Fractures Health Article

Definition

A fracture is a complete or incomplete break in a bone resulting from the application of excessive force. An injury may be classified as a fracture-dislocation when a fracture involves the bony structures of any joint with associated dislocation of the same joint.

Description

Fractures usually result from traumatic injury to a bone, causing the continuity of bone tissues or bony cartilage to be disrupted or broken. Fracture classifications include simple, compound, incomplete, and complete. Simple fractures (more recently termed closed fractures) are not obvious on the surface, as the skin has not been broken and remains intact. Compound fractures (now commonly referred to as open fractures) break the skin, exposing bone and causing additional soft tissue injury and possible infection. Single and multiple fractures refer to the number of breaks in the same bone. Fractures are termed complete if the break is completely through the bone, and described as incomplete or "greenstick" if the fracture occurs partly across a bone shaft. This latter type of fracture is often the result of bending or crushing forces applied to a bone.

Fractures are also named by the specific portion of the bone involved and the nature of the break. Identification of a fracture line can further classify fractures. Types include linear, oblique, transverse, longitudinal, and spiral fractures. Fractures can be further subdivided by the positions of bony fragments and are described as comminuted, non-displaced, impacted, overriding, angulated, displaced, avulsed, and segmental.

Fracture lines identification

Linear fractures have a break that runs parallel to the bone's main axis or in the direction of the bone's shaft. For example, a linear fracture of the arm bone could

extend the entire length of the bone. Oblique and transverse fractures differ in that an oblique fracture crosses a bone at approximately a 45° angle to the bone's axis. In contrast, a transverse fracture crosses a bone's axis at a 90° angle. A longitudinal fracture is similar to a linear fracture. Its fracture line extends along the shaft but is more irregular in shape and does not run parallel to the bone's axis. Spiral fractures are described as crossing a bone at an oblique angle, creating a spiral pattern. This type of break usually occurs in the long bones of the body such as the upper arm bone (humerus) or the thigh bone (femur).

Bony fragment position identification

Comminuted fractures have two or more fragments broken into small pieces, in addition to the upper and lower halves of a fractured bone. Fragments of bone that maintain their normal alignment following a fracture are described as being non-displaced. An impacted fracture is characterized as a bone fragment forced into or onto another fragment, resulting from a compressive force. Overriding is a term used to describe bony fragments that overlap and shorten the total length of a bone. Angulated fragments result in pieces of bone being at angles to each other. A displaced bony fragment occurs from disruption of normal bone alignment with deformity of these segments separate from one another. An avulsed fragment occurs when bone fragments are pulled from their normal position by forceful muscle contractions or resistance from ligaments. Segmental fragmented positioning occurs if fractures in two adjacent areas occur, leaving an isolated central segment. An example of segmental alignment occurs when the arm bone fractures in two separate places, with displacement of the middle section of bone.

Causes and symptoms

Individuals with high activity levels appear to have a greater risk for fractures. This group includes children and athletes participating in contact sports. Because of an increase in bone brittleness with aging, elderly persons are also included in this high-risk population. It has been recognized that up to the age of 50, more men suffer from fractures than women due to occupational hazards. However, after the age of 50, more women suffer fractures than men. Specific diseases causing an increased risk for fractures include Paget's disease, rickets, osteogenesis imperfecta, osteoporosis, and prolonged disuse of a nonfunctional body part such as after a stroke.

Symptoms of fractures usually begin with pain and swelling at the involved site. There may also be a great deal of tenderness in the area near the fracture. The skin in the area may be pale and an obvious deformity may be present. In more severe cases, there may be a loss of pulse below the fracture site (such as in the extremities), accompanied by numbness, tingling, or paralysis below the fracture. An open or compound fracture is often accompanied by bleeding or bruising. If a leg is fractured, weakness will usually accompany the injury, causing difficulty with weight bearing.