Definition[edit | edit source]A fracture is a discontinuity in a bone (or cartilage) resulting from mechanical forces that exceed the bone's ability to withstand them.[1] Fractures can occur in a variety of methods: Show
Location[edit | edit source]Type of Bone Fractured[2]
Types of Bone Fracture[edit | edit source]In general, there are many different classification systems used for fractures which fall within a set number of patterns:[2]
Pathophysiology of Bone Healing[edit | edit source]The pathophysiological sequence of events that occur following a fracture for bone healing can be divided into three main phases[2][4][5]
Phase 1 - Inflammatory Phase (Hours - Days)[edit | edit source]Immediately at the time of fracture, the space between the ends of the fracture is filled with blood, forming a haematoma. This prevents additional bleeding and provides structural and biochemical support for the influx of inflammatory cells. The inflammatory reaction results in the release of cytokines, growth factors and prostaglandins, all of which are important in healing. The fibroblasts, chondroblasts and the ingrowth of capillaries is then infiltrated by fibrovascular tissue. This forms a matrix for bone formation and primary callus. Phase 1 takes approximately a week, forming a primary callus which is non-mineralized.[2] This is not readily visible on radiography. Phase 2 - Reparative Phase (Days - Weeks)[edit | edit source]Over the next few weeks, this primary callus is transformed into a bony callus by the activation of osteoprogenitor cells. These cells lay down woven bone which stabilises the fracture site. [2] Soft callus is organised and remodelled into hard callus over several weeks. Soft callus is plastic and can easily deform or bend if the fracture is not adequately supported. Hard callus is weaker than normal bone but is better able to withstand external forces and equates to the stage of "clinical union", i.e. the fracture is not tender to palpate or with movement. This can be seen on radiographs within 7-10 days after injury. Phase 3 - Remodelling Phase (Months to Years)[edit | edit source]The remodelling phase is the longest phase and may last several years. [2] This phase represents the gradual formation of compact cortical bone with greater biomechanical properties. This allows for the reduction of the width of the callus. During remodelling, the healed fracture and surrounding callus responds to activity, external forces, functional demands and growth. Bone (external callus) which is no longer needed is removed and the fracture site is smoothened and sculpted. Remodelling can result in almost perfect healing, however, where the alignment of the fracture site is not perfect, a residual deformity may remain.[1] [6] Complications[edit | edit source]Many of the aforementioned fracture types can also go on to have additional complications (and many associated soft tissue injuries). See Fracture Complications
[10] Clinical Features of Fracture[edit | edit source]Clinical features vary depending on the cause of injury, its nature and the patient's level of consciousness. These features are :
When Is Fracture Healed[edit | edit source]The average time for bone healing is about 6-8 weeks, but can varies depending upon many factors; Local Factors
[13] Treatment and Prognosis[edit | edit source]The basics of fracture healing rely on alignment and immobilisation. Alignment may or may not be necessary depending on the degree of displacement, the importance of correct alignment (e.g. index finger vs rib), and the patient (e.g. professional athlete vs debilitated elderly). Immobilisation can be achieved in a variety of ways, depending on the location, morphology of the fracture, and device of fixation
Fixation Devices[edit | edit source]Stress Sharing Devices[edit | edit source]It allows micromotion between the two fractured sites and partial transmission of load. This promotes secondary bone healing with callus formation (a relatively rapid bone healing). For example; intramedullary nail, casts, and rods. Stress Shielding Devices[edit | edit source]The stress at the fracture site is transmitted through the shielding device therefore, there is no motion at the fracture site. This promotes primary bone healing without callus formation (slower than the healing with callus formation). For example; compression plate[14][15]. Role of Physiotherapy[edit | edit source]The physiotherapist’s role is to identify the root cause of the problem and select appropriate treatment techniques to help patients return to their desired activities of daily living. As with any physiotherapy session, conducting a patient assessment is crucial. The problem-oriented medical record (POMR) system is based on a data collection system that incorporates the acronym SOAP:
The treatment provided is largely dependent on the problems identified during your initial assessment. may include a mixture of the following: Examples of early treatment include;
References[edit | edit source]
What are the 4 types of fracture?These are the main types of bone fractures:. Simple or Closed Fracture. A bone fracture is classified as simple or closed if the broken bone remains within the body and does not push into or out of the skin. ... . Compound or Open Fracture. ... . Incomplete or Partial Fracture. ... . Complete Fracture.. What is a Greenstick fracture?A greenstick fracture occurs when a bone bends and cracks, instead of breaking completely into separate pieces. The fracture looks similar to what happens when you try to break a small, "green" branch on a tree.
What is it called when a piece of bone breaks off?A fracture is a break in any bone in the body. There are different kinds of fracture: The bone may be fractured but stable, which is known as a simple fracture or a closed fracture. Bone fragments may be sticking through the skin, which is known as a compound fracture or an open fracture.
What type of fracture is a complete break and the bone pierces the skin?A traumatic accident like a fall or car crash can break your leg or other bones in your body. If a broken bone pierces your skin, it's called a compound fracture. You'll need surgery to realign your bones and then a cast to keep them immobilized.
|