A bone fracture (sometimes abbreviated FRX or Fx , F x , or < b> # ) is a medical condition in which there is partial or complete rest in bone survival. In more severe cases, bone can be broken down into sections. Bone fractures can be caused by high-impact effects or stress, or minimal trauma injury due to certain medical conditions that weaken the bones, such as osteoporosis, osteopenia, bone cancer, or osteogenesis imperfecta, where fractures are then properly termed pathologic fractures.
Video Bone fracture
Signs and symptoms
Although the bone tissue itself does not contain nociceptors, bone fractures are painful for several reasons:
- Break through the continuity of the periosteum, with or without similar discontinuities in the endosteum, as both contain multiple pain receptors
- The nearby soft tissue edema caused by bleeding of damaged periosteal veins causes a tenderness
- Unconscious muscle muscles try to hold the bone fragments in place.
- Hematoma at the fracture site.
Damage to adjacent structures such as nerves, muscles or blood vessels, spinal cord, and nerve roots (for spinal fractures), or the contents of the skull (for skull fractures) can cause other specific signs and symptoms.
Complications
Some fractures can cause serious complications including conditions known as compartment syndrome. If left untreated, eventually, compartment syndrome may require amputation of affected limbs. Other complications may include non-union, in which the cracked bone fails to heal or mal union, in which the fractured bone heals by means of deformation.
Fracture complications can be classified into three major groups, depending on the time of occurrence. These are as follows -
- Immediate complication - occurs at the time of fracture
- Initial complications - occur within the initial few days after fracture
- Late complications - occur long after fracture
Maps Bone fracture
Pathophysiology
The natural process of healing the fracture begins when the bone is injured and the surrounding tissue bleeds, forming a fracture hematoma. Blood clots to form blood clots that lie between broken pieces. Within days, blood vessels grow into a matrix like a jelly-like blood clot. New blood vessels carry phagocytes to the area, which gradually eliminate non-living material. The blood vessels also carry fibroblasts in the vessel wall and this breeds and produces collagen fibers. In this way, the blood clot is replaced by a collagen matrix. The consistency of collagen rubber allows bone fragments to move only in small quantities unless gravity or persistent is applied.
At this stage, some fibroblasts begin to lay the bone matrix in the form of collagen monomer. These monomers spontaneously converge to form a bone matrix, in which bone crystals (calcium hydroxyapatite) are stored in between, in the form of insoluble crystals. The mineralization of this collagen matrix tightens and turns it into bone. In fact, the bone is the mineralized collagen matrix; if the mineral dissolves out of the bone, it becomes supple. The average healing bone callus is sufficiently mineralized to appear on X-rays within 6 weeks in adults and less in children. These early "webbing" bones do not have the strong mechanical properties of mature bones. With the remodeling process, the woven bone is replaced by a mature "lamellar" bone. The whole process can take up to 18 months, but in adults, the healing bone strength is usually 80% normal at 3 months after the injury.
Several factors can help or inhibit bone healing process. For example, tobacco smoking inhibits the bone healing process, and adequate nutrition (including calcium intake) will help the bone healing process. Emphasize the pressure on the bone, after the bone has been adequately healed to withstand the weight, also build bone strength.
Although there are theoretical concerns about NSAIDs slowing down the rate of healing, there is not sufficient evidence to ensure the use of this type of analgesic in simple fractures.
Smoking effect
Smokers generally have lower bone density than non-smokers, so they have a much higher risk of fractures. There is also evidence that smoking slows the healing of bones.
Diagnosis
Bone fractures can be diagnosed based on history and physical examination performed. Radiographic imaging is often done to confirm the diagnosis. In certain circumstances, close radiographic examination of joints is indicated to exclude dislocations and fractures-dislocations. In situations where projection radiography alone is insufficient, Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) may be indicated.
Classification
In orthopedic medicine, fractures are classified in various ways. Historically they were named after doctors who first described the condition of the fracture, however, there was a more systematic classification as well.
They can be divided into stable versus unstable depending on the possibility that they can shift farther.
Mechanism
- Traumatic fracture - This is a fracture due to the ongoing trauma. for example, fractures caused by falls, road traffic accidents, fights, etc.
- Pathological Fracture - Bone fractures that have been made weak by some underlying disease are called pathologic fractures. for example, bone fractures attenuated by metastasis. Osteoporosis is the most common cause of pathologic fractures.
- Periprosthetic fracture - This is a fracture at the point of mechanical weakness at the end of the implant
Soft-tissue engagement
- Closed fractures are those whose skin is intact
- Open/complex fractures involve injuries that communicate with a fracture, or where a fracture hematoma is exposed, and thus may expose the bone to contamination. Open injuries carry a higher risk of infection.
- Net fracture
- Contaminated fracture
Moving
- Non-displaced
- Refugee
- Translated, or latus ad , with sideways move.
- Angry
- Played
- Shortened
Fracture pattern
- Linear fracture: Fracture parallel to the long bone axis
- Transverse fracture: Fracture that is right angle to the long bone axis
- Oblique fracture: Fractures that are diagonal to the long axis of the bone (more than 30 Â °)
- Spiral fractures: Fractures where at least one part of the bone has been twisted
- Affected fractures: Fractures that occur when bone fragments are moved to one another
- Avulsion fracture: Fracture in which bone fragments are separated from the main mass
Fragments
- Fracture is incomplete: It is a fracture in which bone fragments are still partially joined, in such cases, there are cracks in the osseous tissue that do not fully cross the width of the bone.
- Complete fracture: It is a fracture in which bone fragments are completely separated.
- Comminutive fracture: It is a fracture in which the bone breaks into several parts.
Anatomical location
The Orthopedic Trauma Association Committee for Encoding and Classification published a classification system in 1996, adopting a system similar to the AO Foundation 1987 system. In 2007, they expanded their systems, bringing together two systems of broken arms, hands, feet and ankles.
Classification named person
A number of classifications are named after the person (eponymous) who developed them.
- "Denis Classification" for vertebral fractures
- "Frykman Classification" for lower arm fracture (radius fracture and ulna)
- "Gustilo opens the fracture classification"
- "Classification of Letournel and Judet" for Acetabular Fractures
- "Neer classification" for humerus fracture
- Seinsheimer classification, Evans-Jensen classification, Pipkin classification, and Park classification for hip fracture
Treatment
Treatment of fractures is broadly classified as surgical or conservative, the latter essentially referring to non-surgical procedures, such as pain management, immobilization or other non-surgical stabilization. A similar classification is open compared to closed treatment , where open treatment refers to treatments where fracture sites are opened surgically, regardless of whether the fracture is open or closed fractures.
Pain Management
In arm fractures in children, ibuprofen has been found to be as effective as a combination of acetaminophen and codeine.
Immobilization
Since bone healing is a natural process that will occur most often, fracture treatment aims to ensure the best function of the injured part after healing. Bone fractures are usually treated by restoring cracked bone fragments to their natural position (if necessary), and maintaining the position when the bone heals. Often, aligning the bone, called reduction, in a good position and verifying the leveling enhanced by X-rays is all that is needed. This process is very painful without anesthesia, just as painful as breaking the bone itself. For this purpose, broken limbs are usually immobilized with plaster or gypsum or fiberglass splints that hold the bone in position and disable the joints above and below the fracture. When early post-fracture edema or swelling decreases, fractures may be placed on a removable brace or orthosis. If treated surgically, surgical nails, screws, plates, and wires are used to hold the broken bones together more directly. Or, a cracked bone can be treated with the Ilizarov method which is a form of an external fixator.
Sometimes smaller bones, such as the phalanx of the toes and fingers, can be treated without a cast, by the buddy wrapping them, which functions the same function to make the cast. By allowing only limited movement, fixation helps maintain anatomical alignment while allowing callus formation, toward the target of achieving unity.
The splinting results in the same results as casting in children who have distal radius fractures with slight shifts.
Surgery
Surgical methods for treating fractures have their own risks and benefits, but usually surgery is performed only if conservative treatment has failed, may very well fail, or tend to produce poor functional outcomes. With some fractures such as hip fractures (usually caused by osteoporosis), surgery is offered routinely because non-operative treatments produce prolonged immobilization, which usually results in complications including chest infections, pressure sores, deconditions, deep vein thrombosis (DVT), and emboli lung, which is more dangerous than surgery. When joint surfaces are damaged by fractures, surgery is also usually recommended to make accurate anatomical reduction and restore smooth joint.
Infection is particularly harmful to bone, due to the nature of recrudescent bone infection. The tissue bone is dominated by an extracellular matrix, not a living cell, and some of the blood vessels needed to support this low metabolism are only capable of carrying a limited number of immune cells to the injury to fight infection. For this reason, open fractures and osteotomies call for very careful antiseptic procedures and the use of prophylactic antibiotics.
Occasionally, bone grafting is used to treat fractures.
Sometimes the bones are reinforced with metal. These implants should be carefully designed and installed. The stress shield occurs when a plate or screw carries too much of the bone load, causing atrophy. This problem is reduced, but not eliminated, by the use of low-modulus materials, including titanium and alloys. Heat generated by friction mounting hardware can accumulate easily and damage bone tissue, reducing the strength of the connection. If different metals are installed in contact with each other (ie, titanium plates with cobalt-chromium alloy or stainless steel screws), galvanic corrosion will occur. The resulting metal ions can damage bone locally and can cause systemic effects as well.
More
A Cochrane review of low-intensity throbbing ultrasound to speed healing on newly broken bones is not enough evidence to justify routine use. Other reviews have found tentative helpful evidence. This may be an alternative to operations for established nonunions.
Vitamin D supplementation combined with additional calcium marginally reduces the risk of hip fractures and other types of fractures in older adults; However, vitamin D supplements alone do not reduce the risk of fractures.
Children
In children, whose bones are still developing, there is the risk of growth plate injury or greenstick fractures.
- A greenstick fracture occurs due to mechanical failure on the voltage side. That's because bones are not as fragile as in adults, it's not really cracked, but rather shows a bow without the complete interruption of the bone cortex on the surface opposite to the given force.
- Growth slabs, such as the Salter-Harris fracture, require careful care and accurate reduction to ensure that the bones continue to grow normally.
- Plastic bone deformation, in which the bone is permanently bent, but not broken, is also possible in children. This injury may require osteotomy (bone cut) to straighten the bone if it has been repaired and can not be adapted to a closed method.
- Certain fractures mainly occur in children, including fractures of the clavicle fracture and the supracondylary of the humerus.
See also
- Stress fracture
- Distraction of osteogenesis
- Rickets
- Katagmatic
- H. Winnett Orr, a US Army surgeon who developed an orthopedic cast
References
External links
- Fraktur and Dislokasi Kompendium Orthopedic Trauma Association
- Official information on orthopedic surgery American Association of Orthopedic Surgeons (AAOS)
- Fracture Radiographic Atlas
Source of the article : Wikipedia
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