Orthopedic Fractures

In orthopedic medicine, fractures are classified as closed or open (compound) and simple or multi-fragmentary (formerly comminuted).

Closed fractures are those in which the skin is intact, while open (compound) fractures involve wounds that communicate with the fracture and may expose bone to contamination. Open injuries carry an elevated risk of infection; they require antibiotic treatment and usually urgent surgical treatment (debridement). This involves removal of all dirt, contamination, and dead tissue.

Simple fractures are fractures that only occur along one line, splitting the bone into two pieces, while multi-fragmentary fractures involve the bone splitting into multiple pieces. A simple, closed fracture is much easier to treat and has a much better prognosis than an open, contaminated fracture. Other considerations in fracture care are displacement (fracture gap) and angulation. If angulation or displacement is large, reduction (manipulation) of the bone may be required and, in adults, frequently requires surgical care. These injuries may take longer to heal than injuries without displacement or angulation.

Another type of bone fracture is a compression fracture. An example of a compression fracture is when the front portion of a vertebra in the spine collapses due to osteoporosis, a medical condition which causes bones to become brittle and susceptible to fracture (with or without trauma).

Other types of fracture are:
• Complete Fracture - A fracture in which bone fragments separate completely.
• Incomplete Fracture - A fracture in which the bone fragments are still partially joined.
• Linear Fracture - A fracture that is parallel to the bone's long axis.
• Transverse Fracture - A fracture that is at a right angle to the bone's long axis.
• Oblique Fracture - A fracture that is diagonal to a bone's long axis.
• Compression Fracture - A fracture that usually occurs in the vertebrae.
• Spiral Fracture - A fracture where at least one part of the bone has been twisted.
• Comminuted Fracture - A fracture causing many fragments.
• Compacted Fracture - A fracture caused when bone fragments are driven into each other
• Open Fracture - A fracture when the bone reaches the skin

Source: http://en.wikipedia.org/wiki/Bone_fracture

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Complications & Prevention

Complications:
A compound fracture can lead to infection of the bone or bone marrow. In some cases this infection can progress to a chronic infection called osteomyelitis, requiring treatment with antibiotics and careful management in hospital.

If the bones in a fracture refuse to join up again, or if they take a particularly long time to do so, the bone may lose its blood supply and die. This is known as avascular necrosis. In some cases, surgery may be needed if the fracture refuses to join up.

Fractures near or through joints may result in the joint becoming permanently stiff or unable to bend properly.

Prevention:
To grow, develop and maintain healthy bones, it is important that you have enough calcium in your diet. Good sources of calcium include milk, cheese and yoghurt. Vitamin D helps the body to absorb calcium - you can find it in margarine and oily fish.

Because of the way bones are made, they get stronger and denser with regular exercise. It is particularly important that older people remain active, as this will help to reduce their risk of fractures.

The female hormone oestrogen regulates the use of calcium in a woman's body. After the menopause, women produce far less oestrogen, making calcium regulation more difficult. This means that it is particularly important that women make their bones as strong as possible before the menopause.

Source: http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=166&sectionId=6

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Complications

Many potential complications are related not only to wearing a cast but also to the healing of the underlying fracture.

Immediate complications

- Compartment syndrome

Compartment syndrome is a very serious complication that can happen because of a tight cast or a rigid cast that restricts severe swelling.

Compartment syndrome happens when pressure builds within a closed space that cannot be released. This elevated pressure can cause damage to the structures inside that closed space or compartment—in this case, the muscles, nerves, blood vessels, and other tissues under the cast.

This syndrome can cause permanent and irreversible damage if it is not discovered and corrected in time.

Signs of compartment syndrome

Severe pain
Numbness or tingling
Cold, pale, or blue-colored skin
Difficulty moving the joint or fingers and toes below the affected area.

If any of these symptoms occur, call the doctor right away. The cast may need to be loosened or replaced.

A pressure sore or cast sore can develop on the skin under the cast from excessive pressure by a cast that is too tight or poorly fitted.

Delayed complications

- Healing problems


Malunion: The fracture may heal incorrectly and leave a deformity in the bone at the site of the break. (Union is the term used to describe the healing of a fracture.)

Nonunion: The edges of the broken bone may not come together and heal properly.

Delayed union: The fracture may take longer to heal than is usual or expected for a particular type of fracture.

Children are at risk for a growth disturbance if their fracture goes through a growth plate. The bone may not grow evenly, causing a deformity, or it may not grow any further, causing one limb to be shorter than the other.

Arthritis may eventually result from fractures that involve a joint. This happens because joint surfaces are covered by cartilage, which does not heal as easily or as well as bone. Cartilage may also be permanently damaged at the time of the original injury.

Source: http://www.emedicinehealth.com/cast_care/page7_em.htm