Students must be able to define fracture.
 Students must be able to outline different
types of fractures .
 Students must be able to outline different
clinical features of fractures.
 Students must be able to describe different
stages of fracture healing.
Students must be able to recognize different
complications of fractures.
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DEFINITION:
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A Fracture is an interruption in the continuity of Bone.
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The symbol # represents a Fracture.
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1. PAIN: This is immediate from local inflammatory
reaction. Marked tenderness over fracture site.
2.DEFORMITY: Due to displacement of bony
fragments, Eg. Dinner fork deformity in distal Radius
Fracture.
3.OEDEMA: Immediately after Injury. Commonly
temporary Posterior cast is first applied and then the
plaster is reapplied as soon as the swelling subsides
4.MUSCLE SPASM: It is a protective reflex in Muscle
to prevent the worsening of Injury.
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5.LOSS OF FUNCTION:
Complete loss of function in severe fractures. Some
activity may be possible in less severe injury.
6.ABNORMAL MOVEMENTS/CREPITUS:
Friction between broken ends of bones. Do not try to
elicit it , it may further worsen the injury.
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7. SHOCK: Hypovolaemic shock due to severe blood
loss, In shaft of Femur fracture (1.7 litres of blood may
be loosed)
8.LIMITATION OF JOINT MOVEMENT: Joint
mobility can be affected due to,pain, spasm,fear,
swelling,mechanical obstruction.
9.MUSCLE ATROPHY: There will be loss of strength
in disused muscles.It is found after few weeeks of
Injury.
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HEALING OF COMPACT BONE:
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Starts within few seconds of Fracture. The process of
Fracture Healing takes place through five stages ().
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I STAGE: HAEMATOMA FORMATION
As a result of tearing of Blood vessels during injury,
Haematoma forms at the fracture site.
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II STAGE: PERIOSTEAL AND ENDOSTEAL
PROLIFERATION:
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Proliferation of cells from deep surface of periosteum
adjacent to fracture site. These cells are the precursors
of Osteoblasts, At the same time cell proliferate from
endosteum in each fragment and it forms a bridge
between bone ends and Haematoma is gradually
reabsorbed.
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III STAGE : CALLUS FORMATION
The proliferating cells mature as osteoblast or chondroblast.
Chondroblast forms cartilage. The osteoblast lays down a
intercellular matrix of collagen and Polysaccharides which
then impregnated with Calcium salts forming immature
bone called CALLUS or Woven bone (1st Radiological
sign) .
IV STAGE : CONSOLIDATION:
The Osteoblastic activity results in change of primary
Callus to bone which has lamellar structure and at the end
of range union is complete. New Bone forms as a thickened
mass at fracture site and obliterates the Medullary cavity.
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V STAGE : REMODELLING
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The Lamellar structure is changed and bone adapts by
strengthening along the line of stress imposed upon it.
The excess bone is removed and original shape
reappears
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Haematoma is formed, Since no medullary cavity the
second stage differ.
Cancellous bone has greater area of contact between
fragments of bone, bone forming tissue is facilitated by
open arrangement of Trabeculae as it grows from both
fragments.
Osteogenic cells lays down intercellular matrix which
calcifies to form woven bone.
Clinical tests of union:
 Absence of pain in Weight bearing, Lifting or
movement
 Absence of tenderness on firm palpation at fracture site
 Absence of mobility between the fragments
Radiological criteria of union:
 Visible callus bridging the #.
 Continuity of bone trabeculae across the #
Clinically
Adult
Child
Upper limb
6-8 weeks
3-4 weeks
Lower limb
12-16 weeks
6-8 weeks
Radiologically
Bridging callus formation
Remodelling
Biomechanically: Full or near full Functional ability
Depends on number of factors.
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Type Of Bone: Cancellous bone heals more quickly than
compact bone. Healing of long bones depends on their size so
that bones of the upper limb unite earlier (3-12 weeks) than do
those of the lower limb (12-18) weeks.
Revascularization of devitalized bone and soft tissues adjacent
to the fracture site.
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BLOOD SUPPLY: Adequate blood supply is essential for
normal healing
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FIXATION: If a Fracture is rigidly immobilized, the stimulus
for callus is lost, so a small amount of movement at Fracture
site encourage healing
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AGE. Union of a fracture is quicker in children and
consolidation may occur at between 4 and 6 weeks.
Age makes little difference to union in adults unless
there is accompanying pathology.
Certain drugs such as non-steroidal anti-inflammatory
drugs may interfere with fracture healing as they have
an impact upon the inflammatory process.
Smoking: There are increased rates of delayed union
and non-union in smokers.
Ultrasound: low intensity Ultrasound may accelerate
Fracture healing
IMMEDIATE COMPLICATIONS
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Haemorrage
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Damage to arteries
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Damage to surrounding soft tissues.
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Wound Infection
Fat embolism ( ARDS- Acute Respiratory distress
syndrome)
Shock
Chest Infection
Compartment syndrome
Nerve Injury
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Deformity
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Osteoarthritis
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Aseptic necrosis
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Traumatic Chondromalacia
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Reflex Sympathetic Dystrophy