LECTURE

13
FRACTURE
Break in the continuity of hard tissue
like bone, cartilage etc.

Etiology
I. Predisposing or indirect causes
1. Certain bones due to superficial position, shape,
osseos structure, movement

2. Smooth, slippery roads, floors of stable & sheds

3. Diseased condition of bones: osteomalacia,

osteoporosis, ostitis, necrosis of bone, caries etc.

4. Old age
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II. Exiting or direct causes

1. External violence

2. Internal violence: Excessive or in coordinate

muscular action e.g. Galloping or jumping

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Classification
Broadly in 3 type
I. Simple fr. II. Compound fr. III. Complicated fr.

I. Simple fracture (Close fr. ): One which does not

communicate with out side i.e. no wound on skin

II. Compound fracture (open fr.): Which communicate

with out side i.e. wound on skin
a. Primary and b. Secondary

III. Complicated fracture: Injury to important neighboring

vessels or nerve
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A fracture can be incomplete or complete
1. Incomplete #:

a. Greenstick # : Partly broken, bent like

green stick, young ones

b. Partial or splintered # : Splints separated

from main bone

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c. Fissured # : Crack extending through bone
longitudinal, transverse or oblique seen

in tibia, radius & metacarpals

d. Sub periosteal (intra periosteal) # : # of cortical

bone without rupture of periosteum

e. Deferred # : Is incomplete # separation occur after

some period due to violence, strain

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2. Complete #: Line is complete through its thickness &
bone broken in to two or more fragments

a. Single #: Broken in one place only,

two fragments
a. Double # : Two #s in same bone,
three or more fragments
c. Multiple # : More than two #s line
comminuted : Fragments from same point

3. Avulsion # : Tearing of bony prominenece by forcible pull

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Based on portion of bone involved

a. Diphysary # : Involving diphysis (shaft) of

long bone

b. Epiphysary # (Epiphysary separation) : at the

junction of epiphys & shaft of bone, common in
young's due to incomplete calcification of
epiphysis

c. Supracondylar #: # above the condyle e.g.

supracondylar # of humerus

d. Condyloid # (condylar): e.g. condyloid # of

humerous, femur.

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e. Intercondylar # : Between the condyles of the bone
f. Transcondylar # : Line of # is at the level of
condyles
e. Petrochanteric # : # of femur passing through the
greater trochanter
h. Transcervical # : # through neck of femur
i. Periarticular # : # is close to articular extremity

without extending into joint

j. Articular # ( joint # ) : # involving articular surface
k. Extracapsular # : # near joint but not entering with

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Depending on the direction of the fracture
a. Transverse # : At right angle to the axis of the bone
b. Longitudinal # : longitudinal direction
c. Oblique #
d. Spiral #

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Depending on the relationship between the fragments

a. Torsion # : Fragment has been twisted and

separated

b. Impacted # : Fragment firmly driven into another or

one bone into the fracture site of another

c. Dentate # : Ends of fragments are toothed and

interlocked

d. Riding # ( overriding # ) : Fragments lie side by

side, causing shortening of the limb

e. Distracted # : Fragment are separated by muscular

pull e.g. # of olecranon.
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A fracture can be
a. Compression # : Due to compression causing
reduction in the size of bone e. g. # of vertebrae

b. Depressed # : Fragment is
depressed below the surface
e.g. # of skull bone

c. Collie's # : # of distal end of radius,

abduction of paw is noticed

d. Pathological # ( spontaneous/
secondary #) : due to weakening of
bone due to disease
e. Congenital ( intra uterine ) # : Of foetus in uterus dul
Incidence

In dogs :
Commonly – femur and pelvis
Less commonly – tibia, radius, ulna, humerus

In bovine :
Commonly – tibia, humerus, metatarsus and pelvis
Less commonly – radius, ulna, femur, scapula, tarsus

In horse :
Commonly – pelvis, tibia, humerus, ulna, metacarpus

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Symptoms
1. Deformity: Shortening, angulations, rotation,

abduction adduction, local swelling

2. Loss of function : Inability to bear weight

3. Abnormal mobility : Abnormal movement at

abnormal site
4. Pain : Due to movement of fragments

5. Crepitus : Due to rubbing of fragments

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Diagnosis

From symptoms
Conform by radiograph

Treatment

Includes 3 steps
I. Reduction of the fracture fragments

II. Alignment of fracture fragments

III. Retention and immobilization

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Healing and repair of fructure

Blood clot - invaded by capillaries - granulation tissue –

osteoblast is invaded – bone and cartilage is laid down
in irregular pattern to form CALLUS

Internal callus : Plugs medullary cavity

External callus : Between cortex and periosteum

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Clinically process of fracture healing and repair occurs in
four stages

1. Stage of haematoma formation

2. Formation of Soft callus

3. Formation of Primary bone callus

4. Formation of Secondary bone callus

(Consolidation & Re modeling of callus)

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 Fracture repairé

Stage1 Stage 2 Stage 3 Stage 4

Haematoma Soft callus Primary bone Secondary bone
callus callus
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Formation of Haematoma:

 Periosteum, haversian canal, endosteum and bone

marrow.

 Blood accumulate in and around fracture site within 24

hours.

 It gets coagulated and forms

haematoma.

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Formation of Soft Callus/Fibrous/ Temporary callus:
There will be ingrowth of fibroblast, fibrin and capillaries into
clot and capillaries from periosteum, haversian canal,
endosteum and bone marrow.
At same time there will be migration of wandering
phagocytic cells, macrophages, remove RBC, debris, then
we get the fibro-vascular- soft callus.

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 Formation of Primary bone callus:

pH of medium/clot is lowered or is acidic in beginning

because of presence of damaged tissues.

This acidity mobilize calcium from bone fragments.

At same time enzyme Phosphatase is released by osteoclast

cells which will also favor mobilization of calcium from
plasma and the area will be hypersaturated with calcium.

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Gradually osteoclast cells changes the medium pH to
alkaline.

This will favor deposition of calcium.

This is known as primary bone callus. Takes about 3

weeks.

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Formation of Secondary callus:
For proper healing, sustained immobilization is a must.

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Permanent bone is formed.

Consolidation & Re modeling of callus

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Complications of fracture and repair

1. Nerve injury
2. Injury to blood vessels
3. Injury to viscera
4. Failure of implants
5. Mal union
6. A vascular necrosis
7. Non union
8. Delayed union
9. Shortening of bone
10. Infection

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