Fracture Definition and Types Quiz

Fracture Definition and Etiology

• A fracture is a break or disruption in a bone's continuity.
• Causes include motor vehicle accidents, falls, direct blows, indirect forces (muscle contractions), sports injuries, vigorous exercise, malnutrition, and bone diseases (e.g., osteoporosis).

Types of Fractures

• Complete: The entire cross-section of the bone is broken, often displaced (out of normal position).
• Incomplete: Only a portion of the cross-section or the bone is broken, possibly longitudinal.
• Closed (simple): The skin (or mucous membrane) is not broken.
• Open (compound): The skin is broken, exposing the fracture.
• Pathologic: Occurs through diseased bone (e.g., osteoporosis, bone cysts, tumors, bone metastasis).

Fracture Patterns

• Greenstick: One side of the bone is broken, the other bent (common in children).
• Transverse: Straight across the bone.
• Oblique: At an angle across the bone.
• Spiral: Twists around the bone shaft.
• Comminuted: Bone splinters into more than three fragments.
• Depressed: Bone fragments driven inward (e.g., skull, facial fractures).
• Compression: Bone collapses inwards (e.g., vertebral fractures).
• Avulsion: A piece of bone is pulled off by a ligament or tendon attachment.
• Impacted: One bone fragment is wedged into another.
• Overriding: Displaced fracture fragments overlap.
• Dislocation: Fracture accompanied by the bone being out of joint.

Clinical Manifestations

• Physical findings: Pain, tenderness (muscle spasms from reflexes), swelling (tissue disruption or bleeding), false motion/crepitus (grating of bone fragments), deformity, loss of function, discoloration (ecchymosis), numbness/tingling (paresthesia).
• Altered neurovascular status: Injury to muscles, blood vessels, nerves, compression leading to reduced blood supply (ischemia).
• Signs of impaired blood flow/neurological impairment: Progressive pain, pain with movement, loss of sensation, loss of movement, reduced skin color (pallor), slow capillary refill, shock.
• Hemorrhage: Internal bleeding (especially in femoral and pelvic fractures) can be life-threatening.

Diagnostic Evaluation

• Blood tests
• X-rays
• MRI
• CT scans
• Arthroscopy (not always used)
• Electromyogram

Stages of Bone Healing

• Hematoma formation (within 48-72 hours).
• Hematoma transforms into granulation tissue.
• Callus formation.
• Osteoblastic proliferation (bone production).
• Bone remodeling.
• Healing completed within 6 weeks (up to 6 months in older individuals).

Complications of Fractures

• Immobility-related Complications: Muscle atrophy, loss of strength, loss of range of motion, joint contractures, pressure sores, diminished respiratory, cardiovascular, digestion, and possibly pooling respiratory secretions, orthostatic hypotension, anorexia, constipation and other digestive issues.
• Acute complications: Venous stasis and thromboembolism (especially hip and lower extremity fractures), neurovascular compromise, infection (especially open fractures), shock.
• Fat embolism syndrome: Mobilization of marrow or tissue fat (and platelets and free fatty acids) to the lungs causing rapid symptoms: respiratory distress, mental disturbances, fever.
• Bone healing problems: Delayed union, nonunion, malunion.

Fracture Management

• Broad goals: anatomic realignment/immobilization and restoring function.
• Reduction : restoring bone fragments to proper position (closed reduction or open reduction).
• Immobilization: Maintaining alignment.
• Rehabilitation