Fracture

A fracture is a break in a bone, sometimes accompanied by extensive swelling of the surrounding soft tissues, bleeding into muscles and joints, rupture of the tendons, contusion or severing of nerves, and damage to major blood vessels. Injuries are the most frequent cause of fractures, which are most common in men between the ages of 20 and 40. The bones of the arms and legs are most often involved.

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Classification

Fractures may be classified in several ways depending on the extent of the wound, the direction of the fracture line, the position of the fragments, and the cause of the break. In simple, or closed, fracture there is no wound extending to the skin surface, while in a compound, or open, fracture the skin surface is broken, and the wound extends from the broken skin area to the bone injury. Open fractures may become infected and require immediate care in a hospital operating room.

As seen on an X-ray film, the fracture line may be described as longitudinal, transverse, oblique, or spiral. In an incomplete fracture the break does not interrupt the continuity of the bone, while in a complete fracture the break extends clear through the bone. In a comminuted fracture the bone is splintered or crushed, and the fragments are embedded in one another.

A fracture is said to be displaced when the bone fragments have moved from their normal position. When the fracture fragments overlap, causing a shortening of the bone, the fracture is said to be overriding. A fracture is said to show angulation when the fragments have moved into a position that is not in line with the rest of the bone, and rotation is said to be present when a fragment has rotated on its axis in relation to the axis of the bone.

A stress, or fatigue, fracture is a sudden giving away of the bone as a result of cumulative stress on the bone. 'A pathological fracture is one that occurs in an area that was previously weakened by a tumor or other disorder.

Treatment

Successful treatment requires the reduction, or setting, of the fracture and adequate immobilization of the affected area to insure healing. The term "reduction" refers to bringing the fracture fragments back into close apposition and alignment. The means employed to obtain reduction are manipulation (closed reduction), the use of traction devices, or surgical correction (open reduction).

Once the fracture fragments are reduced to their normal position, they must be held in that position until the bone has healed. Among the devices used to immobilize the fracture are plaster casts or splints, traction devices, and metal nails, rods, or screws that are inserted into the bone during surgery.

The healing of a fracture is a natural process. Although fracture repair is more rapid in children, the age of the patient and his ability to repair bone are virtually unrelated in normal persons. In such patients, the healing of fractures is not influenced by the use of vitamins, hormones, extra dietary calcium, or other nutritional supplements. Healing may be delayed by certain disorders, such as malnutrition and infections, particularly a local infection at the site of the fracture.

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