Bone Fracture Types

Fracture Types

• Complete fractures involve a bone broken entirely into two or more separate pieces, potentially needing surgery or immobilization based on severity.
• Incomplete fractures cause partial bone damage, are often due to bending or low impact, and are more common in children because their bones are more flexible; they usually heal well with immobilization.
• Open (Compound) fractures occur with high-energy trauma which results in the bone breaking through the skin, which increases infection risk and typically requires surgical intervention.
• Closed (Simple) fractures involve bone breaks that do not puncture the skin, often treated with casting or splinting, and are usually moderately difficult to treat.
• Comminuted fractures result from severe trauma causing the bone to shatter into three or more pieces, a high difficulty injury often requiring surgery and hardware for fixation, and frequently occur in the elderly.
• Linear fractures result from direct impact parallel to the bone axis which are often moderate in severity, and may heal with immobilization, more common in people of all ages.
• Oblique fractures are a result of slanted force applied to the bone and often occur at an angle to the bone shaft which may need surgical fixation.
• Spiral fractures are due to twisting force on the bone, often encircling it, and are difficult to treat due to misalignment, frequently requiring surgery, and more common in children and athletes.
• Transverse fractures are caused by direct impact perpendicular to the bone, running straight across at a 90-degree angle and requires surgical stabilization to treat.
• Greenstick fractures happen due to bending force on soft bones, breaking one side while bending the other with treatment involving use of a cast.
• Torus (Buckle) fractures are due to compressive force causing buckling of the bone cortex without a complete break, a condition typically seen in children resolving with immobilization.

Other Fracture Considerations

• Bowing Fracture: Longitudinal force is the cause, with one bone bending the other fracturing completely, more common in children.
• Pathologic Fracture: Occurs secondary to disease weakening it and can lead to angular deformity, painless swelling, or generalized bone pain.
• Stress Fracture: Repetitive strain from activity causes small cracks, more common in athletes, runners or any person doing repetitive physical activities.
• Fatigue Fracture: Overuse leading to microfractures, and requires activity modification.
• Transchondral Fracture: Repetitive microtrauma or sudden force that damages cartilage, and depending on where the injury is the treatment ranges from easy to difficult.

General Info on Fractures

• Fractures of healthy bones, especially the tibia, clavicle, and lower humerus, usually occur in young people as a result of trauma.
• Fractures of hand and foot bones are often caused by accidents in the workplace
• Fractures of the upper femur, upper humerus, vertebrae, and pelvis occur more frequently in older adults and are often linked to osteoporosis.
• Hip fractures, the most serious result of osteoporosis, exhibit significant geographical variations.
• Stress fractures are painful due to increased remodeling; initially pain only occurs during activity and is usually relieved by rest and soft tissue swelling.
• Transchondral fractures may be asymptomatic, or painful during movement.

Types of Bone Healing

• Primary bone healing occurs when fracture ends are stabilized

• Secondary bone healing occurs when there is movement at the fracture sites.

Primary Direct Bone Healing

• Bone heals direct remodeling
• Requires rigid stabilization like surgical fixation
• has no callus formation
• and is generally faster

Secondary Indirect Bone Healing

• Bone goes through inflammatory, reparative and remodeling phases
• Can use non-rigid fixation like casting
• Involves callus formation
• Takes longer to heal

Bone Healing Process Flowchart

• Bones break, disrupting the periosteum, blood vessels, and surrounding soft tissues resulting in damaged bone ends that bleed into nearby soft tissue
• A blood clot forms creating a hematoma in between fractured ends and beneath the periosteum
• Dead tissue and debris trigger inflammation with vasodilation, plasma exudation, and infiltration of leukocytes.
• New blood vessels from soft tissue and marrow invade the area increasing blood flow
• Bone cells are activated and procallus forms along bone shaft and covers fractures
• Subperiosteal procallus forms along the bone's outer surface.
• The matrix mineralizes and hard callus forms as osteoblasts synthesize collagen and matrix in procallus.
• The unnecessary callus is resorbed while creating new areas of stress.

Types of Joint Dislocations

• Shoulder (Glenohumeral Joint) causes glenohumeral dislocation resulting from general trauma with the shoulder being the most dislocated joint in the body
• Elbow (Radial Head), pulling on the hand or forearm the radial head can slip out, also known as "nursemaid's elbow"
• Elbow dislocation can be traumatic with broken bones commonly occurring, and the ulna or radial head bones can get dislocated in the joint
• Wrist, falling on a hyper extended hand causes dislocation of carpal bones
• Hand dislocation occurs due to hyperextension, is common in contact sports
• Hip are posterior from car accidents
• Hip anterior occurs from forced abduction rare in healthy individuals from falling from high altitudes
• Knee dislocations are unstable joints of various types such as anterior, posterior, medial, lateral, and rotary caused by hyperextension

Other disclocation information

• Shoulder dislocations may damage the capsule and nerves
• Nerve damage can disrupt the nerve sensory and paralyze deltoid muscle
• Disrupting circulation can lead to ischemia and permanent disability
• In hip can cause avascular necrosis of the femoral head

General Signs and Symptoms of Dislocation

• Pain from inflammatory
• Swelling due to joint deformity and muscle contractions
• Limited range of motion and broken bones

Dislocations - Symptoms and Limitations

• Shoulder dislocation happens with severe arm pain and limits its movement.
• Elbow dislocation in kids limits pain at rest but hurts to move the arm
• Adult Elbow dislocation also causes severe arm pain and resistance to movement, and can also cause joint deformity
• Wrist dislocation causes lots of pain and inhibits bearing any weight
• Painful finger dislocation
• Car accidents causing pain and in the thigh or inguinal region causing immobility, resulting in the leg appearing shortened
• Anterior hip has lots of pain and you cant move or rotate flexing the leg
• Various knee dislocations also cause pain and immobility

General Information for Ligaments and Tendons

• Tendons- muscles to bones enabling movement
• Ligaments- connect bone to joint
• Injuries to tendon or ligaments include sprains, strains and ruptures
• Ligaments are in knee elbow and ankle for stability
• Tendons are throughout body handling lots of movement like the achilles tendon

General Tendon Notes

• Tendon is muscle to bone
• Ligaments are bone to bone - Their difference is in function not structure
• Sprains are ligament injury with stretching and tearing
• wrist ankle elbow and knee commonly injured
• Avulsion injuries separate soft tissues from attachment is sports
• Strains are in tendons and ruptures with stretching and tearing
• hands feet knee and arm are usually injured
• Injuries can be due to heavy strain trauma
• Also can be from arthritis, lupus or injections, antibiotics

Strains

• First degree - fibers are stretched and functional with a stable joint
• Second degree - partial tearing occurs with muscle contraction
• Third degree - theres improper contraction because the muscle is completely torn

Healing

• Torn area with bleeding
• Formation with collagen in ligaments over 3-4 days
• Muscle tissues align with collagen that interweaves
• Collagen fibres attach and connect to the bones restoring joints
• Injuries are also more susceptible to joint dislocations

Other joint injuries

• commonly seen in finger and elbow sprains with the inability to function
• the injuries limit mobility and cause lots of pain

The step by step for pain transmission

• Noxious stimulus activates pain receptors that convert to electrical signals
• these receptors cause a response using stimuli
• signals travel through spinal cord to neurons through brain using Ad fibers with well localized fast pain
• slow transmissions are through unmyelinated C fibers which transmit slow pain
• Spinothalamic tracts carry this signal through brain which sends signals to cerebral cortex to control the location of pain
• pain is understood with 3 systems
• sensoring which uses the somatosensory cortex to identify
• affective- motivational is limbic feeling and the brainstem
• cognitive is modified experience which modify thoughts
• all of this information gets enhanced and suppressed as well and transmitted using enkephalins, endorphins

Role for pain modulation

• The body regulates pain using signals that is regulated using a pain threshold with neuromodulator which gets raised using certain actions like exercising and such
• Different methods of inhibitory for the body is to increase and decrease pain by releasing chemicals like prostaglandins histamines

Pain Modulations

• Are by means of chemical modulators like releasing chemicals that increase pain
• Other factors like endorphins also affect this