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Fracture

Globally, nearly 10 million cases of fractures are recorded each year, usually resulting from traumatic injury to bones.


Presentation

The site of fracture is main determinant of how serious it will be. Regardless of location, pain is the main presentation. This happens because the nerves and muscle tissues surrounding the bone will invariably respond to the additional pressure they have to contend with, as the broken bone “bleeds”. Surrounding muscles also spasm as the defence system of the body attempts to fight the fracture. A fracture leads to inability to use the affected area partially or completely and there will also be swelling and discoloration as a result of the bruising.

Severe Pain
  • The patient complained of severe, painful limitation of motion on straightening or bending.[ncbi.nlm.nih.gov]
  • […] and the inability to walk Ankle: Severe pain, swelling, tenderness to touch, bruising, deformity, and the inability to walk Foot: Severe pain, swelling, bruising, numbness in toes and foot, decreased range of motion, inability to walk comfortably, and[my.clevelandclinic.org]
  • Surgery is normally reserved for those with severe pain, weakness, or inability to feel their arms or legs.[emedicinehealth.com]
  • Severe Pain Burst fractures cause severe pain. Typically, this is pain at the level of the fracture, that is, in the back. However, pain may also be present in the legs following the distribution of the affected nerves.[spineuniverse.com]
Arm Pain
  • Here however, we describe the case of a young, amateur athlete presenting with acute right, upper arm pain after throwing a ball. Examination showed right upper arm deformity and tenderness to palpation, without any distal neurovascular deficits.[ncbi.nlm.nih.gov]
  • Arm: Pain, swelling, abnormal bend, difficulty using or moving arm, warmth, bruising, or redness Elbow: Pain, swelling, bruising, stiffness, a ‘pop’ noise at the time of fracture, or visible deformity Wrist: Pain, swelling, decreased use of hand and wrist[my.clevelandclinic.org]
Fracture
  • Two fragments transverse fracture oblique fracture spiral fracture Three fragments bending wedge fracture spiral wedge fracture segmental fracture Multiple fragments segmental fracture fragmented wedge fracture irregular multifragmental fracture comminuted[radiopaedia.org]
  • After open reduction of fractures of the acetabulum. Displaced acetabular fractures. Complex acetabular fractures. Stabilization of acetabular fractures in elderly patients. CT of acetabular fractures: postoperative appearances.[web.archive.org]
  • […] junction of the spine Rib fracture Sternal fracture Shoulder fracture Clavicle fracture Scapular fracture Arm fracture Humerus fracture (fracture of upper arm) Supracondylar fracture Holstein-Lewis fracture – a fracture of the distal third of the humerus[en.wikipedia.org]
  • Wall Fractures - Radiology of the Acetabulum - Reduction - T Shaped Fractures - Total Hip Replacement for Acetabular Fractures - Transverse Fractures of the Acetabulum - Triradiate Approach - Two-Column Fractures - Classification and Column Theory -[wheelessonline.com]
  • Risk ratios were significantly higher in men than in women for all fractures and for osteoporotic fractures, but not for hip fracture. Low BMD accounted for only 23% of the smoking-related risk of hip fracture.[ncbi.nlm.nih.gov]
Hip Pain
  • Her left hip pain worsened during follow-up, and a radiograph showed progressive collapse of the left femoral head.[ncbi.nlm.nih.gov]
  • A 9-year-old girl presented to the emergency room complaining of right hip pain that occurred after a pedestrian car accident.[ncbi.nlm.nih.gov]
  • Hip fractures are more common in older persons, and any elderly riders who sustain a fall and complain of hip pain should be suspect for this injury.[whmentors.org]
Bone Disorder
  • […] abnormality), Fracture of bone (disorder), bone; fracture, fracture; bone, Fracture, NOS, Fracture, FRACTURES, Fracture, cause unspecified, Broken Bones, Bone Fractures, Bone Fracture, Bone, Broken, Bones, Broken, Broken Bone, Fractures, Bone, Fracture[fpnotebook.com]
  • […] morphologic abnormality) , Fracture of bone (disorder) , bone; fracture , fracture; bone , Fracture, NOS , Fracture , FRACTURES , Fracture, cause unspecified , Broken Bones , Bone Fractures , Bone Fracture , Bone, Broken , Bones, Broken , Broken Bone[fpnotebook.com]
Joint Dislocation
  • dislocation ; - in order to maintain inadequate radial length & RU joint reduction, consider pinning of RU joint for 6 weeks to allow for anatomic healing of interosseous membrane; - radial head: - ORIF is indicated unless comminution precludes adequate[wheelessonline.com]
Neck Pain
  • The patient complained of neck pain that radiated to the left shoulder and arm, but he did not exhibit any neurological abnormalities.[ncbi.nlm.nih.gov]
  • PATIENTS CONCERNS: A 47-year-old woman felt neck pain with weakness and numbness in both upper limbs for 5 months.[ncbi.nlm.nih.gov]

Workup

Clinical diagnosis of a bone fracture is based on the history given as well as physical examination performed [8]. Imaging via X-Ray is performed to get a better view of the bone suspected to have been fractured. When X-ray proves insufficient, a CT or MRI scan can be performed.

Treatment

In early fracture management, the main aim is to control hemorrhage, provide pain relief and remove potential sources of contamination (both foreign body and nonviable tissues) [9]. As soon as these are accomplished, the fracture will be reduced and reduction maintained. Following maintenance, fracture union is optimised and the chances of complications are reduced greatly.

Again, treatment is also focused on ensuring that following healing, the limb affected will return to its highest level of functioning. It is often accomplished by obtaining and maintenance of a reduction in the fracture with an immobilisation technique that makes it possible for the fracture to heal and also offering the patient decent functional aftercare. Depending on the type situation, non-operative or surgical treatment can be deployed.

Prognosis

The prognosis for most cases of fracture is dependent on the kind of bone injured, the part broken, the direction the breach of continuity faces, and other general complications [6]. When the fracture involves bones with many strong muscles inserted into them, cure becomes a lot more difficult. Prognosis is more positive when the fracture involves bones with little levers attached to them that are capable of displacing the fragments.

Etiology

The main etiologic factors for bone fractures include fall from a height, commonly seen in children and the elderly, road and sports related accidents and direct impact on the bone. Repetitive force as can be seen with running can also lead to stress induced fracture in bones in some parts of the body such as the foot, ankle, tibia or hip. All of these are external factors that can lead to bone fracture [2].

There are however, certain internal factors that can bring about fractures. Apart from old age, tumor, infections and osteoporosis can also lead to fractures.

Epidemiology

Fractures are relatively common. Every woman aged 50 years and above has a 50% chance of suffering from a fracture. In men, the possibility is reduced to 20% [3]. Around the world, nearly 10 million cases of fractures are recorded each year. Wrist fractures are the most common form of fractures with hip, humeral and symptomatic vertebral fractures being the next most popular fracture types. The highest incidence is seen in Europe and the Americas with 34.8% and 15.7% of cases seen here.

Sex distribution
Age distribution

Pathophysiology

Actual fracture injuries to the bone affect the local soft tissue, the bone marrow, periosteum and the local soft tissues. The fracture destabilises the general structure making it difficult for this part of the body to carry out its normal activities until healing is complete [4].

The most important stage in the fracture healing is the inflammatory phase as well as subsequent hematoma formation. Around this stage, cellular signalling mechanisms work in line with chemotaxis and an inflammatory mechanism to attract the cells that are necessary to initiate the healing process. In less than 7 days, granulation tissue is formed by the body between the fracture fragments. Different biochemical signalling substances are involved in the formation of the soft callus which takes place over a period of two weeks [5].

With hard callus formation, cell proliferation and differentiation in the granulation tissue brings about production of osteoblasts and chondroblasts. The extracellular organic matrixes of woven bone and cartilage are synthesised respectively by the osteoblasts and chondroblasts after which a new formed bone is mineralised. The entire stage takes 4 to 16 weeks to complete.

Prevention

There is no total way of preventing a fracture but these basic steps can help in the reduction of the risk [10].

  • Consistent consumption of bone building meals such as milk, yoghurt, and cheese help in building strong bones. Vitamin supplements (A and D) can also be consumed as long as they do not interfere with other medications being consumed by the individual. 
  • While engaging in any sport activities, wear the right clothing and gear. Also alternate exercise activities to prevent fractures.
  • While working with heavy equipment, adhere to all precautionary instructions and avoid operating heavy equipment if you do not understand how they work.

Summary

A fracture occurs when any bone in the body loses its natural characteristics and most especially, its continuity. For a fracture to take place, the perisoteum, the bone marrow and other soft tissues around the bone must be injured. There are three known types of fractures. They include pathologic, stress and greenstick fractures [1]. The characteristic that determines what type of fracture an individual is facing include its anatomy, how the articular surface is involved, the fragmentation, etc.

Patient Information

A fracture refers to a crack in any bones in the body. Some of the common causes of fractures include falls, industrial injuries, vehicular accidents and sports related injuries.

Treatment and recovery from a fracture is dependent on the location and severity of the injury. A severe fracture may require surgery to implant devices into the bone so as to maintain the right alignment as the healing process plays out. In some cases, cast or splint maybe enough treatment to ensure full recovery. Regardless of type of fracture, early treatment and diagnosis is important to complete healing.

References

Article

  1. Lidgren L. The Bone and Joint Decade 2000 -2010. Bull World Health Organ [online]. Sept 2003;81(9):629.
  2. Orthopaedic Trauma Association Committee for Coding and Classification. Fracture and dislocation compendium. J Orthop Trauma 1996 10 (Suppl 1:v-ix): 1–154.
  3. Mollon B, da Silva V, Busse JW, Einhorn TA, Bhandari M. Electrical stimulation for long-bone fracture-healing: a meta-analysis of randomized controlled trials. J Bone Joint Surg Am 2008 90 (11): 2322–30.
  4. Handa R, Ali Kalla A, Maalouf G. Osteoporosis in developing countries. Best Pract Res Clin Rheumatol. Aug 2008;22(4):693-708
  5. Moran DS, Israeli E, Evans RK, Yanovich R, Constantini N, Shabshin N, et al. Prediction model for stress fracture in young female recruits during basic training. Med Sci Sports Exerc. Nov 2008;40(11 Suppl):S636-44.
  6. Eiff MP, Hatch RL. Fracture Management for Primary Care, 3rd, Elsevier Saunders, Philadelphia 2012. p.26.
  7. Wilkins KE. Principles of fracture remodeling in children. Injury 2005; 36 Suppl 1:A3.
  8. Jones ET. Skeletal growth and development as related to trauma. In: Skeletal Trauma in Children, 3rd, Green NE, Swiontkowski MF. (Eds), Saunders, Philadelphia 2003. p.6.
  9. McGowan HJ. Sports Medicine Reource Manual, 1st, Seidenberg P, Beutler AL. (Eds), Saunders, Philadelphia 2007. p.147.
  10. Macmahon P, Eustace SJ. General principles. Semin Musculoskelet Radiol 2006; 10:243.

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Last updated: 2017-08-09 18:06