WHAT IS A FRACTURE?

A fracture is a medical condition that occurs when bone continuity is lost. The vast majority of bone fractures are due to high-energy impact forces or bone stress. A fracture can also occur in certain situations where bone strength is low, such as: osteoporosis, certain cancers, certain situations of osteogenesis imperfecta, in these situations the fracture is known as a pathologic bone fracture.

WHAT IS IMPORTANT TO KNOW ABOUT FRACTURES?

Most fractures are caused by falls and accidents. A fracture of a bone that occurs in a certain condition is called a pathologic bone fracture. An open fracture is a fracture that is associated with integumentary and soft tissue damage. There are several types of fractures, such as:
– avulsion fractures;
– comminuted fractures;
– non-displaced fractures;
Bone healing is a natural process by which new bone is formed between the fractured ends.

TYPES OF FRACTURES

• Avulsion fractures – when a muscle or ligament pulls on the bone, fracturing it;
• Comminuted fractures – when the bone is fragmented into several pieces;
• Compression fractures – occur mainly in the cancellous bone of the vertebrae, for example the front portion of the vertebra may be fractured due to osteoporosis;
• Dislocation/ dislocation fracture – a joint can be dislocated/ dislocated and one of the bones is fractured;
• Greenwood fracture – one side of the bone is fractured and the other is intact – commonly occur in children;
• Incomplete fracture – it is a partial fracture of the bone, most of the time it is visualized with difficulty on X-ray;
• Impacted fractures – when the bone is fractured and one of the bone fragments enters the other bone;
• Intra-articular fractures – when the fracture track reaches the joint surface;
• Longitudinal fractures – when the fracture runs the length of the bone;
• Oblique fractures – fractures on the diagonal of the bone;
• Pathological fractures – which occur in the presence of pre-existing bone damage, such as tumors, osteoporosis;
• Spiral fractures – are caused by twisting of the bone;
• Stress fractures – more common in athletes, the bone breaks due to repetitive stress on a specific area of bone;
• Transverse fracture – a fracture that runs straight through the bone.

WHAT ARE THE SYMPTOMS OF FRACTURES?

The signs and symptoms of a fracture depend on the patient’s age and general condition as well as the severity of the trauma. The most common are:

• pain;
• edema of the affected area;
• change in skin coloration in the affected area;
• limb angulation ;
• the patient is unable to lean on the affected limb;
• the patient cannot move the affected area;
• if it is an open fracture – it may bleed.

WHAT CAUSES FRACTURES?

Most fractures are caused by a fall or road accident.
There are 2 important factors in the production of fractures:
1-bone strength;
2-impact energy.
Associated conditions such as osteoporosis, infections and tumors can cause a decrease in bone strength, and a lower impact energy is required to produce fractures.
The stress fractures that occur in high-performance athletes require repetitive low-intensity trauma, which weakens bone strength and leads to fractures.

DIAGNOSIS AND TREATMENT

The clinical signs of fracture consist of bone crackling, intransmissibility of movements, abnormal movements in the focus, pain on palpation in a fixed point.
For imaging diagnosis we can use a simple X-ray, supplemented in some situations with MRI or CT.
Bone strengthening is a natural bone healing process.
Treatment of fractures consists in ensuring optimal conditions for bone healing. These consist in immobilizing the fracture in the correct position, which is done under anesthesia and can be done without incision, by manipulation or surgery.
Immobilization of the fractured area after its reduction is done with:
– plaster or plastic orthoses and will be maintained until bone consolidation occurs;
– metal plates and screws applied by minimally invasive surgical techniques;
– centromedullary rods – inserted into the medullary canal;
– external fixators – using pins that are inserted through the skin into the bone.
Normally, fractures are immobilized for 2 to 8 weeks, the duration of immobilization depending on the affected bone and the type of fracture.
Strengthening – the healing process involves osteoclasts (bone cells) that remove old, damaged bone tissue and osteoblasts that help form new bone. The bone callus is the new bone that englobes the fractured fragments, appears at the end of each bone fragment, joins with the other for complete regeneration.
In the last stage of healing, bone remodeling occurs to reduce excess callus.