Fracture Types and Causes

Fracture Types and Causes

• Complete Fracture: Results from high-impact trauma, falls, or direct blows
  • More common in adults and the elderly
  • Bone breaks entirely into two or more separate pieces
  • Treatment depends on severity, ranging from surgery to immobilization
• Incomplete Fracture: Caused by bending or lower-impact force
  • More common in children with flexible bones
  • The bone cracks but remains in one piece
  • Heals with immobilization and is often less challenging to treat
• Open (Compound) Fracture: Caused by high-energy trauma, accidents, or sports injuries
  • More common in young adults and athletes
  • Any bone, often limbs, can be affected
  • The bone breaks through the skin, thus increasing the risk of infection
  • High difficulty to treat due to infection, which often requires surgical intervention
• Closed (Simple) Fracture: Results from trauma, falls, or sports injuries
  • Can occur in all age groups
  • The bone breaks but does not puncture the skin
  • Treatment typically involves casting or splinting
• Comminuted Fracture: Caused by severe trauma
  • Common in the elderly (osteoporotic bones) and trauma victims
  • Long bones (e.g., femur, tibia) are typically involved
  • The bone shatters into three or more pieces
  • Presents high difficulty to treat
  • Often requires surgery with implants
• Linear Fracture: Results from direct impact parallel to the bone axis
  • Can occur in all age groups
  • Often occurs in long bones (e.g., femur, tibia, humerus)
  • The fracture runs parallel to the long axis of the bone
  • May heal with immobilization
• Oblique Fracture: Caused by slanted force applied to the bone
  • Common in athletes and can occur in all age groups
  • Often affects long bones (e.g., tibia, femur)
  • The fracture occurs at an angle to the bone shaft
  • Surgical fixation may be needed
• Spiral Fracture: Caused by a twisting force on the bone
  • Common in children & athletes but is also noted in abuse cases
  • Long bones (e.g., tibia, femur, humerus) are often impacted
  • The fracture spirals around the bone due to rotational force
  • Treatment typically presents difficulty to alignment
  • Often needs surgery
• Transverse Fracture: Results from direct impact perpendicular to the bone
  • Occurs in all age groups
  • Often affects long bones (e.g., femur, tibia)
  • The fracture runs straight across the bone at a 90-degree angle
  • May require surgical stabilization
• Greenstick Fracture: Results from a bending force on soft bones
  • Common in children with flexible bones
  • Affects radius, ulna, tibia
  • One side of the bone breaks while the other side bends
  • Easier to treat, and heals well with casting
• Torus (Buckle) Fracture: Results from a compressive force causing buckling
  • Occurs in children
  • Affects radius and ulna
  • The bone cortex buckles but does not break completely
  • Easier to treat and heals well with immobilization
• Bowing Fracture: Caused by longitudinal force on paired bones
  • Occurs in children
  • Impacts radius-ulna and tibia-fibula
  • One bone bends significantly; the paired bone may experience a complete fracture
  • Difficult to treat since it requires significant force for correction
• Pathologic Fracture: Occurs in bone weakened by underlying disease
  • Common in the elderly with conditions such as osteoporosis, cancer, and metabolic bone disorders
  • Can occur in any bone but commonly affects vertebrae, femur, and ribs
  • Occurs in bones weakened by disease
  • Often results from minimal trauma
  • Requires addressing the underlying disease
• Stress Fracture: Repetitive strain from physical activity, such as sports
  • Typically seen in athletes, military recruits, dancers, and runners
  • Occurs in weight-bearing bones (e.g., tibia, metatarsals)
  • Small cracks form due to repetitive stress without a single traumatic event
  • Moderate to treat, as it only needs rest and gradual activity increase
• Fatigue Fracture: Overuse and muscle imbalance led to microfractures
  • Typically occurs in young adults, athletes, and military personel
  • Affects tibia, metatarsals, and pelvis
  • Caused by abnormal stress or torque applied repeatedly to a normal bone
  • Activity modification and rehabilitation is required
• Transchondral Fracture: Repetitive microtrauma or force causing cartilage damage
  • Occurs in adolescents
  • Affects the distal femur, ankle, patella, elbow, and wrist
  • Involves fragmentation of articular cartilage sometimes with bone underneath
  • Moderate to difficult, depending in severity of fragment displacement
• Fractures of healthy bones, particularly the tibia, clavicle, and lower humerus, tend to occur in young persons as the result of trauma.
• Fractures of the hands and feet are often caused by accidents in the workplace.
• The incidence of fractures of the upper femur, upper humerus, vertebrae, and pelvis is highest in older adults and often is associated with osteoporosis.
• Hip fractures, the most serious outcome of osteoporosis, have a wide variation in geographic occurrence.
• Pathologic fractures can cause angular deformity, painless swelling, or generalized bone pain.
• Stress fractures are painful because of accelerated remodeling; initially, pain occurs during activity and is usually relieved by rest.
• Local tenderness and soft tissue swelling.
• Transchondral fractures may be entirely asymptomatic or may be painful during movement with limits range of motion which creates audible clicking or crunching sounds.

Bone Healing Processes

• Primary (Direct) Bone Healing: Occurs when fracture ends are stabilized
  • The bone heals without callus formation
  • Involves direct remodeling by osteoclasts and osteoblasts
  • Requires rigid stabilization, often with surgical hardware.
• Secondary (Indirect) Bone Healing: A result of movement at the fracture site
  • Includes callus formation
  • Healing incorporates healing through the inflammatory, reparative, and remodeling phases
  • Stability is achieved through non-rigid fixation
• Bone healing happens in phases:
  • Fracture: bone breaks; disrupting, periosteum, blood vessels and surrounding soft tissue
  • Hematoma formation: blood clot forms and bone tissue dies
  • Inflammatory: triggers vasodilation
  • Vascularization: new blood vessels invade the fracture area
  • Pro callus forms; bone forming cells activate
  • Callus Formation: Osteblasts creates collagen
  • Bone remodeling: eliminates unnecessary callus and aligns repaired tissue.

Joint Dislocations and Subluxations

• Shoulder (Glenohumeral Joint): Glenohumeral dislocation from general trauma
  • Most frequently dislocated joint in body
• Elbow (Radial Head Dislocation / Nursemaid's Elbow): Radial head subluxation from pulling arm
  • Radial head slips away from ligament
• Elbow (Adults): elbow dislocation (often fracture) from trauma
  • Less common in children
• Wrist: distortion of distal ulna and carpal joint from fall
  • any of the joint are susceptible
• Hand (Metacarpophalangeal & interphalangeal) Dislocation: both digits dislocation from fall
  • Common in contact sports.
• Hip (Posterior and Anterior) Dislocation: either direction disortion after car accident.
  • Requires significant trauma
  • Anterior rare in healthy individuals
• Knee: anterior/posterior dislocation from sports or hyperextension
  • The knee is an unstable joint
  • Depends on soft tissues
  • Shoulder dislocations may cause nerve damage.
  • Dislocations may lead to ischemia. -Hip joint distortion can develop into avascular necrosis.

Signs and Symptoms of Bone Dislocations

• Pain : inflammation accumulating in the joint or injury in tendons and ligaments
• Joint Deformity: Fluid buildup in a area
• Limited Motion: caused by effusion and displacement of joints

Specific Joint Dislocations - Causes Symptoms and Treatment

• Shoulders, from general trauma, are very painful and hard to move
• Elbow (children), pulling of the arm. Is not painful at rest but has discomfort
• Elbow: Pain
• Wrists: Dislocation with pain
• Hand: tenderness with muscle pull
• Hips, usually in accident and flexed knee..
• Knee: Different types from pain

Tendons and Ligaments

• Tendons : Fibrous connective tissues attaching bone to muscle. Their injuries are "strains".
• Ligaments: Fibrous connective tissues attaching bone to a joint. Their injuries are called a "sprain". They heal and add elastic fibers to allow flexibility.
• Both provide injuries by trauma and lack function depends.
• Some have some commonality like wrist, elbow, and knee.

Strains & Sprains - Classification

• First degree : Fibers are stretched and the joint remain stable.
• Second degree: Partial tearing, weakness in the joint,.
• Third degree: Complete tear, it becomes unstable in movement.

-Tendons and ligament injuries cause pain functional limitations. You might see joint swelling, flexion, a grating, crackling, but that is a key symptom if not relieved, the process may continue to loss and weaknesses.