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Fracture - medical condition in which there is a break in the continuity of the bone.

- can be the result of high force impact or stress, or trivial injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture.

By cause

1. Traumatic fracture - This is a fracture due to sustained trauma2. Pathological fracture - A fracture through a bone which has been made weak by

some underlying disease is called pathological fracture.

Orthopedic

In orthopedic medicine, fractures are classified in various ways. Historically they are named after the doctor who first described the fracture conditions. However, there are more systematic classifications in place currently.

All fractures can be broadly described as:

Closed (simple) fractures: are those in which the skin is intact 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.

Compression fractures: 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).

Other types of fracture are:

Complete fracture: A fracture in which bone fragments separate completely. 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.

Linear fracture: A fracture that is parallel to the bone's long axis. Transverse fracture: A fracture that is at a right angle to the bone's long axis.

Oblique fracture: A fracture that is diagonal to a bone's long axis. Spiral fracture: A fracture where at least one part of the bone has been twisted. Comminuted fracture: A fracture in which the bone has broken into several

pieces. Impacted fracture: A fracture caused when bone fragments are driven into each

other. Avulsion fracture: A fracture where a fragment of bone is separated from the

main mass.

Anatomical location

An anatomical classification may begin with specifying the involved body part, such as the head or arm, followed with more specific localization. Fractures that have additional definition criteria than merely localization can often be classified as subtypes of fractures that merely are, such as a Holstein-Lewis fracture being a subtype of a humerus fracture. However, most typical examples in an orthopedic classification given in previous section cannot appropriately be classified into any specific part of an anatomical classification, as they may apply to multiple anatomical fracture sites.

Skull fracture o Basilar skull fractureo Blowout fracture - a fracture of the walls or floor of the orbito Mandibular fractureo Nasal fractureo Le Fort fracture of skull - facial fractures involving the maxillary bone and

surrounding structures in a usually bilateral and either horizontal, pyramidal or transverse way.

Spinal fracture o Cervical fracture

Fracture of C1, including Jefferson fracture Fracture of C2, including Hangman's fracture Flexion teardrop fracture - a fracture of the anteroinferior aspect of

a cervical vertebral Clay-shoveler fracture - fracture through the spinous process of a

vertebra occurring at any of the lower cervical or upper thoracic vertebrae

Burst fracture - in which a vertebra breaks from a high-energy axial load

Compression fracture - a collapse of a vertebra, often in the form of wedge fractures due to larger compression anteriorly.

Chance fracture - compression injury to the anterior portion of a vertebral body with concomitant distraction injury to posterior elements

Holdsworth fracture - an unstable fracture dislocation of the thoraco lumbar junction of the spine

Rib fracture Sternal fracture Shoulder fracture

o Clavicle fractureo Scapular fracture

Arm fracture o Humerus fracture (fracture of upper arm)

Supracondylar fracture Holstein-Lewis fracture - a fracture of the distal third of the humerus

resulting in entrapment of the radial nerve.o Forearm fracture

Ulnar fracture Monteggia fracture - a fracture of the proximal third of the

ulna with the dislocation of the head of the radius Hume fracture - a fracture of the olecranon with an

associated anterior dislocation of the radial head Radius fracture

Essex-Lopresti fracture - a fracture of the radial head with concomitant dislocation of the distal radio-ulnar joint with disruption of the interosseous membrane.

Distal radius fracture Galeazzi fracture - a fracture of the radius with

dislocation of the distal radioulnar joint Colles' fracture - a distal fracture of the radius with

dorsal (posterior) displacement of the wrist and hand Smith's fracture - a distal fracture of the radius with

volar (ventral) displacement of the wrist and hand Barton's fracture - an intra-articular fracture of the

distal radius with dislocation of the radiocarpal joint.

Hand fracture o Scaphoid fractureo Rolando fracture - a comminuted intra-articular fracture through the base

of the first metacarpal boneo Bennett's fracture - a fracture of the base of the first metacarpal bone

which extends into the carpometacarpal (CMC) joint. o Boxer's fracture - a fracture at the neck of a metacarpal

Pelvic fracture o Fracture of the hip boneo Duverney fracture - an isolated pelvic fracture involving only the iliac wing.

Femoral fracture

o Hip fracture (anatomically a fracture of the femur bone and not the hip bone)

Patella fracture

Crus fracture o Tibia fracture

Bumper fracture - a fracture of the lateral tibial plateau caused by a forced valgus applied to the knee

Segond fracture - an avulsion fracture of the lateral tibial condyle Gosselin fracture - a fractures of the tibial plafond into anterior and

posterior fragments Toddler's fracture - an undisplaced and spiral fracture of the distal

third to distal half of the tibiao Fibular fracture

Maisonneuve fracture - a spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane.

Le Fort fracture of ankle - a vertical fracture of the antero-medial part of the distal fibula with avulsion of the anterior tibiofibular ligament.

Bosworth fracture - a fracture with an associated fixed posterior dislocation of the proximal fibular fragment which becomes trapped behind the posterior tibial tubercle. The injury is caused by severe external rotation of the ankle.

o Combined tibia and fibula fracture Trimalleolar fracture - involving the lateral malleolus, medial

malleolus and the distal posterior aspect of the tibia Bimalleolar fracture - involving the lateral malleolus and the medial

malleolus. Pott's fracture

Foot fracture o Lisfranc fracture - in which one or all of the metatarsals are displaced from

the tarsuso Jones fracture - a fracture of the proximal end of the fifth metatarsalo March fracture - a fracture of the distal third of one of the metatarsals

occurring because of recurrent stresso Calcaneal fracture

OTA classification

The Orthopaedic Trauma Association, an association for orthopaedic surgeons, adopted and then extended the classification of Müller and the AO foundation ("The Comprehensive Classification of the Long Bones") an elaborate classification system to describe the injury accurately and guide treatment. There are five parts to the code:

Bone: The OTA classification of a fracture starts by coding for the bone involved:

(1) Humerus fracture, (2) Radius fracture/Ulnar fracture, (3) Femoral fracture, (4) Tibial fracture/Fibular fracture, (5) Spinal fracture, (6) Pelvic fracture, (7) Carpal fracture, (8) Metacarpal fracture, (9) Phalanx fracture of the hand, (10) Talus fracture, (11) Calcaneus fracture, (12) Navicular fracture, (13) Cuneiform bone fracture, (14) Cuboid bone fracture, (15) LisFranc fracture, (16) Metatarsal fracture, (17) Phalanx fracture of the foot, (18) Patella fracture, (19) Clavicular fracture, (20) Scapular fracture

Other systems

There are other systems used to classify different types of bone fractures:

"Denis classification" for spinal fractures

"Frykman classification" for forearm fractures (fractures of radius and ulna)

"Gustilo open fracture classification"

"Letournel and Judet Classification" for Acetabular fractures

"Neer classification" for humerus fractures

"Seinsheimer's Classification" for femoral fractures

Causes

• Traumatic event

Fall from a height

Road traffic accidents 

Sporting injuries

Direct blow on the bone 

• Overuse

• Old age

• Disease

Osteoporosis

Bone cancer

Tumor

Infection

Congenital bone cysts

Most common sites for bone fracture

• Wrist

• Ankle

• Foot

• Hips

Factors increases risk of getting a fracture

• As we get older risk increases

• Poor nutrition, including lack of calcium in the diet

• Obesity

• Previous history of fracture(s)

• Prevention

• Nutrition and sunlight 

• Physical activity 

• The (female) menopause

• Do several short weight-bearing exercise sessions each week.

• Do not smoke.

• Consume only moderate quantities of alcohol, or don't drink it.

• Make sure you get adequate exposure to daylight.

• Make sure your diet has plenty of calcium-rich foods. For those who find this difficult, talk to your doctor about taking calcium supplements.

• Possible complications of a bone fracture?

• Heals in the wrong position (malunion)

• Disruption of bone growth

• Persistent bone or bone marrow infection 

Signs and Symptoms

1. DOTS(Deformity Open Wound Tenderness Swelling)2. Guarding3. Crepitus

4. History

CLOSED FRACTURE OPEN FRACTURE

Pain Bleeding

Swelling Protruding broken bone from skin

Bruising

Angulations

Immobility

Deformity

Sound of snapping bones

Treatments of Fractures

First Aid

If you think you have broken a bone, or you’re helping someone who has, try and support the affected area to stop it from moving around. This will help to prevent further damage and will ease the pain. You can use cushions, clothes or your hand to support the area.

If you have an open fracture, don’t try to close the wound or put the bone back into place. Cover the wound with a clean dressing or cloth until you can get treatment.

Non-surgical treatment

Many fractures can be treated without surgery. Treatment for these fractures includes casts or splints that can be applied around a fractured limb after the fracture is reduced to limit movement and encourage healing. Casts are very commonly used for mild or moderately severe fractures of the extremities. Once in place, a cast is usually left on for several weeks.

1. CAST2. POP

(Plaster Of Paris)3. POP Slab or Splint4. Traction

Surgical treatment of fractures

1. Metal plates may be screwed onto your broken bone to prevent it from moving and to promote healing

2. Metal rod may be placed inside the center of a long bone to help reattach two ends of a fracture and to maintain alignment. This technique is called intramedullary fixation.

3. Pins and rods may be placed in your bones and continue outside your skin, where they can be attached to a metal cage. This technique is known as external fixation and allows for slight adjustments to be made to the orientation and position of a bone as it heals.

Rehabilitation – Restoring the patient as close to pre-injury functional level as possible

1. FRAME

What you can do to improve your fracture?

1. Apply ice to a fracture to reduce swelling

2. Prevent any movement of a victim if a head, neck, or back fracture is suspected

3. Try to immobilize the broken bone if a person must be moved or carried to safety