Fracture

A break in a bone, usually across its width. There are 2 main types: closed (simple) or open (compound) fractures. In a closed fracture, the broken bone ends remain beneath the skin and little surrounding tissue is damaged; in an open fracture, 1 or both bone ends project through the skin. If the bone ends are not aligned, the fracture is termed “displaced”. Fractures can be further divided according to the pattern of the break, for example, transverse or spiral fractures of long bones. In a greenstick fracture, the break is not through the full width of the bone. This type of fracture occurs only in children because their bones are more pliable. In an avulsion fracture, a small piece of bone is pulled off by a tendon. Most fractures are the result of a fall, but in osteoporosis the bone is weakened, and fractures such as compression fractures of the vertebrae are common. Common sites of fracture include the hand, wrist (see Colles’ fracture), ankle joint, clavicle, and the neck of the femur (see femur, fracture of). There is usually swelling and tenderness at the fracture site. The pain is often severe and is usually made worse by movement. X-rays can confirm a fracture. Because bone begins to heal soon after it has broken, the first aim of treatment is to ensure that the bone ends are aligned. Displaced bone ends are manoeuvred back into position, under general anaesthetic, by manipulation either through the skin or through an incision. The bone is then immobilized. In some cases the ends of the bone may be fixed with metal pins or plates. Most fractures heal without any problems. Healing is sometimes delayed because the blood supply to the affected bone is inadequate (as a result of damaged blood vessels) or because the bone ends are not close enough together. If the fracture fails to unite, internal fixation or a bone graft may be needed. Osteomyelitis is a possible complication of open fractures. (See also Monteggia’s fracture; pelvis; Pott’s fracture; rib, fracture of; skull, fracture of.)