Fracture : Diagnosis, Complications and Prevention

Fracture : Diagnosis, Complications and Prevention

Fracture is a medical condition which leads to break in the continuity of the bone. A bone fracture can be the result due to high force impact or stress, or trivial injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture.

Classification:

By Cause:

  • Traumatic fracture – This is a fracture due to trauma. e.g.- Fractures caused by a fall, road traffic accident, fight and many others
  • Pathological fracture – A fracture of bone due to certain disease that has made bone weak is called pathological fracture. e.g.- a fracture through a bone weakened by metastasis. Osteoporosis is the most common cause of pathological fracture.

All fractures can be broadly described as:

  • Closed (simple) fractures: Are those in which the skin is intact
  • Open (compound) fractures: Involve wounds that communicate with the fracture, and may thus expose bone to contamination. Open injuries carry a higher risk of infection.

Other types of fracture are:

  • Complete fracture: A fracture in which bone fragments separate completely.
  • 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.
  • 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.
  • Spiral fracture: A fracture where at least one part of the bone has been twisted.
  • Comminuted fracture: A fracture in which the bone has broken into several pieces.
  • Impacted fracture: A fracture caused when bone fragments are driven into each other.
  • Avulsion fracture: A fracture where a fragment of bone is separated from the main mass.

Symptoms

Fractures can cause

  • Pain and bleeding
  • Swelling
  • Bruising or discolored skin around the affected area
  • The patient is unable to put weight on the injured area
  • The patient cannot move the affected area

If it is an open fracture there may be:
Bleeding
Damage to adjacent structures such as nerves or vessels, spinal cord and nerve roots (for spine fractures), or cranial contents (for skull fractures) can cause other specific signs and symptoms.

Causes

The fractures are generally caused due to fall with a great impact or road accident.

Healthy bones are extremely tough and resilient and can withstand powerful impacts. When people enter old age two factors make their risk of fractures greater; weaker bones and a greater risk of falling. Children are physically more active than adults, thus they are more prone to accidents or fall that may result in fractures. People with debilitating illnesses and conditions that may weaken their bones also have a higher risk of fractures. Examples include osteoporosis, infection or a tumor.

Diagnosis

A fractured bone can be diagnosed clinically based on the history and the physical examination of the patient.

Imaging by X-ray is often performed to view the bone suspected of being fractured.

In certain suitations, x-ray alone is not sufficient, a computed tomograph (CT scan) or MRI may be performed.

Complications 

Mal union: This occurs either when the fracture heals in the wrong position or it shifts (the fracture itself shifts).

Interruption of bone growth – If during childhood bone fracture affects both ends of bones, there is a risk that the normal development of that bone may be affected, raising the risk of a subsequent deformity.

Persistent bone or bone marrow infection – If there is a break in the skin. Bacteria can get in and infect the bone or bone marrow, which may leads to persistent infection (osteomyelitis). Patients may need to be hospitalized and treated with antibiotics. Sometimes surgical drainage and curettage is required.

Bone death (Avascular necrosis) – If the bone loses its essential supply of blood it may die.

Prevention

Nutrition and sunlight – The human body needs adequate supplies of calcium for healthy bones. Milk, cheese, yoghurt and dark green leafy vegetables are good sources of calcium. Our body also needs vitamin D to absorb calcium. By exposing to sunlight, as well as eating eggs and oily fish are good ways of getting vitamin D.

Physical activity – The more weight-bearing exercises the person does, the stronger and denser their bones will be. Examples include skipping, walking, running, and dancing any exercise where the body pulls on the skeleton. Older age not only results in weaker bones, but often in less physical activity, which further increases the risk of even weaker bones. It is important for people of all ages to stay physically active.

The (female) menopause – Hormones estrogen, which regulates a woman’s calcium, starts to drop and continues to do so until after the menopause. In other words, calcium regulation is much more difficult after the menopause. Consequently, women need to be especially careful about the density and strength of their bones during and after the menopause.

Treatment

Closed fractures is reduced with or without anesthesia and then reduced. Treatment of bone fractures are broadly classified as surgical or conservative:

The conservative approach is referred to any non-surgical procedure, such as pain management, immobilization or other non-surgical stabilization.

Conservative approach Fracture treatment is usually aimed at making sure there is the best possible function of the injured part after healing. Treatment also focuses on providing the injured bone with the best circumstances for optimum healing.

Cast Immobilization: After the bone is fractured, it is reduced i.e. they must aligned while they heal. This may include:

  • Plaster casts or plastic functional braces – these hold the bone in position until it has healed. Now a days porous casts are used. These porous castes are easy to apply and are not uncomfortable.
  • Metal plates and screws – current procedures use minimally invasive techniques.
  • Intra-medullary nails – Internal steel rods are placed down the center of long bones. Flexible wires may be used in children.
  • External fixators – these may be made of metal or carbon fiber; they have steel pins that go into the bone directly through the skin. They are a type of scaffolding outside the body. Usually the fractured bone area is immobilized for between two to eight weeks. The duration depends on which bone is affected and whether there are any complications, such as a blood supply problem or an infection.

Pain management: Pain killers like ibuprofen, diclofenac is used to relieve pain.

PhysiotherapyOnce the fracture is healed it is necessary to restore muscle strength as well as mobility to the affected area. If the fracture occurred near or through a joint there is a risk of permanent stiffness – the individual may not be able to bend that joint as well as before.

Surgery approach: If there is a damage to the skin and soft tissue around the affected bone or joint, plastic surgery might be required.

  • Bone grafting: Bone grafting is a surgical procedure that replaces missing bone in order to repair bone fractures that are extremely complex, pose a major health risk to the patient, or fail to heal properly.

References:

http://www.cdc.gov/nutrition/everyone/basics/vitamins/calcium.html
http://www.nlm.nih.gov/medlineplus/fractures.html 
http://orthoinfo.aaos.org/topic.cfm?topic=A00139
Fracture assesment tool by WHO: http://www.shef.ac.uk/FRAX/tool.jsp

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