Bone Tute

1. Discuss the various presenting forms of osseous fractures

Classification of Fractures

Complete Fractures are fractures where the bone has fully separated into two or more fragments; in
contrast an Incomplete fracture is where the cortex of the bone is only partially divided.

Simple or Closed Fractures are where there is a clean break of the bone without it breaking through
the overlying skin, in contrast a Compound or Open Fracture is one that breaks through the
overlying skin.

Complicated Fractures are fractures that impact upon adjacent structures (eg. nerves, vessels)

Compression Fractures are what often occur in osteoporotic lumbar vertebrae, where the
anterior aspect of the lumbar vertebrae loses osseous mass, fractures and causes kyphosis.

Displaced Fracture is a category of fracture where the bone has moved from its normal position, if
severe resulting in deformity.

Types of Fracture Lines

 Transverse Fractures occur perpendicular to the bone and are the most common. Are also
easiest to heal.

 Oblique Fractures occur on an angle to the bone. They are common.

 Spiral Fractures are often misaligned, messy, complicated fractures that result in chronic
inflammation and possibly a wound.

 Comminuted Fracture is when the bone is broken into many small pieces, and commonly
needs to be repaired with wiring and plates. MORE THAN 2

 Greenstick Fracture is an incomplete fracture that is common in younger children where the
bones have not yet fully ossified. It presents as a bone with a slight bend.

 Open Fracture exposes the bone marrow to the exterior (septicemia risk)

2. Discuss the healing stages of an osseous fracture

1. Reactive Phase (1-2 days)
 Fracture and inflammatory phase
 Granulation tissue formation
2. Reparative Phase (1st week)
 Cartilage callus formation (soft and hard callus)
 Lamellar bone deposition
3. Remodeling Phase (Several weeks)
 Remodeling to original bone contour

3. Discuss the contributing factors in the genesis (cause) of a pathological fracture

If the force that generates the fracture is very low, chances are that it is a pathological fracture. This
can occur in:
 Osteonecrosis
 Osteoporosis
 Osteomalacia
 Paget’s Disease
 Congenital Bone Disorders
 1° and 2° Neoplasia

4. Discuss the factors that may prevent or slow the progression of bone healing.
Factors that affect bone healing

 Poor blood supply

 Vascular Compression – From bone or neoplasia etc.
 Nutritional deficiency – in Vitamin C or Vitamin D
 Metabolic Disorders – Diabetes or low Thyroidism
 Infections
 Drugs – Specifically Corticosteroids
 Neoplasias – Inhibit healing

5. Discuss the pathogenesis and pathology of Osteonecrosis

Osteonecrosis occurs when your bones lose their blood supply. The bones die and eventually collapse,
leading to pain and arthritis. You can have osteonecrosis in one or several bones. It is most common in
the upper leg. Other common sites are your upper arm and your knees, shoulders and ankles. The
disease can affect men and women of any age, but it usually strikes in your thirties, forties or fifties.

Early in the disease you might not have any symptoms. Later, you will probably have joint pain that
becomes more severe as the disease gets worse.

No one is sure what causes the disease. Risk factors include

 Long-term steroid treatment

 Alcohol abuse
 Joint injuries
 Having certain diseases, including arthritis and cancer

Treatments include medicines, using crutches, limiting activities that put weight on the affected joints,
electrical stimulation and surgery.
Case

• What do you see? What will you particularly look for on examination? Looking at the lesion what type
of injury is likely to be present here?

• What does the radiograph show? 


• What is your diagnosis based on the patient’s history, clinical 
presentation, and radiographic
investigation? 


• In general terms, how would this injury be treated? Why? 


• What complications are likely to occur in relation to this injury? 


 Fibula & Tibia displaced compound(?) fracture

 Pain, tenderness, bone exposure

 Ortho referral

 Cast

 If poor healing potential for necrosis

• The orthopaedic surgeon treats his fracture. You review the patient 24hrs later and find that both
feet show same colour, turgor and temperature. Pulse is equally present in both feet. 


How would the healing progress in this case? 


What factors could prevent completion or prolong the healing 
process? 


 Well progression

 Factors of retardation etc