Fracture
Fracture is a local discontinuation of the normal architecture of the bone. Fracture is suspected if there is visible deviation of structure, pain, swelling, loss of function associated with the fractured bone.
Causes for Fracture
Fractures can be caused by various reasons and those can be broadly classified as traumatic and pathological fracture. Traumatic fractures are the result of direct blunt force trauma. Pathological fractures occur due to conditions which weaken the bone structure. Rickettes, osteoporosis, chronic kidney diseases, hypovitaminosis D, and chronic liver diseases can weaken the bone by interfering with mineralization, and even minor blunt force can cause a fracture.
Classification of Fracture
There are various classifications of fractures.
• Anatomical classification: Anatomical classification uses the actual anatomical location of the bone in the body.
• Orthopedic classifications: Orthopedic classification is the most commonly used classification. Under this classification is open fracture, which is a fracture with overlying skin damaged. In closed fracture, the overlying skin is intact.
Fracture is clinically sub-divided according to the displacement. Also, according to the anatomy of the fracture there are various categories.
Complete fracture – bone fragments are divided completely.
Incomplete fracture – bone fragments are not completely divided.
Linear fracture – fracture line is parallel to the long axis of the bone.
Transverse fracture – fracture line is at right angles to the long axis of the bone.
Oblique fracture – fracture line is diagonal to the long axis of the bone.
Spiral fracture – fracture runs around the bone in a spiral shape and segments may be twisted
Comminuted fracture – bone is fractured into more than two segments
Impacted fracture – bone is fractured and wedged into each other
Fracture Diagnosis
Fracture definitive diagnosis is through imaging. Commonly used imaging methods are x rays. Other methods such as computer tomography may be used to assess the associated soft tissue injury.
Complications of Fracture
Complications of fracture can be classified according to chronology. Immediate complications are vessel, muscle and nerve injury. Intermediate complications are fat embolism, soft tissue transposition, infection. Long term complications are non union, mal union and delayed union.
Fracture Treatment
Basic principles of fracture treatment are pain management, immobilization and approximation. Bone segments need to be approximated properly to facilitate satisfactory healing. It is recommended to have more than 2/3 fracture surface approximation. According to the bone fractured, the amount of deviation clinically allowed varies. For example, for humerus fracture <15o angulations is allowed. Immobilization is essential because if there is free movement the callous formation will be interrupted and non union may result. Methods of immobilization differ according to the bone fractured. External immobilization is commonly done with Plaster of Paris cast. Internal immobilization can be done with intramedullary wiring, plates and screws. Upper limb fractures need to be kept in a cast for at least 6 weeks while lower limb fractures require double that. Opioid analgesics are the preferred option due to the severity of pain. To enhance bone healing bone grafting can be done. Serial imaging is essential for follow up and assessment of fracture healing.
Is there any difference between Fracture and Break?
Fracture is a break in the bone. Fracture and break means the same thing.