• Most fractures occur to the shaft of long bones
• Bone is well vascularized and highly innervated
• Heals relatively rapidly when ends are well approximated (6 weeks or less)•
Healed bone often stronger
• than original due to external
• calcification
Signs and Symptoms of a Fracture
1. Pain and Swelling 2. Deformity. 3. Loss of continuity.
4. Irregularity. 5. Crepitus. 6. Bony tenderness. 7. Loss
FRACTURE DIAGNOSIS of function. 8. Abnormal mobility
Fractures Definition
Fracture is a break in continuity of a 🔷 Deforming Forces
The deforming forces causing fractures can be classified as:
HISTORY OF TRAUMA-
• Falling dawn , RTA, Football
• ECHEMOSIS.
bone or loss of normal anatomical
continuity of a bone. 🔹
a. Direct b. Indirect
Direct impact causes severe injuries, e.g. open fractures, comminuted
• SWELLING.
• Direct blow
🔹
fractures, etc.
Indirect impact causes less severe injuries and is classified as follows:
i. A bending force: produces a transverse fracture.
• DEFORMITY
• By palpation-
• tenderness, crebitus (pathognomonic).
ii. A torsional force: produces a spiral fracture. • REMEMBER???Always examine distally
iii. A combination of both bending and torsional force: produces a
comminuted fracture with a butterfly fragment/fragments.
🔷 Pathological Fracture
It is a fracture occurring as a result of pre-existing pathology.The pathology
softens the bone considerably and this soft bone yields to a very trivial
🔻
trauma and fractures, e.g. malignancy, osteomyelitis, etc.
HISTORY OF MILD TRAUMA WITH A HISTORY OF CHRONIC PAIN
(PATHOLOGICAL FRACTURE)
🔷 Stress Fracture
It is a type of pathological fracture due to unaccustomed stress getting
concentrated on one part of the bone, e.g. March fracture seen in soldiers
after a long route march.
🔹
I. Depending on basic nature
🔹 a. Closed or simple.
b. Open or compound.
🔹
II.Depending on the displacements
🔹a.b. Displaced fracture
Undisplaced fracture.
Fracture Types:
🔹simple (closed): little or no bone displacement
-Incomplete fracture
-Complete fracture. 🔹compound fracture: ruptures the skin & bone protrudes
III. Depending on the nature of the 🔹 green stick: occurs mostly in children whose bones have not calcified or
hardened
🔹
fracture line
🔹 a-Transverse fracture.
b-Oblique fracture. 🔹 transverse: crack perpendicular to long axis of the bone-displacement may
-Long oblique occur
🔹
-Short oblique
c. Spiral fracture. 🔹oblique: diagonal crack across the long axis of the bone
Types of Fracture -Long spiral
-Short spiral 🔹 spiral: diagonal crack involving a "twisting" of the bone aboutthe
longitudinal axis (occurs in skin when bindings are too tight)
🔹 d.Comminuted fracture:
In this type, there are more than two 🔹 comminuted (blow out): "crushing" fracture-more common in elderly-may
require screw, rods& wires may cause permanent discrepancy in leg length
🔹
fragments at one fracture site.
e. Segmental fracture:
In a single bone, fracture occurs at two 🔹 impacted: one end of bone is driven up in to the other-mayresultin length
discrepancy
🔹
different levels.
f. Intra-articular fracture:
🔹depressed-broken :bone is pressed inward (skull fracture)
Fracture & Bone A fracture that involves (extends into) the
Healing
articular surface of a joint.
🔹 avulsion-fragment of bone is pulled away by tendon (Hip flexors,
🔹 g. Avulsion fracture:
This is a fracture occurring due to a pull by
adductors)
a muscle,
tendon or a ligament at its insertion to the
bone.
by fatema okoff
🔹 Factors Enhancing Bone Healing
-Youth
Stages of Fracture Healing -Early Immobilization of fracture fragments
-Maximum bone fragment contact
-Adequate blood supply
1st Stage: Stage of Hematoma Formation
-Proper Nutrition
This is an important stage of fracture healing.
-Vitamines A&D
During the process of fracture the blood vessels are torn and hence bleeding
-Weight bearing exercise for long bones in the late
occurs almost immediately. Hematoma acts as a vehicle delivering required
stages of healing
material for union and clearing the unwanted material by a process of
-Adequate hormones:
chemotaxis of cells If this stage is deficien (open fractures), healing is
growth hormone
Interfered ,fracture fails to unite.
thyroxine
🔷 CONCEPTS
Fracture healing is a process in which the body heals and repairs the broken
2nd Stage: Stage of Cellular Proliferation
calcitonin
Within 8 hours of the fracture there is inflammation resulting in subperiosteal
bone. and endosteal cellular proliferation.
These cells surround the broken ends of the bone. Factors Inhibiting Bone Healing
Requirements for Bone Healing At the same time the clotted hematoma progressively -Age
1)Vascularity sufficient blood supply the fracture stimulates the release gets absorbed and new capillaries start infiltrating Fractured Femur Healing Time
of growth factors these cellular masses. infant: 4 weeks
that attract stem cells and promote angiogenesis, vasodilation, and healing of teenager: 12 to 16 weeks
the bone. 3rd Stage: Stage of Primary Woven Bone 60 year old adult: 18 to 20 weeks
Formation(Soft Callus) The proliferating cells which are mainly osteogenic and -Extensive local soft tissue trauma
2)Adequate mechanical stability of the fracture achieved with a variety of chondrogenic start to get incorporated into the fibrogenic matrix under the -Bone loss due to the severity of the fracture
techniques influence of Bone Morphogenic Proteins (BMP), Transforming Growth Factor Inadequate -immobilization (motion at the fracture
cast , rod , external fixator , plate & screws Beta (TGF-B) and Fibroblast Growth Factor (FGF), thus forming primary woven site)
-Adequate stability promotes revascularization Proper stabilization is needed bone. -Infection
to prevent deformity and non-union at the fracture site. This bone is soft as it is not fully mineralized. This is supposed to occur during -Avascular Necrosis
excessive motion will interrupt the development of new bone. 2nd and 3rd week.
🔷 Healing takes place in stages and over a period of time (approximately 4th Stage: Stage of Lamellar Bone Formation (Hard Callus)
4 weeks minimum).
Five distinct stages are recognized.
Mineralization occurs and this primary woven bone is transformed into lamellar
bone. 🔹
Factors Influencing Healing
a. Factors not (at all) in control of the treating
doctor
This is supposed to occur between 3 and 6 weeks
This is hard bone and is seen as a bridge or a cuff across the fracture site. ·Nature of the trauma
It indicates early stage of fracture union. - High velocity trauma.
- Low velocity trauma.
5th stage: stage of remodeling ·Nature of the fracture.
emodeling takes place only after the fracture unites (heals) and takes months ·Vascularity of the bone.
and years. ·Age of the patient.
Here the body attempts to give the normal shape and strength to the fractured
bone or in other words to restore its preinjured status. remodeling is rapid in 🔹 b. Factors in control (some control) of the
treating
children and in growing bones and slow in adult bones and almost nil in
osteoporotic bones doctor.
·Proper reduction.
·Adequate fixation
·Adequate immobilization.
Fracture Healing ·Prevention of distraction.
·Prevention of infection.
·Maintaining adequate nutrition.
·Adequate management of other comorbid conditions.
Points to Remember with Regard to Fracture Healing
Fractures are treated by reduction (realignment) & immobilization In most
cases, simple fractures heal completely in approximately 6-8 weeks bones of Immobilization: Cast Disease
elderly heal slower because of poor circulation Most changes are reversible Muscle Atrophy
Two types of bone healing: Primary & Secondary (both usually occur at calcium content in surrounding bone resorption and weakening of tissues at
🔹
some level)
Primary-healing without external fibrocartilagenous callus formation
Seen with rigid (exact) internally or externally fixated reductions
sites of ligament attachments
no stress forces on an immobilized jointr thinning of
articular cartilage Adhesions rjoint stiffness
Similar to haversion remodelling (normal homeostatic bone metabolism) loss of peripheral autonomic vascular control hair loss- shiny mottled skin
🔹
Rate of healing the same as secondary bone healing
Secondary- healing with a small gap between bone ends
External fibrocartilagenous callus forms, leaving area of girth upon healing
sensory dissociation (light touches interpreted as painful)
Therapeutic Implications for Treating Fractures
Active ROM exercises to joints above and below immobilized
🔹
region Resistive ROM exercises to muscle groups that are not immobilized
Once the cast or immobilization device has been removed:
-gentle but progressive resistance exercises of all immobilized joints
-evaluate strength of joint(s) and compare to non-injured
counterparts
return to vigorous activity only after strength discrepency = 15%
• Bone is well vascularized and highly innervated
• Heals relatively rapidly when ends are well approximated (6 weeks or less)•
Healed bone often stronger
• than original due to external
• calcification
Signs and Symptoms of a Fracture
1. Pain and Swelling 2. Deformity. 3. Loss of continuity.
4. Irregularity. 5. Crepitus. 6. Bony tenderness. 7. Loss
FRACTURE DIAGNOSIS of function. 8. Abnormal mobility
Fractures Definition
Fracture is a break in continuity of a 🔷 Deforming Forces
The deforming forces causing fractures can be classified as:
HISTORY OF TRAUMA-
• Falling dawn , RTA, Football
• ECHEMOSIS.
bone or loss of normal anatomical
continuity of a bone. 🔹
a. Direct b. Indirect
Direct impact causes severe injuries, e.g. open fractures, comminuted
• SWELLING.
• Direct blow
🔹
fractures, etc.
Indirect impact causes less severe injuries and is classified as follows:
i. A bending force: produces a transverse fracture.
• DEFORMITY
• By palpation-
• tenderness, crebitus (pathognomonic).
ii. A torsional force: produces a spiral fracture. • REMEMBER???Always examine distally
iii. A combination of both bending and torsional force: produces a
comminuted fracture with a butterfly fragment/fragments.
🔷 Pathological Fracture
It is a fracture occurring as a result of pre-existing pathology.The pathology
softens the bone considerably and this soft bone yields to a very trivial
🔻
trauma and fractures, e.g. malignancy, osteomyelitis, etc.
HISTORY OF MILD TRAUMA WITH A HISTORY OF CHRONIC PAIN
(PATHOLOGICAL FRACTURE)
🔷 Stress Fracture
It is a type of pathological fracture due to unaccustomed stress getting
concentrated on one part of the bone, e.g. March fracture seen in soldiers
after a long route march.
🔹
I. Depending on basic nature
🔹 a. Closed or simple.
b. Open or compound.
🔹
II.Depending on the displacements
🔹a.b. Displaced fracture
Undisplaced fracture.
Fracture Types:
🔹simple (closed): little or no bone displacement
-Incomplete fracture
-Complete fracture. 🔹compound fracture: ruptures the skin & bone protrudes
III. Depending on the nature of the 🔹 green stick: occurs mostly in children whose bones have not calcified or
hardened
🔹
fracture line
🔹 a-Transverse fracture.
b-Oblique fracture. 🔹 transverse: crack perpendicular to long axis of the bone-displacement may
-Long oblique occur
🔹
-Short oblique
c. Spiral fracture. 🔹oblique: diagonal crack across the long axis of the bone
Types of Fracture -Long spiral
-Short spiral 🔹 spiral: diagonal crack involving a "twisting" of the bone aboutthe
longitudinal axis (occurs in skin when bindings are too tight)
🔹 d.Comminuted fracture:
In this type, there are more than two 🔹 comminuted (blow out): "crushing" fracture-more common in elderly-may
require screw, rods& wires may cause permanent discrepancy in leg length
🔹
fragments at one fracture site.
e. Segmental fracture:
In a single bone, fracture occurs at two 🔹 impacted: one end of bone is driven up in to the other-mayresultin length
discrepancy
🔹
different levels.
f. Intra-articular fracture:
🔹depressed-broken :bone is pressed inward (skull fracture)
Fracture & Bone A fracture that involves (extends into) the
Healing
articular surface of a joint.
🔹 avulsion-fragment of bone is pulled away by tendon (Hip flexors,
🔹 g. Avulsion fracture:
This is a fracture occurring due to a pull by
adductors)
a muscle,
tendon or a ligament at its insertion to the
bone.
by fatema okoff
🔹 Factors Enhancing Bone Healing
-Youth
Stages of Fracture Healing -Early Immobilization of fracture fragments
-Maximum bone fragment contact
-Adequate blood supply
1st Stage: Stage of Hematoma Formation
-Proper Nutrition
This is an important stage of fracture healing.
-Vitamines A&D
During the process of fracture the blood vessels are torn and hence bleeding
-Weight bearing exercise for long bones in the late
occurs almost immediately. Hematoma acts as a vehicle delivering required
stages of healing
material for union and clearing the unwanted material by a process of
-Adequate hormones:
chemotaxis of cells If this stage is deficien (open fractures), healing is
growth hormone
Interfered ,fracture fails to unite.
thyroxine
🔷 CONCEPTS
Fracture healing is a process in which the body heals and repairs the broken
2nd Stage: Stage of Cellular Proliferation
calcitonin
Within 8 hours of the fracture there is inflammation resulting in subperiosteal
bone. and endosteal cellular proliferation.
These cells surround the broken ends of the bone. Factors Inhibiting Bone Healing
Requirements for Bone Healing At the same time the clotted hematoma progressively -Age
1)Vascularity sufficient blood supply the fracture stimulates the release gets absorbed and new capillaries start infiltrating Fractured Femur Healing Time
of growth factors these cellular masses. infant: 4 weeks
that attract stem cells and promote angiogenesis, vasodilation, and healing of teenager: 12 to 16 weeks
the bone. 3rd Stage: Stage of Primary Woven Bone 60 year old adult: 18 to 20 weeks
Formation(Soft Callus) The proliferating cells which are mainly osteogenic and -Extensive local soft tissue trauma
2)Adequate mechanical stability of the fracture achieved with a variety of chondrogenic start to get incorporated into the fibrogenic matrix under the -Bone loss due to the severity of the fracture
techniques influence of Bone Morphogenic Proteins (BMP), Transforming Growth Factor Inadequate -immobilization (motion at the fracture
cast , rod , external fixator , plate & screws Beta (TGF-B) and Fibroblast Growth Factor (FGF), thus forming primary woven site)
-Adequate stability promotes revascularization Proper stabilization is needed bone. -Infection
to prevent deformity and non-union at the fracture site. This bone is soft as it is not fully mineralized. This is supposed to occur during -Avascular Necrosis
excessive motion will interrupt the development of new bone. 2nd and 3rd week.
🔷 Healing takes place in stages and over a period of time (approximately 4th Stage: Stage of Lamellar Bone Formation (Hard Callus)
4 weeks minimum).
Five distinct stages are recognized.
Mineralization occurs and this primary woven bone is transformed into lamellar
bone. 🔹
Factors Influencing Healing
a. Factors not (at all) in control of the treating
doctor
This is supposed to occur between 3 and 6 weeks
This is hard bone and is seen as a bridge or a cuff across the fracture site. ·Nature of the trauma
It indicates early stage of fracture union. - High velocity trauma.
- Low velocity trauma.
5th stage: stage of remodeling ·Nature of the fracture.
emodeling takes place only after the fracture unites (heals) and takes months ·Vascularity of the bone.
and years. ·Age of the patient.
Here the body attempts to give the normal shape and strength to the fractured
bone or in other words to restore its preinjured status. remodeling is rapid in 🔹 b. Factors in control (some control) of the
treating
children and in growing bones and slow in adult bones and almost nil in
osteoporotic bones doctor.
·Proper reduction.
·Adequate fixation
·Adequate immobilization.
Fracture Healing ·Prevention of distraction.
·Prevention of infection.
·Maintaining adequate nutrition.
·Adequate management of other comorbid conditions.
Points to Remember with Regard to Fracture Healing
Fractures are treated by reduction (realignment) & immobilization In most
cases, simple fractures heal completely in approximately 6-8 weeks bones of Immobilization: Cast Disease
elderly heal slower because of poor circulation Most changes are reversible Muscle Atrophy
Two types of bone healing: Primary & Secondary (both usually occur at calcium content in surrounding bone resorption and weakening of tissues at
🔹
some level)
Primary-healing without external fibrocartilagenous callus formation
Seen with rigid (exact) internally or externally fixated reductions
sites of ligament attachments
no stress forces on an immobilized jointr thinning of
articular cartilage Adhesions rjoint stiffness
Similar to haversion remodelling (normal homeostatic bone metabolism) loss of peripheral autonomic vascular control hair loss- shiny mottled skin
🔹
Rate of healing the same as secondary bone healing
Secondary- healing with a small gap between bone ends
External fibrocartilagenous callus forms, leaving area of girth upon healing
sensory dissociation (light touches interpreted as painful)
Therapeutic Implications for Treating Fractures
Active ROM exercises to joints above and below immobilized
🔹
region Resistive ROM exercises to muscle groups that are not immobilized
Once the cast or immobilization device has been removed:
-gentle but progressive resistance exercises of all immobilized joints
-evaluate strength of joint(s) and compare to non-injured
counterparts
return to vigorous activity only after strength discrepency = 15%
