

WELCOME
FRACTURE

BY ANUPAMA
Ist year M.Sc. Nursing
BBCON
 Types of fracture

 Open fracture
 Closed fracture
 Complete fracture
 Incomplete fracture
 Comminuted fracture
 a) Open fracture (compound, or
complex fracture)

 Open fracture is one in which the skin or mucous
membrane wound extends to the fractured bone.
Open fractures are graded according
to the following criteria :

 Grade I is a clean wound less than 1cm long.
 Grade II is a larger wound without extensive soft
tissue damage.
 Grade III is highly contaminated ,has extensive soft
tissue damage and is the most severe.
 The outcomes of an open fracture can be
considered in the following way:

 Skin – this can range from a very small wound to
significant tissue loss, whereby coverage will not be
achieved without the aid of plastics surgery (i.e. skin
grafting or a local/free flap)
 Soft tissues – this can also range from very little
tissue devitalisation to significant
muscle/tendon/ligament loss requiring
reconstructive surgery
The outcomes of an open fracture can be
considered in the following way:

 Neurovascular injury – nerves and vessels may be
compressed due to limb deformity, go in to
arteriospasm, develop and intimal dissection or be
transected altogether
 Infection – the rate of infection is very high
following open fracture, due to direct contamination,
reduced vascularity, systemic compromise (such as
following major trauma) and need for insertion of
metalwork for fracture stabilization
 Clinical Features

 Pain
 swelling
 deformity
 with an overlying wound or punctum (in severe
cases, the bone end may be visible protruding from
the wound)
 Treatment of open fracture

 Goals of treatment
1. Preserve life
2. Preserve limb
3. Preserve function
4. Prevent infection
5. Fracture stabilization
6. Soft tissue coverage
 Closed fracture:

 A closed fracture is a broken bone that does not
penetrate the skin.
 most common closed fractures
include:

 Broken Wrist: A wrist fracture is one of the most
common type of fracture that requires medical
treatment. Often closed wrist fractures can be treated
with a cast to hold the healing bones in proper
position. More severe wrist fractures may require
surgery, even when the injury is closed. In these
cases, pins, plates, and screws are commonly used
for treatment.
 most common closed fractures
include:

 Hip Fractures: A broken hip is a type of closed
fracture that can be common in the elderly
population. Almost always these are closed fractures,
as open hip fractures are exceedingly rare injuries.
Despite being a closed fracture, broken hips almost
always require surgical treatment.
 Ankle Fractures: A broken ankle can occur when the
ankle joint is severely twisted in the bone is injured.
Depending on the type and severity of the injury,
surgery may be needed.
 most common closed fractures
include:

 Spinal Compression Fracture: The spinal column is
made of vertebrae stacked upon each other. These
vertebrae can be injured if the bones become thin
from osteoporosis. Spinal compression fractures are
most common in older individuals and often occur
with relatively minor injuries or even no known
injury at all.
 Closed fracture symptoms include
the following:

 Intense pain at the time of injury and when moving
or touching the affected body part.
 A snapping and/or grinding sound.
 Swelling.
 Redness and bruising in the affected area.
 Difficulty supporting weight.
 Visible deformity.
 Treatment

 No Immobilization: Not every fracture requires
intervention. Some broken bones are stable injuries
that can be managed without immobilization or
other intervention. Sometimes a sling or walking
boot may be enough, and other times some simple
reassurance that healing will occur is fine.
 Cast immobilization: Casts are often used for the
treatment of many types of fractures. Casts help to
hold bones in proper alignment and protect the
healing bone
 Treatment

 Internal fixation: Internal fixation is used to realign
broken bones, and then hold the healing bones in
position with metal plates, pins, rods, or screws.
 External Fixation: External fixation is a type of
treatment that can hold bones securely without
having to operate on the surrounding soft tissue.
This treatment is often used when a soft-tissue injury
makes surgery at the site of fracture unsafe.
 Complete fracture

 Bone is split into two or more fragments. The
fracture pattern on x-ray can help predict behavior
after reduction Complete fractures: types
(a) Transverse
(b) Segmental
(c) Spiral
 Transverse Fracture

a) In a transverse fracture the fragments usually remain
in place after reduction
i. A transverse fracture is one that occurs at a 90-degree
angle, straight across the bone. It happens when the
impact comes perpendicular to the site of injury .
ii. Treatment for a Transverse Fracture: The medical
provider will realign the bones through an open
reduction internal fixation (ORIF). Once the bone
fragments are aligned, a traditional cast or splint will
be used to immobilize the bone.
 Oblique Fracture

 An oblique fracture occurs when the bone breaks at
an angle. It tends to occur most often on long bones,
such as the femur or tibia. This type of injury causes
a visible deformity beneath the skin.
 Treatment for an Oblique Fracture: Treatment varies
depending on the severity of the injury. If it’s a
minor fracture, conservative treatment (such as
immobilizing the bone with a cast) will suffice.
However, there are instances when the bones need to
be realigned and surgery is required.
 Spiral fracture

 This happens when a bone is wrenched by the forceful
rotation or twisting of a limb. It results in a clean break
where the bone completely breaks into two fragments.
 Treatment for a Spiral Fracture: The healing process for a
spiral fracture is more complicated than other types of
fractures because the twisting motion results in jagged
edges on the bone. Surgery is required in most cases to
realign the bones and set them back in place with screws,
pins or rods. Post-surgery the patient will wear a cast and
undergo physical therapy before returning to their
regular activities.
 Incomplete fracture

 The bone is incompletely divided and the
periosteum remains in continuity.
 Greenstick fracture

 bone is buckled or bent – Mainly seen in children,
because of their springy bones – Plastically deformed
bones Greenstick Fracture
 In a Greenstick fracture, a portion of the bone breaks
but not completely through. The injured bone may also
bend near the broken portion. This type of injury is
most common in children.
 Treatment for a Greenstick Fracture: If the bone is bent,
the doctor will manually straighten it. And the patient
can wear a removable splint as opposed to a cast.
 
 Compressed fracture: crumpled cancellous bone –
Seen in adults, mainly in vertebral bodies, calcaneum
and tibial plateau
 Incomplete fractures: buckle or torus and greenstick.
 Hairline Fracture

 A hairline fracture is also known as a stress fracture
and occurs mostly on the legs and feet. It is a result
of repetitive movement and occurs when athletes
suddenly increase the frequency or intensity of
workouts such as running or jogging.
 
 Symptoms include pain when participating in your
sport of choice; pain that subsides when resting;
swelling, tenderness, and bruising.

 Treatment for a Hairline Fracture: The most

important thing you can do to heal a stress fracture is
rest. Take time off from exercising.
 Avulsion Fracture

 An avulsion fracture is a break at the site where bone
attaches to a tendon or ligament. When this happens,
the tendon or ligament pulls off a part of the bone it’s
attached to.
 Treatment for an Avulsion Fracture: Surgery is not
necessary for most avulsion fractures; unless the
detached bone fragment ends up at a significant
distance from the bone. The medical provider will
instruct you to rest and ice the injury and will
recommend specific range of motion exercise
 Pathological Fracture

 Pathological fractures occur when a patient has an
illness that has weakened their bones, such as
osteoporosis, arthritis, osteomyelitis, osteosarcoma,
or metabolic bone disorders.
 Treatment for a Pathological Fracture: Treatment
will depend on the underlying condition that caused
the fracture. If the illness doesn’t affect the bone’s
ability to heal, the patient will only need to wear a
cast to immobilize the limb.
 
5 stages of fracture
healing
 stages

 Stage 1: Hematoma Formation
During the break, blood vessels are damaged as well. This
creates a hematoma: clotted blood that swells inside the bone
tissue.
 Stage 2: Granulation Tissue Formation (Inflammation)
Hours later, the hematoma is reabsorbed while being replaced
by inflammatory molecules. These molecules are your body’s
first line of defense and clean out dead bone and prepare the
fracture site for tissue, cartilage, and bone formation. This
stage is a rebuilding of vessels and cells affected by the
fracture.
stages

 Stage 3: Callus Formation
A soft callus is formed. The callus is made of newly formed
osteoblasts (bone-building cells) and osteoclasts (bone-
resorbing cells), the two types of cells needed for your
natural bone remodeling process. Capillaries and supporting
blood vessels connect into the callus as the rebuilding process
continues.
 
 Stage 4: Consolidation
The new bone built to this point is a softer bone called woven
bone. But during the consolidation stage of healing, a
stronger type of bone called lamellar bone replaces the
woven bone.
 Stage 5: Bone Remodeling
The lamellar bone ultimately fills in the fracture site and
aligns in direction of the external forces on the bone. This
stage can last anywhere from a few months to a few years.
 Immediate complications

 IMMEDIATE
A. Systemic hypovolemic Shock
B. Local injury to major vessels , Muscles and tendons ,
Joints & viscera
 Early complications

 A. Systemic:
 Hypovolemic shock
 ARDS
 Fat embolism
 DVT & pulmonary embolism
 Aseptic traumatic fever
 Septicaemia
 Crush syndrome
B. Local:
 Infection
 Compartment syndrome.
 LATE COMPLICATIONS

A. Related to imperfect union
1. Delayed union
2. Non union
3. Mal union
4. Cross union
B. Others : Avascular necrosis, Shortening , Joint
stiffness , Sudeck’s dystrophy , Osteomyelitis , Ischemic
contracture , Myositis ossificans ,OsteoArthritis
 Surgical management

 Bone Reduction :The entire process of restoring close
apposition and alignment of the fracture fragments.
 Close Reduction :Non-invasive method of restoring
close apposition and alignment of fracture
fragments.
 Close Reduction

Advantages
 Minimal risk of hemorrhage
 Minimal risk of infection
 Minimal requirement for anesthesia
 Relatively cheap
 Required little instrumentation or expertise
 Close Reduction

Disadvantages
• Increased risk of soft tissue damage Poor or
inadequate bone reduction
• Interposition of soft tissue between fragment ends
Does not allow the use of internal immobilization
device
• Higher incidence of non-union or mal-union
 Close Reduction: Techniques

 Manipulation: toggling or angulation Traction,
Counter-traction
 Open Reduction

 Restoration of closed apposition of bone fragments
through skin incision and muscle separation at the
fracture site.
 Open Reduction

Indications:
o Recent fractures in which muscle spasm makes close
reduction difficult
o Intracapscular fracture Delay or non-union fracture
o Application of internal fixation device
o Treatment of misalignment
o Removal of sequestra and internal fixation
 Open Reduction

Advantages
 Allows accurate reduction
 Allows use of internal fixation device to provide
rigid immobilization
 Prevent injury to nerves and blood supply
 Prevents interposition of soft tissue between fracture
ends
 Minimize complications of fracture healing
 Open Reduction

Disadvantages
 Increase risk of infection
 Interference at first stage of bone healing
 Increased risk of anesthesia
 Increased instrumentation and expertise
 Stripping of muscle from periosteum may cause
delayed union
 It is expensive.
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THANK YOU