Fractures - general view
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Fractures
By: Ms . S.Peter
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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
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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.
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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
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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
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• 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
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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…..
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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……
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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.
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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.
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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
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Compression fracture
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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….
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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
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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
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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
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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
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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 #
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1.Position – changed or unchanged
Terms used in fracture Follow-up 2. Healing -central or peripheral bony bridging
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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
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COMPLICATIONS OF FRACTURES (General)
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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
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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
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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.
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D. Pulm Embolism : caused by immobility caused by #Assessment: restlessness, apprehension, dyspnea, diaphoresis , ABG changes Implementation: notify if signs present, prepare for anticoagulant therapy
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END OF THIS SESSION