What’s the difference between a break and a fracture?
- A fracture is a break in the continuity of a bone.
- It can be caused by direct force, indirect force, repetitive strain or underlying pathology.
Classes Of Fracture
- Simple (closed)
- Compound (open)
A: Simple (closed)
Simple fractures, also called closed fractures, are broken bones that remain within the body and do not penetrate the skin.
B: Compound (open)
Compound fractures, also called open fractures, are broken bones that penetrate through the skin and expose the bone and deep tissues to the exterior environment.
Types Of Fractures
- 1. Slight
- 2. Comminution producing a butterfly fragment
- 3. Severe or highly comminuted
- Fractures involving a joint
Signs & Symptoms
- Severe pain
- Unnatural movement
- Limb shortening
Treatment Of Fractures
- Closed manipulation
- Mechanical traction
- Open reduction
- Plaster of Paris/bay cast
- Screws &plates, pins & nails
Healing Of A Fracture
There are four stages of healing:-
- Haematoma formation
- Granular tissue formation
- Callus formation
- A blood clot is formed between the bone ends.
Granular tissue formation
- Granular tissue is formed on the surfaces and grows together, absorbing the haematoma and forms the first link between the fragments. This occurs within 24 hours.
- After about 7 days cartilage and ostoid tissue are formed on the periosteal and endosteal surfaces and acts as a natural splint
- Callus is reabsorbed as bone is moulded by the osteoclasts and osteoblasts. The surfaces form a firm bony reunion and the bone regains its original shape.
Looking At Radiographs
- Two radiographic projections at right angles to each other
- Ensure the whole area is included on the radiograph e.g spine
- But be prepared to interpret nonstandard projections
- Look for soft tissue swelling as well as bone changes
- Haemarthroses and fluid levels
- Be familiar with normal anatomy
- Identify secondary ossification centres.
- They are numerous and may be mistaken for bony fragments
- Learn when they appear and fuse
- Identify Normal Variants e.g extra segments in long bones, bi-partite patella etc.
- Look at the whole picture!
- The whole film, every film, request card and the patient!
- Do not be fooled by the “satisfaction of search”
- A – Check adequacy of radiographs
- A – Follow alignment of the bones in systematic order
- B – Follow cortical margin of each bone, check for density and trabecular pattern
- C – Check each joint space, uniform in width
- S – Check for swelling, particularly in area of interest