FRACTURES

JSS HOSPITAL MYSORE

FRACTURESBY :: DR ASHWANI PANCHAL

P.G IN ORTHOPAEDICSORTHOPAEDICS DEPT

JSS HOSPITAL, MYSORE

1 INTRODUCTION 2 CLASSIFICATION OF FRACTURE 3 TYPES OF FRACTURE 4 HEALING OF FRACTURE

FRACTURE,S- includes

> FRACTURE IS DEFINED AS “ BREAK IN THE CONTINUITY OF BONE”.

BREAK DOWN OF BONE IN TWO OR MORE THEN TWO PARTS.

Fractures results from :1} injury 2} repetitive stress 3} Abnormal

weakness

Definition

Classification of fractures

1. ON THE BASIS OF AETIOLOGY

2. ON THE BASIS OF DISPLACEMENTS

3. ON THE BASIS OF RELATIONSHIP WITH EXTERNAL ENVIRONMENT

[ a. ] Traumatic fracture – sustained due to any trauma… e.g. : # caused by a fall , RSA etc

[ b. ] Pathological fracture – it is a # through a bone which has been made weak by some underlying disease

e.g :: # through a bone weakened by metastasis,osteoporosis.

1.ON THE BASIS OF AETIOLOGY

A.UNDISPLACED # :: fracture with absence of significant displacement

B.DISPLACED # : there is displacement of fragment of a bone

FACTORS : # force Muscle pull on the # fragment Gravity

2.ON THE BASIS OF DISPLACEMENTS

DISPLACED FRACTURE / UNDISPLACED #

[a] SIMPLE/CLOSED

A fracture not communicating with ext. environment or skin is intact or if there is any wound these are superficial { unrelated to the fracture }

3.ON THE BASIS OF RELATIONSHIP WITH EXTERNAL ENVIRONMENT

A fracture with break in the overlying skin and soft tissues ,leading to the fracture communicating with the ext. environment

B. COMPOUND/ OPEN #

Simple fracture Spiral fracture Transverse fracture Oblique fracture Comminuted fracture Greenstick fracture Segmental fracture Depressed fracture Compression fracture Green stick fracture Hairline fracture

Types of fracture

Usually caused by directly applied force to fracture site

# line is perpendicular to the long axis of the bone

Transverse fracture

Hairline Fracture

In this type of the fracture the crack only extends into the outer layer of the bone but not completely through the entire bone. It is also known as a Fissure Fracture.

Caused by violence transmitted through limb from a distance (twisting movements)

Oblique -# line is obligue Spiral -#line runs spirally in more than one

plane

Spiral or Oblique

Two or more bone pieces - high energy trauma

# with multiple fragments

Comminuated fracture

There are two fractures in one bone at different levels

SEGMENTAL FRACTURE

The fracture in which one side of the bone is broken and the other side is bent.

Greenstick Fracture

Impacted fractures:• broken bone ends are forced into each other•Cancellous bone is usually invovled and union is often rapid

i

Impacted fracture

Caused by traction, bony fragment usually torn off by a tendon or ligament.

Avulsion fracture

FRACTURE HEALING

Fracture healing Introduction Fracture healing is a complex process that

requires the recruitment of appropriate cells ([[[[fibroblasts, macrophages, chondroblasts, osteoblasts, osteoclasts]]]]) and the subsequent expression of the appropriate genes [[[[(genes that control matrix production and organization, growth factors, transcription factors]]]]]) at the right time and in the right anatomical location

HISTORY In 1975, Cruess and Dumont proposed that

fracture healing may be considered to consist of three overlapping phases: an inflammatory phase, a reparative phase, and a remodeling phase

In 1989, FROST proposed the stages of fracture healing

five stages. stage of haematoma stage of granulation tissue stage of callus stage of modelling stage of remodelling

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There are 3 major phases with sub divisions:

A. Reactive Phase:◦ i. Fracture and inflammatory phase.

◦ ii. Stage of hematoma formation.◦ iii. Granulation tissue formation.

B. Reparative Phase:◦ iv. Cartilage Callus formation.◦ v. Lamellar bone deposition.

C. Remodeling Phase:◦ vi. Remodeling to original bone contour.

STAGES OF FRACTURE HEALING

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A.REACTIVE PHASE

I .Fracture &

inflammatory phase :

After fracture the first change seen is the

presence of blood cells within the tissues which

are adjacent to the injury site. Soon after fracture,

the blood vessels constrict, stopping any further

bleeding.

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ii. Stage of Hematoma formation:

Within a few hours after fracture, the extravascular blood cells form a

blood clot, known as a hematoma. All of the cells within the blood clot

degenerate and die.

The fracture hematoma immobilizes

& splints the fracture.

The fracture haematoma provides a

fibrin scaffold that facilitates

migration of repair cells.

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3

iii. Granulation Tissue Formation:

Within this same area,

the fibroblasts survive and replicate.

They form a loose aggregate of cells,

interspersed with small blood vessels,

known as granulation tissue which

grows forward, outside and inside the

bone to bridge the fracture.

They are stimulated by vasoactive

mediators like serotonin and

histamine.

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B. REPARATIVE PHASE

 iv. Cartilage Callus formation :

Days after the # the periosteal cells proximal

to the fracture gap and fibroblasts develop

into chondroblasts which form hyaline

cartilage.

The periosteal cells distal to the fracture gap

develop into osteoblasts which form woven

bone. These 2 tissues unite with their

counterparts and culminate into new mass of

heterogenous tissue called Fracture Callus

restoring some of its original strength.

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C. REMODELLING PHASE

vi. Remodelling to original bone contour:

The remodeling process substitutes the

trabecular bone with compact bone. The

trabecular bone is first resorbed

by osteoclasts, creating a shallow

resorption pit known as a "Howship's

lacuna".

Then osteoblasts deposit compact bone

within the resorption pit.

Eventually, the fracture callus is

remodelled.

HEALING OF CANCELLOUS BONES

The healing of fracured cancellous bone follows a different pattern

The bone is of uniform spongy texture and has no medullary cavity , so that there is large area of contact between the trabeculae

Union can occur directly between the bony surfaces without having to pass through the stage of callus formation

Following haematoma nd granulation formation,mature osteoblasts lay down woven bone in the intercellular matrix,and the two fragments thus unite.

ORTHOPAEDICS DEPTT JSS HOSPITAL ..MYSORE

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