fractures - general view

Fractures

By: Ms . S.Peter

Fractures

• The fracture occur when the bone is subjected to stress greater than it can absorb

Like----

• Trauma –(Fall from a height , accidents )• Direct blow , sudden twisting motion • Repetitive forces• Extreme muscle contraction • Pathology

When bone is fractured………..

Adjacent structures affect, body organs injures • The blood vessels across the break are ruptured.

Blood clots around the site of the fracture and forms a fracture hematoma.

Because of the disrupted blood supply, many of the bone cells in the fracture site die.

Signs and Symptoms Swelling or tenderness pain Numbness Bleeding Broken skin with bone protruding Limitation or unwillingness to move a limb • Shortening—long bone # -- due to contraction of

muscles attached Fragments may overlap 2-5 cm • Crepitus-- examine by hand--- crepitus – due to rubbing

of fragments • Swelling & Discoloration : Localized—trauma –may not

develop for several hrs or days after injury

Closed fracture(Simple) fracture is one where the fracture does not communicate outside. No break in skin Open fracture:Compound/complex) ( This is one where the fracture communicates with the outside through an open wound.

1. Traumatic

Fracture Types

Open Fracture : Grade I : Clean wound – less than 1 cm longGrade II : Larger wound without extensive soft tissue damage Grade III: Highly contaminated, extensive soft tissue damage, most severe

• Complete fracture : Break across the entire cross section of bone (often move from normal position)• Incomplete Fracture /green stickBreak occurs only through part of the cross section

Transverse Fracture A fracture in which the # line is perpendicular to the long axis of the bone .

Oblique Fracture A fracture in which the # line is at oblique angle to the long axis of the bone.

According to the Path of the fracture Line

Fracture Types…..

Spiral Fracture A severe form of oblique fracture in which the # plane rotates along the long axis of the bone. These #s occur secondary to rotational force.

Longitudinal Fracture A fracture in which the # line runs nearly parallel to the long axis of the bone. A longitudinal fracture can be considered a long oblique fracture.

According to the Path of the Fracture Line

Fracture Types……

Anatomical classification of fractures

Fracture Types ……………

Comminuted Fracture : The bone is broken into more than two fragments.

Stellate fracture: This # occurs in the flat bones of the skull and in the patella, where the fracture lines run in various directions from one point.

Anatomical classification of fractures

Impacted fracture: The bone fragment is driven into another bone fragment

Fracture Types………….

Depressed fracture: This # occurs in the skull where a segment of bone gets depressed into the cranium.

Avulsion fracture: Pulling away of a fragment of bone or tendon and its attachment Eg: 1. The supra spinatus muscle avulsing the greater tuberosity of the humerus. 2. Avulsion fracture of the tibial tuberosity

Fracture Types…..

Anatomical classification of fractures

Compression fracture

Pathological

It is a fracture occurring spontaneously in a bone weakened by some pathological lesion. This lesion may be –• Localized disorder (e.g. secondary malignant

deposit- bone tumors,

• Generalized disorder-eg. Osteoporosis, multiple myeloma, osteomyelitis ….

Fracture Types….

Birth fracture: • It is a fracture in the new born children due to injury during delivery.

Stress fracture : • It is a fracture occurring at a site in the bone subject to repeated minor • stresses over a period of time. Tiny crack in a bone---- caused by the repetitive application of force, often by over use------- Eg. repeatedly jumping up and down if running a long distance. Stress # cause also due to osteoporosis

Stress #sCommon in weight bearing bones- of foot , lower leg—athletes—dancers are of higher risk • Reason---muscles over tires – and transfer stress

to bone – common site is 2, 3 rd metatarsal , heel , fibula and navicular --- on the top of the mid foot

• Recovery----------- -- rest • High impact activity--- Frequency – how often,

duration(how long) intensity(level of exercise)• Osteoporosis – bone insufficiency • Too much too soon

Fracture Types-summary

Simple little or no bone displacement Compound fracture ruptures the skin & bone protrudesGreen stick mostly in children- bones have not calcified or hardened Transverse crack perpendicular to long axis of the bone ?displacementOblique diagonal crack across the long axis of the boneSpiral diagonal crack -a "twisting" of the bone - the longitudinal axis Comminuted "crushing" fracture - more common in elderlyImpacted one end of bone is driven up into the otherDepressed broken bone is pressed inward (skull fracture)Avulsion fragment of bone is pulled away by tendon

FRACTURES DISPLACEMENT• After a complete fracture the fragments usually

displaced:– partly by the force of injury– partly by gravity– partly by the pull of muscles attached to them.

• 4 types: – Translation/Shift– Alignment/Angulation– Rotation/Twist– Altered length

Other Terms used in describing fracture Greenstick- incompleteis the fracture in the young bone of children where the break is incomplete, leaving one cortex intact .

Plastic - Bowing fracture in children without disruption of cortex.Distraction Is a separation of fragments that have been pulled apart.

Greenstick #

Distraction #

1.Position – changed or unchanged

Terms used in fracture Follow-up 2. Healing -central or peripheral bony bridging

Delayed union - the healing process is slower than normal.

Non-union - the healing stopped before union occurred. Malunion - the fracture healed in unacceptable position

Terms used in fracture follow-up

COMPLICATIONS OF FRACTURES (General)

A. FAT EMBOLISM Embolism originating in the Bone marrow after #• Long bone has great risk, occurs within 48 hrs

after #Assessment: restlessness, change in mental status, Tachycardia, tachypnea, hypotension, dyspnea, petechial rash over the chest/neckImplementation: notify, treat symptoms to prevent resp. failure and death

B. Compartment syndrome . Increased pressure within one or more compartments causing massive compromise of circulation in an area. • Leads to decreased circulation and anoxia• After 4-6 of onset-- irreversible neuromuscular

damage occurs Assessment : increased pain, swelling, pain on passive motion, inability to move joints, loss of sensation, pulselessnessImplementation: notify immediately

C. Infection and osteomyelitis- due to interruption of integrity of skin, -- infection invades tissueAssessment: fever, pain, erythema around the # site, tachycardia, elevated WBCImplementation: notify, prepare for aggressive I.V antibiotic therapy========================================== D. Avascular Necrosis : Interruption of blood supply to bony tissue—leads to death of the boneAssessment : Pain, decreased sensation, Implementation: notify if pain and paresthesia, prepare pt for removal of necrotic tissue which will lead to infection.

D. Pulm Embolism : caused by immobility caused by #Assessment: restlessness, apprehension, dyspnea, diaphoresis , ABG changes Implementation: notify if signs present, prepare for anticoagulant therapy

END OF THIS SESSION