Bone fracture

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"Broken bones" redirects here. Bone fracture_sentence_0

For other uses, see Broken Bones. Bone fracture_sentence_1

Bone fracture_table_infobox_0

Bone fractureBone fracture_header_cell_0_0_0
Other namesBone fracture_header_cell_0_1_0 broken bone, bone breakBone fracture_cell_0_1_1
SpecialtyBone fracture_header_cell_0_2_0 OrthopedicsBone fracture_cell_0_2_1

A bone fracture (abbreviated FRX or Fx, Fx, or #) is a medical condition in which there is a partial or complete break in the continuity of the bone. Bone fracture_sentence_2

In more severe cases, the bone may be broken into several pieces. Bone fracture_sentence_3

A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, osteopenia, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture. Bone fracture_sentence_4

Signs and symptoms Bone fracture_section_0

Although bone tissue contains no pain receptors, a bone fracture is painful for several reasons: Bone fracture_sentence_5

Bone fracture_unordered_list_0

  • Breaking in the continuity of the periosteum, with or without similar discontinuity in endosteum, as both contain multiple pain receptors.Bone fracture_item_0_0
  • Edema and hematoma of nearby soft tissues caused by ruptured bone marrow evokes pressure pain.Bone fracture_item_0_1
  • Involuntary muscle spasms trying to hold bone fragments in place.Bone fracture_item_0_2

Damage to adjacent structures such as nerves, muscles or blood vessels, spinal cord, and nerve roots (for spine fractures), or cranial contents (for skull fractures) may cause other specific signs and symptoms. Bone fracture_sentence_6

Complications Bone fracture_section_1

Some fractures may lead to serious complications including a condition known as compartment syndrome. Bone fracture_sentence_7

If not treated, eventually, compartment syndrome may require amputation of the affected limb. Bone fracture_sentence_8

Other complications may include non-union, where the fractured bone fails to heal or mal-union, where the fractured bone heals in a deformed manner. Bone fracture_sentence_9

One form of malunion is the malrotation of a bone, which is especially common after femoral and tibial fractures. Bone fracture_sentence_10

Complications of fractures may be classified into three broad groups, depending upon their time of occurrence. Bone fracture_sentence_11

These are as follows – Bone fracture_sentence_12

Bone fracture_ordered_list_1

  1. Immediate complications – occurs at the time of the fracture.Bone fracture_item_1_3
  2. Early complications – occurring in the initial few days after the fracture.Bone fracture_item_1_4
  3. Late complications – occurring a long time after the fracture.Bone fracture_item_1_5

Bone fracture_table_general_1

ImmediateBone fracture_header_cell_1_0_0 EarlyBone fracture_header_cell_1_0_1 LateBone fracture_header_cell_1_0_2
SystemicBone fracture_cell_1_1_0 SystemicBone fracture_cell_1_1_1 Imperfect union of the fractureBone fracture_cell_1_1_2
LocalBone fracture_cell_1_2_0 LocalBone fracture_cell_1_2_1 OthersBone fracture_cell_1_2_2

Pathophysiology Bone fracture_section_2

Main article: Bone healing Bone fracture_sentence_13

The natural process of healing a fracture starts when the injured bone and surrounding tissues bleed, forming a fracture hematoma. Bone fracture_sentence_14

The blood coagulates to form a blood clot situated between the broken fragments. Bone fracture_sentence_15

Within a few days, blood vessels grow into the jelly-like matrix of the blood clot. Bone fracture_sentence_16

The new blood vessels bring phagocytes to the area, which gradually removes the non-viable material. Bone fracture_sentence_17

The blood vessels also bring fibroblasts in the walls of the vessels and these multiply and produce collagen fibres. Bone fracture_sentence_18

In this way, the blood clot is replaced by a matrix of collagen. Bone fracture_sentence_19

Collagen's rubbery consistency allows bone fragments to move only a small amount unless severe or persistent force is applied. Bone fracture_sentence_20

At this stage, some of the fibroblasts begin to lay down bone matrix in the form of collagen monomers. Bone fracture_sentence_21

These monomers spontaneously assemble to form the bone matrix, for which bone crystals (calcium hydroxyapatite) are deposited in amongst, in the form of insoluble crystals. Bone fracture_sentence_22

This mineralization of the collagen matrix stiffens it and transforms it into bone. Bone fracture_sentence_23

In fact, bone is a mineralized collagen matrix; if the mineral is dissolved out of bone, it becomes rubbery. Bone fracture_sentence_24

Healing bone callus on average is sufficiently mineralized to show up on X-ray within 6 weeks in adults and less in children. Bone fracture_sentence_25

This initial "woven" bone does not have the strong mechanical properties of mature bone. Bone fracture_sentence_26

By a process of remodelling, the woven bone is replaced by mature "lamellar" bone. Bone fracture_sentence_27

The whole process may take up to 18 months, but in adults, the strength of the healing bone is usually 80% of normal by 3 months after the injury. Bone fracture_sentence_28

Several factors may help or hinder the bone healing process. Bone fracture_sentence_29

For example, tobacco smoking hinders the process of bone healing, and adequate nutrition (including calcium intake) will help the bone healing process. Bone fracture_sentence_30

Weight-bearing stress on bone, after the bone has healed sufficiently to bear the weight, also builds bone strength. Bone fracture_sentence_31

Although there are theoretical concerns about NSAIDs slowing the rate of healing, there is not enough evidence to warrant withholding the use of this type analgesic in simple fractures. Bone fracture_sentence_32

Effects of smoking Bone fracture_section_3

Smokers generally have lower bone density than non-smokers, so they have a much higher risk of fractures. Bone fracture_sentence_33

There is also evidence that smoking delays bone healing. Bone fracture_sentence_34

Diagnosis Bone fracture_section_4

A bone fracture may be diagnosed based on the history given and the physical examination performed. Bone fracture_sentence_35

Radiographic imaging often is performed to confirm the diagnosis. Bone fracture_sentence_36

Under certain circumstances, radiographic examination of the nearby joints is indicated in order to exclude dislocations and fracture-dislocations. Bone fracture_sentence_37

In situations where projectional radiography alone is insufficient, Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) may be indicated. Bone fracture_sentence_38

Classification Bone fracture_section_5

"Compound Fracture" redirects here. Bone fracture_sentence_39

For the 2013 horror film, see Compound Fracture (film). Bone fracture_sentence_40

In orthopedic medicine, fractures are classified in various ways. Bone fracture_sentence_41

Historically they are named after the physician who first described the fracture conditions, however, there are more systematic classifications as well. Bone fracture_sentence_42

They may be divided into stable versus unstable depending on the likelihood that they may shift further. Bone fracture_sentence_43

Mechanism Bone fracture_section_6

Bone fracture_unordered_list_2

  • Traumatic fracture – a fracture due to sustained trauma. e.g., fractures caused by a fall, road traffic accident, fight, etc.Bone fracture_item_2_6
  • Pathologic fracture – a fracture through a bone that has been made weak by some underlying disease is called pathological fracture. e.g., a fracture through a bone weakened by metastasis. Osteoporosis is the most common cause of pathological fracture.Bone fracture_item_2_7
  • Periprosthetic fracture – a fracture at the point of mechanical weakness at the end of an implantBone fracture_item_2_8

Soft-tissue involvement Bone fracture_section_7

Bone fracture_unordered_list_3

  • Closed fractures are those in which the overlying skin is intactBone fracture_item_3_9
  • Open/compound fractures involve wounds that communicate with the fracture, or where fracture hematoma is exposed, and may thus expose bone to contamination. Open injuries carry a higher risk of infection.Bone fracture_item_3_10
    • Clean fractureBone fracture_item_3_11
    • Contaminated fractureBone fracture_item_3_12

Displacement Bone fracture_section_8

Bone fracture_unordered_list_4

  • Non-displacedBone fracture_item_4_13
  • DisplacedBone fracture_item_4_14
    • Translated, or ad latus, with sideways displacement.Bone fracture_item_4_15
    • AngulatedBone fracture_item_4_16
    • RotatedBone fracture_item_4_17
    • Shortened, a reduction in overall bone length when displaced fracture fragments overlapBone fracture_item_4_18

Fracture pattern Bone fracture_section_9

Bone fracture_unordered_list_5

  • Linear fracture: a fracture that is parallel to the bone's long axisBone fracture_item_5_19
  • Transverse fracture: a fracture that is at a right angle to the bone's long axisBone fracture_item_5_20
  • Oblique fracture: a fracture that is diagonal to a bone's long axis (more than 30°)Bone fracture_item_5_21
  • Spiral fracture: a fracture where at least one part of the bone has been twistedBone fracture_item_5_22
  • Compression fracture/wedge fracture: usually occurs in the vertebrae, for example when the front portion of a vertebra in the spine collapses due to osteoporosis (a medical condition which causes bones to become brittle and susceptible to fracture, with or without trauma)Bone fracture_item_5_23
  • Impacted fracture: a fracture caused when bone fragments are driven into each otherBone fracture_item_5_24
  • Avulsion fracture: a fracture where a fragment of bone is separated from the main massBone fracture_item_5_25

Fragments Bone fracture_section_10

Bone fracture_unordered_list_6

  • Incomplete fracture: a fracture in which the bone fragments are still partially joined, in such cases, there is a crack in the osseous tissue that does not completely traverse the width of the bone.Bone fracture_item_6_26
  • Complete fracture: a fracture in which bone fragments separate completely.Bone fracture_item_6_27
  • Comminuted fracture: a fracture in which the bone has broken into several pieces.Bone fracture_item_6_28

Anatomical location Bone fracture_section_11

An anatomical classification may begin with specifying the involved body part, such as the head or arm, followed with more specific localization. Bone fracture_sentence_44

Fractures that have additional definition criteria than merely localization often may be classified as subtypes of fractures, such as a Holstein-Lewis fracture being a subtype of a humerus fracture. Bone fracture_sentence_45

Most typical examples in an orthopaedic classification given in the previous section cannot be classified appropriately into any specific part of an anatomical classification, however, as they may apply to multiple anatomical fracture sites. Bone fracture_sentence_46

Bone fracture_unordered_list_7

OTA/AO classification Bone fracture_section_12

Main article: Müller AO Classification of fractures Bone fracture_sentence_47

The Orthopaedic Trauma Association Committee for Coding and Classification published its classification system in 1996, adopting a similar system to the 1987 AO Foundation system. Bone fracture_sentence_48

In 2007, they extended their system, unifying the two systems regarding wrist, hand, foot, and ankle fractures. Bone fracture_sentence_49

Classifications named after people Bone fracture_section_13

Main category: Orthopedic classifications Bone fracture_sentence_50

A number of classifications are named after the person (eponymous) who developed it. Bone fracture_sentence_51

Bone fracture_unordered_list_8

Prevention Bone fracture_section_14

Both high- and low-force trauma can cause bone fracture injuries. Bone fracture_sentence_52

Preventive efforts to reduce motor vehicle crashes, the most common cause of high-force trauma, include reducing distractions while driving. Bone fracture_sentence_53

Common distractions are driving under the influence and texting or calling while driving, both of which lead to an approximate 6-fold increase in crashes. Bone fracture_sentence_54

Wearing a seatbelt can also reduce the likelihood of injury in a collision. Bone fracture_sentence_55

A common cause of low-force trauma is an at-home fall. Bone fracture_sentence_56

When considering preventative efforts, the National Institute of Health (NIH) examines ways to reduce the likelihood of falling, the force of the fall, and bone fragility. Bone fracture_sentence_57

To prevent at-home falls they suggest keeping cords out of high-traffic areas where someone could trip, installing handrails and keeping stairways well-lit, and installing an assistive bar near the bathtub in the washroom for support. Bone fracture_sentence_58

To reduce the impact of a fall the NIH recommends to try falling straight down on your buttocks or onto your hands. Bone fracture_sentence_59

Finally, taking calcium vitamin D supplements can help strengthen your bones. Bone fracture_sentence_60

Treatment Bone fracture_section_15

Treatment of bone fractures are broadly classified as surgical or conservative, the latter basically referring to any non-surgical procedure, such as pain management, immobilization or other non-surgical stabilization. Bone fracture_sentence_61

A similar classification is open versus closed treatment, in which open treatment refers to any treatment in which the fracture site is opened surgically, regardless of whether the fracture is an open or closed fracture. Bone fracture_sentence_62

Pain management Bone fracture_section_16

In arm fractures in children, ibuprofen has been found to be as effective as a combination of paracetamol and codeine. Bone fracture_sentence_63

Immobilization Bone fracture_section_17

Since bone healing is a natural process that will occur most often, fracture treatment aims to ensure the best possible function of the injured part after healing. Bone fracture_sentence_64

Bone fractures typically are treated by restoring the fractured pieces of bone to their natural positions (if necessary), and maintaining those positions while the bone heals. Bone fracture_sentence_65

Often, aligning the bone, called reduction, in a good position and verifying the improved alignment with an X-ray is all that is needed. Bone fracture_sentence_66

This process is extremely painful without anaesthesia, about as painful as breaking the bone itself. Bone fracture_sentence_67

To this end, a fractured limb usually is immobilized with a plaster or fibreglass cast or splint that holds the bones in position and immobilizes the joints above and below the fracture. Bone fracture_sentence_68

When the initial post-fracture oedema or swelling goes down, the fracture may be placed in a removable brace or orthosis. Bone fracture_sentence_69

If being treated with surgery, surgical nails, screws, plates, and wires are used to hold the fractured bone together more directly. Bone fracture_sentence_70

Alternatively, fractured bones may be treated by the Ilizarov method which is a form of an external fixator. Bone fracture_sentence_71

Occasionally smaller bones, such as phalanges of the toes and fingers, may be treated without the cast, by buddy wrapping them, which serves a similar function to making a cast. Bone fracture_sentence_72

A device called a Suzuki frame may be used in cases of deep, complex intra-articular digit fractures. Bone fracture_sentence_73

By allowing only limited movement, immobilization helps preserve anatomical alignment while enabling callus formation, toward the target of achieving union. Bone fracture_sentence_74

Splinting results in the same outcome as casting in children who have a distal radius fracture with little shifting. Bone fracture_sentence_75

Surgery Bone fracture_section_18

Other Bone fracture_section_19

A Cochrane review of low-intensity pulsed ultrasound to speed healing in newly broken bones found insufficient evidence to justify routine use. Bone fracture_sentence_76

Other reviews have found tentative evidence of benefit. Bone fracture_sentence_77

It may be an alternative to surgery for established nonunions. Bone fracture_sentence_78

Vitamin D supplements combined with additional calcium marginally reduces the risk of hip fractures and other types of fracture in older adults; however, vitamin D supplementation alone did not reduce the risk of fractures. Bone fracture_sentence_79

Children Bone fracture_section_20

Main article: Child bone fracture Bone fracture_sentence_80

In children, whose bones are still developing, there are risks of either a growth plate injury or a greenstick fracture. Bone fracture_sentence_81

Bone fracture_unordered_list_9

  • A greenstick fracture occurs due to mechanical failure on the tension side. That is since the bone is not so brittle as it would be in an adult, it does not completely fracture, but rather exhibits bowing without complete disruption of the bone's cortex in the surface opposite the applied force.Bone fracture_item_9_103
  • Growth plate injuries, as in Salter-Harris fractures, require careful treatment and accurate reduction to make sure that the bone continues to grow normally.Bone fracture_item_9_104
  • Plastic deformation of the bone, in which the bone permanently bends, but does not break, also is possible in children. These injuries may require an osteotomy (bone cut) to realign the bone if it is fixed and cannot be realigned by closed methods.Bone fracture_item_9_105
  • Certain fractures mainly occur in children, including fracture of the clavicle and supracondylar fracture of the humerus.Bone fracture_item_9_106

See also Bone fracture_section_21

Bone fracture_unordered_list_10

Credits to the contents of this page go to the authors of the corresponding Wikipedia page: fracture.