INTRODUCTION TO FRACTURES

OBJECTIVES
To define fractures and understand various types of classification. To study the salient features of open and pathological fractures.

To differentiate between fracture, dislocation and subluxation.

DEFINITION
Break in the continuity of bone

Basics of Fractures
Deformation of bone is directly proportional to the nature, magnitude and direction of force. Treatment protocols are based on these deformation patterns. Deforming forces can be direct or indirect.

CLASSIFICATION
Etiology

Traumatic

Pathological

Displacement

Undisplaced

Displaced

DISPLACED & UNDISPLACED

Relationship with external environment

Open

Closed

OPEN & CLOSED FRACTURES

Nature of fracture line / Basic Pattern

Transverse

Oblique

Spiral

Comminuted

Segmented

OPEN FRACTURES
Communicates with the external environment Break in overlying skin and soft tissue Can be an Open fracture from Within or Without Greater risk of infection

GUSTILO AND ANDERSONS CLASSIFICATION OF OPEN FRACTURES

Based on extent of injury and degree of contamination Type I
Wound < 1 cm Little/No contamination Non-complex fracture pattern

Type II
Wound > 1 cm Moderate contamination Fracture pattern may be complex or simple

 Type III
Extensive soft tissue crushing Extensive contamination Subdivided into:
IIIa : Soft tissue coverage by closure

IIIb : Soft tissue reconstruction needed

IIIc : Associated vascular and nerve injury; needs vascular repair

PATHOLOGICAL FRACTURE
Occurs in a bone with weakened structure due to a disease Break occurs due to trivial trauma or even spontaneously Causes can be localized or generalized Commonest Cause ? Most often affected bone ?

Localized Causes
Inflammatory
Osteomyelitis (pyogenic/tubercular)

Neoplastic
Benign : GCT Malignant : Osteosarcoma; Ewings; Secondaries from Lung, Kidney, Prostate

Miscellaneous
Cysts; Dysplasia; Granulomas

Generalized Causes

Hereditary
Osteogenesis imperfecta Osteopetrosis

Acquired
Osteoporosis Rickets/Osteomalacia Scurvy Pagets Disease

Age Wise Distribution of Pathological Fractures

At Birth : 0-5 years : 5-20 years : Osteogenesis imperfecta Osteomyelitis Osteomyelitis, Primary bone malignancies 20-50 years : Malignancy, Osteomalacia > 50 years : Osteomalacia, Multiple myeloma, Secondaries

DISLOCATION
Injury to a joint Articular surfaces are wholly separated Can be traumatic and pathological Traumatic dislocations - FORA Features include Pain, Swelling, Deformity, Loss of movement, Limb shortening Treatment is based on conservative management and operative reduction

SUBLUXATION
Articular surfaces are partly displaced and retain some contact

SUMMARY
Fracture is break in normal continuity of bone It can be classified in many ways which alters the treatment protocols. Most important are Open fractures and Pathological fractures Dislocation is COMPLETE separation of 2 articular surfaces Subluxation is INCOMPLETE separation of 2 articular surfaces

SOURCES
Google Image Search Essential Orthopaedics by J. Maheshwari Essentials of Orthopaedics by RM Shenoy

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