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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | __NOTOC__ |
| | [[File:IMG_20190618_030324.jpg|alt=|right|333x333px]] |
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]'''{{Bone fracture}} |
| | {{CMG}}; {{AE}}[[User:DrMars|Mohammadmain Rezazadehsaatlou[2]]]. |
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| {{Infobox_Disease | | {{SK}} Fracture of bone |
| | Name = {{PAGENAME}}
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| | Image = Broken fixed arm.jpg
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| | Caption = Internal and external views of an arm with a compound fracture, both before and after surgery
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| | DiseasesDB = 4939
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| | ICD10 = {{ICD10|T|14|2|t|08}}
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| | ICD9 = {{ICD9|829}}
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| | ICDO =
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| | OMIM =
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| | MedlinePlus =
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| | eMedicineSubj =
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| | eMedicineTopic =
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| | MeshID = D050723
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| }}
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| {{SI}}
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| {{CMG}}
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| ==Overview== | | ==[[Bone fracture overview|Overview]]== |
| A '''bone fracture''' is a medical condition in which a [[bone]] is cracked or broken. While many fractures are the result of high force impact or [[Stress fracture|stress]], bone fracture can also occur as a result of certain medical conditions that weaken the bones, such as [[osteoporosis]], certain types of [[cancer]] or [[osteogenesis imperfecta]].
| | ==[[Bone fracture historical perspective|Historical Perspective]]== |
| | ==[[Bone fracture classification|Classification]]== |
| | ==[[Bone fracture pathophysiology|Pathophysiology]]== |
| | ==[[Bone fracture causes|Causes]]== |
| | ==[[Bone fracture differential diagnosis|Differentiating Bone fracture from other Diseases]]== |
| | ==[[Bone fracture epidemiology and demographics|Epidemiology and Demographics]]== |
| | ==[[Bone fracture risk factors|Risk Factors]]== |
| | ==[[Bone fracture natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| | ==Diagnosis== |
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| Any type of bone break is a fracture. The word break is not used in a formal orthopaedic terminology.
| | [[Bone fracture history and symptoms|History and Symptoms]] | [[Bone fracture physical examination|Physical Examination]] | [[Bone fracture laboratory findings|Laboratory Findings]] | [[Bone fracture x ray|X Ray]] | [[Bone fracture CT|CT]] | [[Bone fracture MRI|MRI]] | [[Bone fracture ultrasound|Ultrasound]] | [[Bone fracture other imaging findings|Other Imaging Findings]] | [[Bone fracture other diagnostic studies|Other Diagnostic Studies]] |
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| In [[Orthopedic surgery|orthopedic]] [[medicine]], fractures are classified as ''closed'' or ''open'' (compound) and ''simple'' or ''multi-fragmentary'' (formerly ''comminuted'').
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| * Closed fractures are those in which the skin is intact, while open (compound) fractures involve wounds that communicate with the fracture and may expose bone to contamination. Open injuries carry an elevated risk of [[infection]]; they require [[antibiotic]] treatment and usually urgent surgical treatment ([[debridement]]). This involves removal of all dirt, contamination, and dead tissue.
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| * Simple fractures are fractures that only occur along one line, splitting the bone into two pieces, while multi-fragmentary fractures involve the bone splitting into multiple pieces. A simple, closed fracture is much easier to treat and has a much better [[prognosis]] than an open, contaminated fracture. Other considerations in fracture care are displacement (fracture gap) and angulation. If angulation or displacement is large, ''reduction'' (manipulation) of the bone may be required and, in adults, frequently requires surgical care. These injuries may take longer to heal than injuries without displacement or angulation.
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| Another type of bone fracture is a compression fracture. An example of a compression fracture is when the front portion of a [[vertebra]] in the spine collapses due to [[osteoporosis]], a medical condition which causes bones to become brittle and susceptible to fracture (with or without trauma).
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| Other types of fracture are:
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| * Complete Fracture- A fracture in which bone fragments separate completely.
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| * Incomplete Fracture- A fracture in which the bone fragments are still partially joined.
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| * Linear Fracture- A fracture that is parallel to the bone's long axis.
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| * Transverse Fracture- A fracture that is at a right angle to the bone's long axis.
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| * Oblique Fracture- A fracture that is diagonal to a bone's long axis.
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| * Compression Fracture-A fracture that usually occurs in the vertebrae.
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| * Spiral Fracture- A fracture where at least one part of the bone has been twisted.
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| * Comminuted Fracture- A fracture causing many fragments.
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| * Compacted Fracture- A fracture caused when bone fragments are driven into each other
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| * Open Fracture- A fracture when the bone reaches the skin
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| ===OTA classification ===
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| The Orthopaedic Trauma Association, an association for [[Orthopedic surgery|Orthopaedic surgeons]], devised an elaborate classification system to describe the injury accurately and guide treatment.<ref name="pmid8814583">{{cite journal |author= |title=Fracture and dislocation compendium. Orthopaedic Trauma Association Committee for Coding and Classification |journal=J Orthop Trauma |volume=10 Suppl 1 |issue= |pages=v–ix, 1–154 |year=1996 |pmid=8814583 |doi=| url = http://www.ota.org/compendium/intro.pdf | format = pdf | accessdate = 2007-11-28}}</ref><ref>{{cite web | url = http://www.ota.org/compendium/compendium.html | title = Orthopaedic Trauma Association/ Committee for Coding and Classification: Fracture and Dislocation Compendium | accessdate = 2007-11-28 | publisher = Orthopaedic Trauma Association }}</ref> There are five parts to the code:
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| * Bone: Description of a fracture starts by naming the bone
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| ** (1) [[Humerus]]
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| ** (2) [[Radius (bone)|Radius]]/[[Ulna]]
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| ** (3) [[Femur]]
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| ** (4) [[Tibia]]/[[Fibula]]
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| ** (5) [[Vertebral column|Spine]]
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| ** (6) [[Pelvis]]
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| ** (24) [[Carpus]]
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| ** (25) [[Metacarpals]]
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| ** (26) [[Phalanx bones|Phalanx]] (Hand);
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| ** (72) [[Talus bone|Talus]]
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| ** (73) [[Calcaneus]]
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| ** (74) [[Navicular]]
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| ** (75) [[Cuneiform (anatomy)|Cuneiform]]
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| ** (76) [[Cuboid bone|Cuboid]]
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| ** (80) [[LisFranc]]
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| ** (81) [[Metatarsals]]
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| ** (82) [[Phalanx bones|Phalanx]] (Foot);
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| ** (45) [[Patella]]
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| ** (06) [[Clavicle]]
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| ** (09) [[Scapula]]
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| * Location: the part of the bone involved (e.g. shaft of the [[femur]]).
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| ** 1) [[proximal]]
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| ** 2) [[Diaphysis|diaphyseal]]
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| ** 3) [[distal]]
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| * Type: It is important to note whether the fracture is simple or multifragmentary and whether it is closed or open.
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| ** A=simple fracture
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| ** B=wedge fracture
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| ** C=complex fracture
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| * Group: The geometry of the fracture is also described by terms such as transverse, oblique, [[spiral fracture|spiral]], or segmental.
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| * Subgroup: Other features of the fracture are described in terms of displacement, angulation and shortening. A stable fracture is one which is likely to stay in a good (functional) position while it heals; an unstable one is likely to shorten, angulate or rotate before healing and lead to poor function in the long term.
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| ===Other classification systems===
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| There are other systems used to classify different types of bone fractures:
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| * "Neer classification": [[humerus]]<ref name="pmid9155417">{{cite journal |author=Mourad L |title=Neer classification of fractures of the proximal humerus |journal=Orthop Nurs |volume=16 |issue=2 |pages=76 |year=1997 |pmid=9155417 |doi=}}</ref><ref name="titleeMedicine - Proximal Humerus Fractures : Article by Mark Frankle, MD">{{cite web |url=http://www.emedicine.com/orthoped/topic271.htm |title=eMedicine - Proximal Humerus Fractures : Article by Mark Frankle, MD |accessdate=2007-12-15 |format= |work=}}</ref>
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| * "Denis classification": [[Vertebral column|spine]]<ref>{{GPnotebook|1590689797}}</ref>
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| * "Seinsheimer's Classification": [[femur]]<ref name="titleSeinsheimer's Classification of Subtrochanteric Frxs - Wheeless' Textbook of Orthopaedics">{{cite web |url=http://www.wheelessonline.com/ortho/seinsheimers_classification_of_subtrochanteric_frxs |title=Seinsheimer's Classification of Subtrochanteric Frxs - Wheeless' Textbook of Orthopaedics |accessdate=2007-12-15 |format= |work=}}</ref>
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| ==Bone healing==
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| {{main|Bone healing}}
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| The natural process of healing a fracture starts when the injured bone and surrounding tissues bleed. The [[clotting|blood coagulates]] to form a blood [[clot]] situated between the broken fragments. Within a few days [[angiogenesis|blood vessels grow]] into the jelly-like matrix of the blood clot. The new blood vessels bring [[white blood cell]]s to the area, which gradually remove the non-viable material. The blood vessels also bring [[fibroblast]]s in the walls of the vessels and these multiply and produce [[collagen]] fibres. In this way the blood clot is replaced by a matrix of collagen. Collagen's rubbery consistency allows bone fragments to move only a small amount unless severe or persistent force is applied.
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| At this stage, some of the fibroblasts begin to lay down [[bone matrix]] ([[calcium hydroxyapatite]]) in the form of insoluble [[crystal]]s. This mineralization of the collagen matrix stiffens it and transforms it into bone. In fact, bone ''is'' a mineralized collagen matrix; if the mineral is dissolved out of bone, it becomes rubbery. Healing bone [[Fibrocartilage callus|callus]] is on average sufficiently mineralized to show up on [[X-ray]] within 6 weeks in adults and less in children. This initial "woven" bone does not have the strong mechanical properties of mature bone. By a process of remodeling, the woven bone is replaced by mature "lamellar" bone. The whole process can take up to 18 months, but in adults the strength of the healing bone is usually 80% of normal by 3 months after the injury.
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| Several factors can help or hinder the [[bone healing]] process. For example, any form of [[nicotine]] hinders the process of bone healing, and adequate nutrition (including [[calcium]] intake) will help the bone healing process. Weight-bearing stress on bone, after the bone has healed sufficiently to bear the weight, also builds bone strength.
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| <gallery>
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| Image:K-Knie-z2.jpg|X-ray showing a healed [[tibia]] fracture with pins.
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| Image:K-Fuss-z2.jpg|X-ray showing fractured tibia and pinning.
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| </gallery>
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| ==Treatment== | | ==Treatment== |
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| First aid for fractures includes stabilizing the break with a [[splint (medicine)|splint]] in order to prevent movement of the injured part, which could sever [[blood vessel]]s and cause further [[tissue (biology)|tissue]] damage. Waxed cardboard splints are inexpensive, lightweight, waterproof and strong. Compound fractures are treated as open wounds in addition to fractures.
| | [[Bone fracture medical therapy|Medical Therapy]] | [[Bone fracture surgery|Surgery]] | [[Bone fracture primary prevention|Primary Prevention]] | [[Bone fracture secondary prevention|Secondary Prevention]] | [[Bone fracture cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Bone fracture future or investigational therapies|Future or Investigational Therapies]] |
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| At the hospital, closed fractures are diagnosed by taking an [[X-ray]] photograph of the injury.
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| Since [[bone healing]] is a natural process which will most often occur, fracture treatment aims to ensure the best possible ''function'' of the injured part after healing. Bone fractures are typically treated by restoring the fractured pieces of bone to their natural positions (if necessary), and maintaining those positions while the bone heals. To put them back into the natural positions, the doctor often "snaps" the bones back into place. This process is extremely painful without anesthesia, about as painful as breaking the bone itself. To this end, a fractured limb is usually immobilized with a plaster or fiberglass [[Cast (orthopedic)|cast]] which holds the bones in position and immobilizes the joints above and below the fracture. If being treated with surgery, surgical nails, screws, plates and wires are used to hold the fractured bone together more directly. Alternatively, fractured bones may be treated by the [[Ilizarov apparatus|Ilizarov method]] which is a form of external fixator.
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| Occasionally smaller bones, such as [[toes]], may be treated without the cast, by [[buddy wrapping]] them, which serves a similar function to making a cast. By allowing only limited movement, fixation helps preserve anatomical alignment while enabling [[Fibrocartilage callus|callus]] formation, towards the target of achieving union.
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| [[Surgery|Surgical]] methods of treating fractures have their own risks and benefits, but usually surgery is done only if conservative treatment has failed or is very likely to fail. With some fractures such as [[hip fracture]]s (usually caused by [[osteoporosis]] or [[Osteogenesis Imperfecta]]), surgery is offered routinely, because the complications of non-operative treatment include [[deep vein thrombosis]] (DVT) and [[pulmonary embolism]], which are more dangerous than surgery. When a joint surface is damaged by a fracture, surgery is also commonly recommended to make an accurate anatomical reduction and restore the smoothness of the joint. | | ==Case Studies== |
| | [[Bone fracture case study one|Case #1]] |
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| [[Infection]] is especially dangerous in bones, due to their limited blood flow. Bone tissue is predominantly [[extracellular matrix]], rather than living cells, and the few blood vessels needed to support this low metabolism are only able to bring a limited number of [[immune cell]]s to an injury to fight infection. For this reason, open fractures and osteotomies call for very careful [[antiseptic]] procedures and [[prophylactic]] antibiotics.
| | ==Related Chapters== |
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| Sometimes bones are reinforced with metal, but these fracture implants must be designed and installed with care. ''Stress shielding'' occurs when plates or screws carry too large of a portion of the bone's load, causing [[atrophy]]. This problem is reduced, but not eliminated, by the use of low-[[Young's modulus|modulus]] materials, including [[titanium]] and its alloys. The heat generated by the friction of installing hardware can easily accumulate and damage bone tissue, reducing the strength of the connections. If dissimilar metals are installed in contact with one another (i.e., a titanium plate with [[cobalt]]-[[chromium]] alloy or stainless steel screws), galvanic [[corrosion]] will result. The metal [[ion]]s produced can damage the bone locally and may cause systemic effects as well.
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| ==In children==
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| In children, whose bones are still developing, there are risks of either a growth plate injury or a [[greenstick fracture]].
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| * A greenstick fracture occurs because the bone is not as brittle as it would be in an adult, and thus does not completely fracture, but rather exhibits bowing without complete disruption of the bone's [[Cortex (anatomy)|cortex]].
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| * Growth plate injuries, as in [[Salter-Harris fractures]], require careful treatment and accurate reduction to make sure that the bone continues to grow normally.
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| * [[Plasticity (physics)|Plastic deformation]] of the bone, in which the bone permanently bends but does not break, is also possible in children. These injuries may require an [[osteotomy]] (bone cut) to realign the bone if it is fixed and cannot be realigned by closed methods.
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| ==See also==
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| *[[Fibrocartilage callus]] | | *[[Fibrocartilage callus]] |
| *[[Distraction osteogenesis]] | | *[[Distraction osteogenesis]] |
| *[[Rickets]] | | *[[Rickets]] |
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| ==References==
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| {{reflist|2}}
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| {{Fractures}} | | {{Fractures}} |
| {{SIB}}
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| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
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| [[Category:Orthopedic surgery]] | | [[Category:Orthopedic surgery]] |
| [[Category:Orthopedics]] | | [[Category:Orthopedics]] |
| [[Category:Overview complete]]
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| [[ar:كسر عظم]] | | [[ar:كسر عظم]] |
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