Definition[edit | edit source]A fracture is a discontinuity in a bone (or cartilage) resulting from mechanical forces that exceed the bone's ability to withstand them.[1] Fractures can occur in a variety of methods: Show
Location[edit | edit source]Type of Bone Fractured[2]
Types of Bone Fracture[edit | edit source]In general, there are many different classification systems used for fractures which fall within a set number of patterns:[2]
Pathophysiology of Bone Healing[edit | edit source]The pathophysiological sequence of events that occur following a fracture for bone healing can be divided into three main phases[2][4][5]
Phase 1 - Inflammatory Phase (Hours - Days)[edit | edit source]Immediately at the time of fracture, the space between the ends of the fracture is filled with blood, forming a haematoma. This prevents additional bleeding and provides structural and biochemical support for the influx of inflammatory cells. The inflammatory reaction results in the release of cytokines, growth factors and prostaglandins, all of which are important in healing. The fibroblasts, chondroblasts and the ingrowth of capillaries is then infiltrated by fibrovascular tissue. This forms a matrix for bone formation and primary callus. Phase 1 takes approximately a week, forming a primary callus which is non-mineralized.[2] This is not readily visible on radiography. Phase 2 - Reparative Phase (Days - Weeks)[edit | edit source]Over the next few weeks, this primary callus is transformed into a bony callus by the activation of osteoprogenitor cells. These cells lay down woven bone which stabilises the fracture site. [2] Soft callus is organised and remodelled into hard callus over several weeks. Soft callus is plastic and can easily deform or bend if the fracture is not adequately supported. Hard callus is weaker than normal bone but is better able to withstand external forces and equates to the stage of "clinical union", i.e. the fracture is not tender to palpate or with movement. This can be seen on radiographs within 7-10 days after injury. Phase 3 - Remodelling Phase (Months to Years)[edit | edit source]The remodelling phase is the longest phase and may last several years. [2] This phase represents the gradual formation of compact cortical bone with greater biomechanical properties. This allows for the reduction of the width of the callus. During remodelling, the healed fracture and surrounding callus responds to activity, external forces, functional demands and growth. Bone (external callus) which is no longer needed is removed and the fracture site is smoothened and sculpted. Remodelling can result in almost perfect healing, however, where the alignment of the fracture site is not perfect, a residual deformity may remain.[1] [6] Complications[edit | edit source]Many of the aforementioned fracture types can also go on to have additional complications (and many associated soft tissue injuries). See Fracture Complications
[10] Clinical Features of Fracture[edit | edit source]Clinical features vary depending on the cause of injury, its nature and the patient's level of consciousness. These features are :
When Is Fracture Healed[edit | edit source]The average time for bone healing is about 6-8 weeks, but can varies depending upon many factors; Local Factors
[13] Treatment and Prognosis[edit | edit source]The basics of fracture healing rely on alignment and immobilisation. Alignment may or may not be necessary depending on the degree of displacement, the importance of correct alignment (e.g. index finger vs rib), and the patient (e.g. professional athlete vs debilitated elderly). Immobilisation can be achieved in a variety of ways, depending on the location, morphology of the fracture, and device of fixation
Fixation Devices[edit | edit source]Stress Sharing Devices[edit | edit source]It allows micromotion between the two fractured sites and partial transmission of load. This promotes secondary bone healing with callus formation (a relatively rapid bone healing). For example; intramedullary nail, casts, and rods. Stress Shielding Devices[edit | edit source]The stress at the fracture site is transmitted through the shielding device therefore, there is no motion at the fracture site. This promotes primary bone healing without callus formation (slower than the healing with callus formation). For example; compression plate[14][15]. Role of Physiotherapy[edit | edit source]The physiotherapist’s role is to identify the root cause of the problem and select appropriate treatment techniques to help patients return to their desired activities of daily living. As with any physiotherapy session, conducting a patient assessment is crucial. The problem-oriented medical record (POMR) system is based on a data collection system that incorporates the acronym SOAP:
The treatment provided is largely dependent on the problems identified during your initial assessment. may include a mixture of the following: Examples of early treatment include;
References[edit | edit source]
What structure connects bone ends making joints more stable?Ligaments connect the bones of the joint to each other to keep them stable when you move.
What structures connect bone ends?Tendons may also attach muscles to structures such as the eyeball. A tendon serves to move the bone or structure. A ligament is a fibrous connective tissue that attaches bone to bone, and usually serves to hold structures together and keep them stable.
Which of the following allows for smooth movement of bones surfaces against one another at joints?Smooth cartilage prevents friction as the bones move against one another.
What musculoskeletal injuries benefit from the use of a traction splint?Traction is used to immobilize fractures or dislocations displaced by muscle forces that cannot be adequately controlled with simple splints. The most common indications are vertical shear injuries of the pelvis, unstable hip dislocations, acetabular fractures, and fractures of the proximal femur or femoral shaft.
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