Bone Fracture

Is a medical condition in which there is a damage in the continuity of

the bone. A bone fracture can be the result of high force impact or stress,
They occur when the physical force exerted on the bone is stronger than the
bone itself. or a minimal trauma injury as a result of certain medical
conditions that weaken the bones, such as osteoporosis, bone cancer,
where the fracture is then properly termed a( pathologic fracture)

Types of Bone Fracture

There are several types of bone fracture such as

Linear fracture: A fracture that is parallel to the bone's long axis.

Transverse fracture: A fracture that is at a right angle to the bone's long axis.
Oblique fracture: A fracture that is diagonal to a bone's long axis (more than30).
Spiral fracture: A fracture where at least one part of the bone has been twisted.
Incomplete fracture: A fracture in which the bone fragments are still partially
joined. In such cases, there is a crack in the osseous tissue that does not
completely traverse the width of the bone
Complete fracture: A fracture in which bone fragments separate completely.
Comminuted fracture: A fracture in which the bone has broken into several pieces.

Clinical features
Frequent signs and symptoms of bone fracture,

Pain and swelling at the fracture site.

Tenderness close to the fracture.
Paleness and deformity (sometimes).
Loss of pulse below the fracture, usually in an extremity (this is an emergency).
Numbness, tingling or paralysis below the fracture (rare; this is an emergency).
Bleeding or bruising at the site.
Weakness and inability to bear weight.
Management
Initial Management
Before definitive treatment of a fracture is undertaken, attention must be directed
to first aid treatment (Advanced Trauma Life Support (ATLS) , to the clinical
assessment of the patient with special reference to the possibility of associated injuries or
complications, and to resuscitation

First aid :
Ensure that the airway is clear, to control any external hemorrhage, to cover any wound
with a clean dressing, to provide some form of immobilization for a fractured limb,

Clinical assessment
It must be emphasised again that an immediate assessment of the whole patient is required
to exclude injuries to other systems before examination of the skeletal injury. Examination
of the limb should determine:
1. whether there is a wound communicating with the fracture
2. whether there is evidence of a vascular injury
3. whether there is evidence of a nerve injury
4. whether there is evidence of visceral injury.

Resuscitation
Many patients with severe or multiple fractures, or fractures associated with other visceral
injuries, are shocked on arrival at hospital. Time must be spent on resuscitation and dealing
with any other life-threatening injuries before definitive treatment for the fracture is begun
, replenishment of the circulating blood volume, either with transfused blood when time
permits cross-matching, or alternatively by the use of plasma expanders and blood
substitutes.

REDUCTION
This first principle must be qualified by the words if necessary. In many fractures
reduction is unnecessary, either because there is no displacement or because the
displacement is immaterial to the final result, there are three types of reduction

METHODS OF REDUCTION
When reduction is decided upon it may be carried out in three ways:
1. by closed manipulation
2. by mechanical traction with or without manipulation
3. by open operation.

IMMOBILISATION
this second great principle of fracture treatment must be qualified by the words if
necessary. Whereas some fractures must be splinted rigidly, many do not require
immobilisation to ensure union,

INDICATIONS FOR IMMOBILISATION

There are only three reasons for immobilising a fracture:
1. to prevent displacement or angulation of the fragments
2. to prevent movement that might interfere with union
3. to relieve pain

Rehabilitation
Pathologic stages of fractured bone healing
1. Reactive phase
i. Fracture and inflammatory phase
ii. Granulation tissue formation
2. Reparative phase
iii. Cartilage callus formation
iv. Lamellar bone deposition
3. Remodeling phase
v. Remodeling to original bone contour

Reactive phase
After fracture, the first change seen by light and electron microscopy is the presence of blood
cells within the tissues adjacent to the injury site. Soon after fracture, the blood vessels constrict,
stopping any further bleeding. Within a few hours after fracture, the extravascular blood cells
form a blood clot, known as a hematoma. All of the cells within the blood clot degenerate and
die, Within this same area, the fibroblasts survive and replicate. They form a loose aggregate
of cells, interspersed with small blood vessels, known as granulation tissue

Reparative phase
Days after fracture, the cells of the periosteum replicate and transform. The periosteal cells proximal
(closest) to the fracture gap develop into chondroblasts which form hyaline cartilage

The next phase is the replacement of the hyaline cartilage and woven bone with lamellar bone. The
replacement process is known as endochondral ossification with respect to the hyaline cartilage
and bony substitution with respect to the woven bone. Substitution of the woven bone with lamellar
bone precedes the substitution of the hyaline cartilage with lamellar bone. The lamellar bone begins
forming soon after the collagen matrix of either tissue becomes mineralized.

Remodeling phase
The remodeling process substitutes the trabecular bone with compact bone. The trabecular bone is
first resorbed by osteoclasts , Then osteoblasts deposit compact bone within the resorption pit.
Eventually, the fracture callus is remodelled into a new shape which closely duplicates the bone's
original shape and strength. The remodeling phase takes 3 to 5 years depending on factors such as
age or general condition.[6] This process can be enhanced by certain synthetic injectable
biomaterials, such as cerament, which are osteoconductive and actively promote bone healing.