. Fractures may be due to trauma or may be pathological if there is an underlying disorder in the bone prior to the fracture.

Contents

Classification

An accurate description of the fracture is important for achieving good medical records and communicating between professionals. Fractures can be classified according to:

  • anatomical site
    • the exact bone (e.g. radius, femur)
    • which part of the bone (e.g. head, neck, distal one-third, etc.)
    • whether the joint surface is involved (intra-articular)
  • pattern:
    • number of fragments (simple vs comminuted)
    • shape (transverse, oblique spiral)
  • breach of skin (open vs closed)

Fracture healing

Principles of treatment

Essentially:

  1. Reduce
  2. Hold
  3. Rehabilitate

Unless there is persistent movement of the fracture ends or they have become seperated then most fractures will heal of their own accord - it is principally the level of deformity of the healed bone that guides how aggressive management of a fracture needs to be. Fractures involving articular surfaces are a special case in that even minimal levels of deformity can cause future problems with excessive wear and arthritis.

Methods of reduction can include traction (the application of a force along the length of the bone), manipulation or open reduction.

Once reduced the bone needs to be held in an appropriate position to allow healing to take place. Some bones such as metatarsals are so well supported by surrounding structures that no additional measures are required. Maintaining traction whilst the bone heals is another method and may involve skin traction, skeletal traction or in the case of humeral neck fractures simply utilise the weight of the attached limb to maintain force in the length of the bone. If more definitive control of the fracture is needed that a cast (either plaster of paris or resin) can be used. More aggresive methods of fixation involve either internal or external fiaxation devices of which there are many.

The ultimate aim of fracture healing is to restore as much function as possible, as quickly as possible. Depending on the fracture and the method of fixation this must either wait until full union is achieved or can start immediately.

Fractures

Upper limb

Clavicle fracture | Scapular fracture | Proximal humerus fracture | Fracture Radius/ulna | Colles fracture


Lower limb

Fracture femoral neck | Fracture femoral shaft | Fracture Tibial plateau

Pelvis