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

A bone fracture 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 pathological fracture. Although broken bone and bone break are common colloquialisms for a bone fracture, break is not a formal orthopedic term. 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, while 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.

Other considerations in fracture care are displacement (fracture gap) and angulation. If angulation or displacement is large, reduction (manipulation) of the bone may be required and, in adults, frequently requires surgical care. These injuries may take longer to heal than injuries without displacement or angulation. Another type of bone fracture is a compression fracture. It 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:
y y y y y y y y

Complete fracture: A fracture in which bone fragments separate completely. Incomplete fracture: A fracture in which the bone fragments are still partially joined. 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 a number of pieces. Impacted fracture: A fracture caused when bone fragments are driven into each other.

C=complex fracture Group: The geometry of the fracture is also described by terms such as transverse. (72) Talus. B=wedge fracture.OTA classification The Orthopedic Trauma Association. (73) Calcaneus. A stable fracture is one which is likely to stay in a good (functional) position while it heals. (3) Femur.[2][3] There are five parts to the code: y Bone: Description of a fracture starts by coding for the bone involved:}} (1) Humerus. (2) Radius/Ulna. (06) Clavicle. or segmental. (75) Cuneiform. (25) Metacarpals. (81) Metatarsals. oblique. (76) Cuboid. (24) Carpus. (82) Phalanx (Foot). angulate or rotate before healing and lead to poor function in the long term. (26) Phalanx (Hand). Subgroup: Other features of the fracture are described in terms of displacement. (09) Scapula y y y y Location: a code for the part of the bone involved (e. (74) Navicular.g. (4) Tibia/Fibula. an association for orthopaedic surgeons. diaphyseal=2. Type: It is important to note whether the fracture is simple or multifragmentary and whether it is closed or open: A=simple fracture. spiral. (6) Pelvis. The diaphysis is considered to be the rest of the bone between these two squares. an unstable one is likely to shorten. shaft of the femur): proximal=1. Except at the proximal femur the distal and proximal regions of the bone are defined by a square that is as wide as the as the distance between the condyles. (80) LisFranc. (45) Patella. distal=3 (at the ankle the malleolar region is considered separately due to the pre-existing Weber classification and coded as 4[4]). 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. (5) Spine. angulation and shortening. Other classification systems There are other systems used to classify different types of bone fractures: y y y y y y "Denis classification": spine "Frykman classification": radius and ulna "Gustilo open fracture classification" "Letournel and Judet Classification": Acetabular Fractures "Neer classification": humerus "Seinsheimer's Classification": femur .

Muscle spasms trying to hold bone fragments in place y y Pathophysiology Main article: Bone healing The natural process of healing a fracture starts when the injured bone and surrounding tissues bleed. By a process of remodeling. The new blood vessels bring phagocytes to the area. after the bone has healed sufficiently to bear the weight. At this stage. forming a fracture Hematoma. any form of nicotine hinders the process of bone healing. with or without similar discontinuity in endosteum. . as both contain multiple nociceptors. Healing bone callus is on average sufficiently mineralized to show up on X-ray within 6 weeks in adults and less in children. and adequate nutrition (including calcium intake) will help the bone healing process. some of the fibroblasts begin to lay down bone matrix (calcium hydroxyapatite) in the form of insoluble crystals. The blood vessels also bring fibroblasts in the walls of the vessels and these multiply and produce collagen fibres. In fact. but in adults the strength of the healing bone is usually 80% of normal by 3 months after the injury. The bone shards can also embed in the muscle causing great pain. it becomes rubbery. also builds bone strength. Several factors can help or hinder the bone healing process. which gradually remove the non-viable material. For example. The blood coagulates to form a blood clot situated between the broken fragments. the woven bone is replaced by mature "lamellar" bone. This mineralization of the collagen matrix stiffens it and transforms it into bone. Edema of nearby soft tissues caused by bleeding of torn periosteal blood vessels evokes pressure pain. The whole process can take up to 18 months. Collagen's rubbery consistency allows bone fragments to move only a small amount unless severe or persistent force is applied.Signs and symptoms Although bone tissue itself contains no nociceptors. if the mineral is dissolved out of bone. Within a few days blood vessels grow into the jelly-like matrix of the blood clot. bone is a mineralized collagen matrix. bone fracture is very painful for several reasons: y Breaking in the continuity of the periosteum. Although there are theoretical concerns about NSAIDs slowing the rate of healing. In this way the blood clot is replaced by a matrix of collagen. there is not enough evidence to warrant withholding the use of this type analgesic in simple fractures. Weight-bearing stress on bone. This initial "woven" bone does not have the strong mechanical properties of mature bone.

based on the history given and the physical examination performed by a healthcare professional. a computed tomograph (CT scan) may be performed. In situations where x-ray alone is insufficient. X-ray showing the distal portion of a fractured tibia and intramedular nail. Open fractures may be obvious if bone is exposed but small wounds may need surgical exploration to determine if they are only superficial or connected to the fracture. Usually there will be an area of swelling. . Treatment X-ray showing the proximal portion of a fractured tibia with an intramedullary nail. X-ray radiographs can be requested to view the bone suspected of being fractured.Diagnosis A bone fracture can be diagnosed clinically. abrasion. bruising and/or tenderness at the suspected fracture site.

but usually surgery is done only if conservative treatment has failed or is very likely to fail. Occasionally bone grafting is used to treat a fracture. about as painful as breaking the bone itself. called reduction. Stress shielding occurs when plates or screws carry too large of a portion of the bone's load. This problem is reduced. in good position and verifying the improved alignment with an X-ray is all that is needed. surgery is offered routinely. towards the target of achieving union. aligning the bone. surgical nails. reducing the strength of the . causing atrophy. because the complications of non-operative treatment include deep vein thrombosis (DVT) and pulmonary embolism. ibuprofen has been found to be equally effective as the combination of acetaminophen and codeine. fractured bones may be treated by the Ilizarov method which is a form of external fixator. Bone tissue is predominantly extracellular matrix. such as phalanges of the toes and fingers. open fractures and osteotomies call for very careful antiseptic procedures and prophylactic antibiotics.[13] Immobilization Since bone healing is a natural process which will most often occur. the fracture may be placed in a removable brace or orthosis. due to their limited blood flow. By allowing only limited movement. Bone fractures are typically treated by restoring the fractured pieces of bone to their natural positions (if necessary). which are more dangerous than surgery. which serves a similar function to making a cast. If being treated with surgery. When the initial post-fracture edema or swelling goes down. plates and wires are used to hold the fractured bone together more directly. When a joint surface is damaged by a fracture. Occasionally smaller bones. These implants must be designed and installed with care. including titanium and its alloys. and the few blood vessels needed to support this low metabolism are only able to bring a limited number of immune cells to an injury to fight infection. screws. a fractured limb is usually immobilized with a plaster or fiberglass cast or splint which holds the bones in position and immobilizes the joints above and below the fracture. surgery is also commonly recommended to make an accurate anatomical reduction and restore the smoothness of the joint. and maintaining those positions while the bone heals. Infection is especially dangerous in bones. but not eliminated. Surgery Surgical methods of treating fractures have their own risks and benefits. With some fractures such as hip fractures (usually caused by osteoporosis or osteogenesis Imperfecta). Alternatively. The heat generated by the friction of installing hardware can easily accumulate and damage bone tissue. This process is extremely painful without anesthesia. For this reason.Pain management In arm fractures in children. fixation helps preserve anatomical alignment while enabling callus formation. To this end. fracture treatment aims to ensure the best possible function of the injured part after healing. Often. may be treated without the cast. by the use of low-modulus materials. by buddy wrapping them. Sometimes bones are reinforced with metal. rather than living cells.

If not treated. a titanium plate with cobalt-chromium alloy or stainless steel screws). The metal ions produced can damage the bone locally and may cause systemic effects as well. it does not completely fracture. Other complications may include non-union. Results however do not support its effectiveness.[14] Complications An old fracture with nonunion of the fracture fragments. where the fractured bone fails to heal or mal-union. . galvanic corrosion will result. where the fractured bone heals in a deformed manner. since the bone is not as brittle as it would be in an adult. compartment syndrome can result in amputation of the affected limb. but rather exhibits bowing without complete disruption of the bone's cortex in the surface opposite the applied force.. there are risks of either a growth plate injury or a greenstick fracture. Electrical bone growth stimulation or osteostimulation has been attempted to speed or improve bone healing.connections. If dissimilar metals are installed in contact with one another (i. In children Main article: Child bone fracture In children. whose bones are still developing. That is.e. y A greenstick fracture occurs due to mechanical failure on the tension side. Some fractures can lead to serious complications including a condition known as compartment syndrome.

These injuries may require an osteotomy (bone cut) to realign the bone if it is fixed and cannot be realigned by closed methods. is also possible in children. such as fracture of the clavicle & supracondylar fracture of the humerus.y y y Growth plate injuries. as in Salter-Harris fractures. in which the bone permanently bends but does not break. . Certain fractures are known to occur mainly in the pediatric age group. Plastic deformation of the bone. require careful treatment and accurate reduction to make sure that the bone continues to grow normally.


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