Pathology and healing of fractures

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1. Initial definitions: Fracture: A fracture is present when there is loss of continuity in the substance of a hone. The term covers all bony disruptions, ranging from the situation when ( I ) a bone is broken into many fragments (multifragmentary or comminuted fracture) to (2) hairline and even microscopic fractures. To the layman the word 'fracture' implies a more severe injury than a simple break in the bone, but in the strict medical sense there is no difference between these terms.

2. Open fracture: All fractures are either c losed or open. In an open fracture there is a wound in continuity with the fracture, and the potential exists for organisms to enter the fracture site from outside. All open fractures therefore carry the risk of becoming infcctcd. In addition, blood loss from external haemorrhage may be significant. (Note: the term 'compound' is still frequently used to describe a fracture which is open: the term 'simple', to describe a closed fracture, may lead to confusion, and is now largely abandoned.)

3. Closed fracture: In a closed fracture the skin is either intact, or if there are any wounds these are superficial or unrelated to the fracture. So long as the skin is intact, there is no risk of infection from outside (blood-borne infection of closed fractures being extremely rare). Any haemorrhage is internal.

Fracture BorneHow Simple Skull Fracture HealsHow Simple Skull Fracture Heals

4. Dislocation: In a dislocation there is complete loss of congruity between the articulating surfaces of a joint. The bones taking part in the articulation are displaced relative to one another. For example, in a dislocated shoulder the head of the humerus loses all contact with the glenoid; in the common anterior dislocation, the head of the humerus is displaced anteriorly.

5. Subluxation: In a subluxation, the articulating surfaces of a joint arc no longer congruous, but loss of contact is incomplete. The term is often used to describe the early stages in a condition which may proceed to complete dislocation (e.g. in a joint infection or in rheumatoid arthritis).

6. Sprain: A sprain is an incomplete tear of a ligament or complex of ligaments responsible for the stability of a joint, e.g. a sprain of the ankle is a partial tear of the external ligament and is not associated with instability (as distinct from a complete tear). The tenu sprain is also applied to incomplete tears of musclcs and tendons.

Fall The Point ElbowDirect Violence FractureDirect Fracture

8. Direct violence (b): A bono- may also he fractured if it forcibly strikes a resistant object. For example, a fall on the point of the elbow may fracture the olecranon.

7. Causes of fracture: Direct violence (a): Fractures are caused by the application of stresses which exceed the limits of strength of a bone. Violence is the commonest cause. In the case of direct violence, a bone may be fractured by being struck by a moving or falling object, e.g. a fracture of the terminal phalanx of a linger by a hammer blow.

with cxccssivc frequency to a bone, may result in fracture. This mechanism is often compared with fatigue in metals which break after repeated bending beyond their elastic limit. The commonest of these fractures involves the second metatarsal the 'march fracture' (so-called because of its frequency in army recruits).

March Fracture

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