yogabook / pathologie / fracture

fracture

Definition of

Complete or incomplete interruption of the continuity of a bone. Distinguish between open (contact of the bone with the outside world) and covered fractures, further according to course: transverse, longitudinal, oblique, spiral, according to the shape of the gap: Y or T, by number of fragments (single-fragment fractures, i.e. only one split, fragment fractures, up to 3 additional fragments, comminuted fractures, more than three), by position of the fracture ends, by dislocated or not, by localization (shaft fractures, fractures close to the joint, joint fractures), further by complete or incomplete. Fractures are very painful although only the periosteum contains nociceptors. Further pain is caused by bleeding and soft tissue edema(pressure pain).
For fracture healing, see bone/fracture healing

1. open fractures:
   • Grade I: impaling of the skin, insignificant soiling (contamination), simple fracture shape
   • Grade II: severing of the skin, circumscribed skin and soft tissue contusion, moderate contamination, all types of fracture
   • Grade III: Extensive soft tissue destruction, frequent vascular and nerve injury, severe wound contamination, extensive bone fragmentation
   • Grade IV: „Subtotal“ (i.e. incomplete) amputation injury, with less than 1/4 of the soft tissue mantle intact and extensive nerve and blood vessel injuries.
2. Closed fractures:
   • Grade 0: No or insignificant soft tissue injury, indirect force, simple fracture form
   • Grade I: Superficial skin abrasion or contusion due to fragment pressure from the inside, simple to moderate fracture form
   • Grade II: Deep, dirty skin abrasion, contusion due to direct force, imminent compartment syndrom, moderate to severe fracture form
   • Grade III: Extensive skin contusion or destruction of the musculature, subcutaneous decollement (detachment, shearing of the skin from the underlying tissue such as fat or muscle), manifest compartment syndrom, injury to a major vessel
3. By shape:
   • Transverse fracture: Simple, transverse fracture. Often caused by direct force applied to the fixed limb, e.g. by a blood straddle in football.
   • Oblique fracture: Like a transverse fracture, but the fracture line runs at a different angle. The course of the accident is also similar, but with an oblique force.
   • Flexion fracture: Caused by bending of the limb at an edge or direct impact. It can be a transverse fracture, an oblique fracture or a fragmentary fracture (oblique fracture with bending wedge). One example is the so-called parry fracture, in which direct force causes an isolated fracture of the ulna in the shaft area.
   • Spiral or torsion fracture: A fracture line that spirals over a shorter or longer distance. Caused by indirect force (twisting of the fixed limb). Common in alpine skiing.
   • Burst fracture: Occurs in the bony skull. Fracture caused by blunt force. Star-shaped fracture lines, often with indentation of fragments.
   • Compression fracture: Fracture caused by force acting on the longitudinal axis of a bone. Often caused by a fall from a great height.
   • Avulsion fracture („bony avulsion„): sudden increase in tension of a tendon or ligament at the bony attachment, due to the – especially in younger people – higher tensile strength of the tendons and ligaments compared to the bone, a cortical shell or even an entire bone fragment is torn off.
   • Shear fracture
   • Greenstick fracture: type of fracture in children in which the periosteum does not tear. The result is a kink formation like a fresh green twig.
   • Fatigue fracture (fatigue fracture, stress fracture): Fracture caused by constant cyclical loading of a bone; also known as a „march fracture“ on the metatarsal bone.

ICD various

Cause

1. Direct exposure to force
2. Indirect non-local exposure to violence
3. Repeated exposure to microtrauma(fatigue fracture)
4. Inadequate trauma with pre-damaged bone (spontaneous fracture)

Predisposing

1. for spontaneous fracture: osteoporosis, bone tumor, bone metastasis

Diagnosis

1. safe signs
2. uncertain characters

The absence of certain signs is not proof of the absence of a fracture!

Symptoms

1. Immediately on breakage: noise
2. Pain at rest
3. marked pain on movement
4. closed: see diagnosis
5. Open: Wound with possibly visible bone fragment

Complications

1. Fat embolism
2. for open fractures: sepsis, osteomyelitis
3. Compartment syndrome
4. Sudeck’s disease with prolonged casting
5. Risk of thrombosiswith plaster cast
6. CRPS
7. Necrosis
8. Infections (especially open fractures)
9. Blood loss up to volume deficiency shock
10. Injury to neighboring structures
11. Pseudoarthrosis (formation of a false joint due to the bone ends not growing together)
12. Bridging callus (additional bone mass that does not conform to the shape, if the fragments do not fit exactly or do not lie against each other, reversible within months or years)
13. ischemic contracture

Therapy

1. Reposition
2. Retention (fixation)
3. Plaster, splinting if necessary
4. Exclusion of the lesion of neighboring nerves