Introduction to bone fracture

INTRODUCTION TO

BONE FRACTURE Suheab A. Maghrabi, MBBS, MSc.Teaching Assistant, Orthopaedic Department,

College of Medicine, University of Hail,

Hail, Saudi Arabia.

Definition

• A bone fracture is a break in

the structural continuity of

bone.

Pathology of bone fracture

• Single highly stressful traumatic incident .

• Repetitive stress of normal degree leading to mechanical

failure

• Normal stress acting on an abnormally weakened bone

(pathological fracture).

Types of bone fracture

• Complete, two or more fragments

Cont.

• Incomplete:

• “Greenstick”, in the pediatric age group.

• Due to thicker periosteum and softer bone.

• Stress fracture

• Compression fracture.

Cont.

• Physeal fracture

• Fracture through the physis

(growth plate).

• Need special care.

• Can result in growth arrest.

Bone healing

• With-callus (secondary healing):

1. Tissue destruction and hematoma development.

2. Inflammation and cellular proliferation.

3. Callus formation.

• Contains osteoprogenic, osteoclast, osteoblast, and chodroprogenic

cells.

• Development of immature bone (woven).

4. Consolidation.

• Woven bone turn into lamellar bone.

5. Remodeling.

Cont.

• Without-callus (primary healing):

• Cutting cone mechanism.

Factors affecting bone healing

• Mechanical stability.

• Blood supply.

• Patient general health.

• Age.

Principle of fracture treatment

• REDUCE, HOLD, EXERCISE.

• Aim of reduction:

• Adequate apposition.

• Normal alignment.

• Restore length.

Cont.

• Reduction methods:

1. Manipulation:

• Minimal displacement, most of children fracture.

• Stages:

• Pulling distal fragment (dis-impaction).

• Reverse the original direction of the deforming force.

• Alignment adjustment.

2. Mechanical traction:

• Either until union or till the operation.

• e.g. Shaft of femur.

Cont.

3. Open reduction, indications:

• Fail of closed reduction.

• Articular fracture.

• Avulsion fracture.

• Neurovascular injury.

• Pathological fracture.

• Unstable fracture.

• Multiple fractures.

• Poor healing potential.

Cont.

• HOLD.

• Methods:

• Cast/ splint.

• Internal fixation

• wires

• Screws

• Plates and screws

• IM Nail

• External fixation

• Ring and pins.

• Sever soft tissue damage.

• Sever comminuted fracture.

• Pelvic and open fractures.

Open fracture

• Bone Fracture with open wound.

• Gastilo classification• I, less than 1cm, low energy, clean wound.

• II, more than 1cm, medium energy, clean wound.

• III, high energy, extensive soft tissue loss, vascular injury

• IIIA, minimum soft tissue damage

• IIIB, soft tissue damage and periosteal stripping.

• IIIC, vascular injury

• Treatment• Wound debridement

• Prophylactic antibiotic

• Stabilization of fracture

• Early definitive wound care.

Thank you