A fracture is a break in bone continuity that can be classified by various factors including aetiology (traumatic, fatigue, or pathologic), displacement (undisplaced or displaced), relationship with the external environment (simple or compound), and fracture pattern (complete or incomplete). Traumatic fractures result from direct or indirect forces, while fatigue fractures occur from repeated loading, and pathologic fractures result from underlying diseases like osteoporosis. The document also details different fracture types and patterns, including their causes and characteristics.

1. FRACTURE
VIBHUTI NAUTIYAL
MPT (MUSCULOSKELETAL)

2. INTRODUCTION
 A fracture is a break in the structural continuity of bone.
 It may be no more than a crack, a crumpling or a splintering of the cortex; more
often the break is complete and the bone fragments are displaced
 It can be classified on the basis of aetiology, the relationship of the fracture with
the external environment, the displacement of the fracture, and the pattern of the
fracture
 If the overlying skin remains intact it is a closed (simple) fracture; if the skin or
one of the body cavities is breached it is open (or compound) fracture

4. ON THE BASIS OF AETIOLOGY
1. Traumatic:
a. Direct force:
 The bone breaks at the point of impact
 Subjected to excessive force
 Soft tissues are also damaged
 Usually splits the bone into transversely or bends it over a fulcrum so as to create a
break with a ‘butterfly fragment’
 Damage to the overlying skin is common
 Example: fall, RTA etc

5. b. Indirect force:
 Bone breaks at a distance from where the force is applied
 Soft tissue damage at the site of fracture is not inevitable
 Applies mainly to long bone
 Mechanism:
 Twisting causes a spiral fracture
 Compression causes short oblique fracture
 Bending results in fracture with a triangular ‘butterfly’ fragment
 Tension tends to break the bone transversely

7. 2. Fatigue or stress fracture:
 Occur in normal bone
 Which is subjected to repeated heavy loading
 These high loads create minute deformations that initiate the normal process of remodelling
 When exposure to stress and deformation is repeated and prolonged, resorption occurs faster than
replacement and leaves the area liable to fracture
 Example: athletes, dancers, military and patients with chronic inflammatory disorders who are on
treatment with steroids
3. Pathologic fractures:
 A fracture which has been made weak by some underlying disease
 A trivial or no force may be required to cause such a fracture
 Example: osteoporosis, osteogenesis imperfect, cyst, metastasis

9. ON THE BASIS OF DISPLACEMENT
1. Undisplaced fracture: absence of significant displacement
2. Displaced fracture:
 A fracture may be displaced
 The displacement can be in the form of shift, angulation or rotation
 Factors responsible for displacement:
 Fracturing force
 Muscle pull on the fracture fragment
 gravity

11. ON THE BASIS OF RELATIONSHIP
WITH EXTENRAL ENVIRONMENT
1. Simple fracture:
 Fracture not communicating with the external environment
 Overlying skin and the other soft tissues are intact
 Also known as closed fracture
2. Compound fracture:
 Also known as open fracture
 Break in the overlying skin and soft tissues
 Communicating with the external environment

13. a. Internal compounding:
 Compounding from within
 Sharp fracture end pierces the skin from within
b. External compounding:
 Compounding from without
 Object causing the fracture lacerates the skin and soft tissues over the bone

14. ON THE BASIS OF PATTERN
1. Complete fracture:
 Bone is split into two or more fragments
a. Transverse fracture:
 Fracture line is perpendicular to the long axis of the bone
 Caused by a tapping or bending force
 X- ray: fragments usually remains in place after reduction
b. Oblique fracture:
 Fracture line is oblique
 Caused by a bending force

15.  Has a component along the long axis of the bone
 X- ray: tend to shorten and re- displace even if the bone is splinted
c. Spiral fracture:
 Fracture line runs spirally in more than one plane
 Caused by a primarily twisting force
 X- ray: same as oblique fracture
d. Comminuted fracture:
 Fracture with multiple fragments
 Caused by a compression or crushing force along the long axis of the bone
 X- ray: more than two fragments; unstable

16. e. Segmental fracture:
 Two fractures in one bone
 But at different level
2. Incomplete fracture:
 Bone is incompletely divided
 Periosteum remains in continuity
 Example: greenstick fracture:
 Bone is buckled or bent
 Seen in children
 Bone is more springy than adults

18. FRACTURE DISPLACEMENT
1. Translation (shift):
 Fragments may be shifted forwards, backwards or sideways in relation to each
other
 Fracture will usually unite as long as sufficient contact between surfaces is
achieved
2. Angulation (tilt):
 May be tilted or angulated in relation to other
 Malalignment if in corrected
 May lead to deformity of the limb

19. 3. Rotation (twist):
 One of the fragments may be twisted on its longitudinal axis
 The bone looks straight
 But the limb ends up with a rotational deformity
4. Length:
 The fragments may be separated and distracted
 Or they may overlap, due to muscle spasm
 Causing shortening

21. THANK YOU