1. INTRODUCTION TO
BONE FRACTURE
Suheab A. Maghrabi, MBBS, MSc.
Teaching Assistant, Orthopaedic Department,
College of Medicine, University of Hail,
Hail, Saudi Arabia.
2. Definition
• A bone fracture is a break in
the structural continuity of
bone.
3. Pathology of bone fracture
• Single highly stressful traumatic incident .
• Repetitive stress of normal degree leading to mechanical
failure
• Normal stress acting on an abnormally weakened bone
(pathological fracture).
4. Types of bone fracture
• Complete, two or more fragments
5. Cont.
• Incomplete:
• “Greenstick”, in the pediatric age group.
• Due to thicker periosteum and softer bone.
• Stress fracture
• Compression fracture.
6. Cont.
• Physeal fracture
• Fracture through the physis
(growth plate).
• Need special care.
• Can result in growth arrest.
7. Bone healing
• With-callus (secondary healing):
1. Tissue destruction and hematoma development.
2. Inflammation and cellular proliferation.
3. Callus formation.
• Contains osteoprogenic, osteoclast, osteoblast, and chodroprogenic
cells.
• Development of immature bone (woven).
4. Consolidation.
• Woven bone turn into lamellar bone.
5. Remodeling.
10. Factors affecting bone healing
• Mechanical stability.
• Blood supply.
• Patient general health.
• Age.
11. Principle of fracture treatment
• REDUCE, HOLD, EXERCISE.
• Aim of reduction:
• Adequate apposition.
• Normal alignment.
• Restore length.
12. Cont.
• Reduction methods:
1. Manipulation:
• Minimal displacement, most of children fracture.
• Stages:
• Pulling distal fragment (dis-impaction).
• Reverse the original direction of the deforming force.
• Alignment adjustment.
2. Mechanical traction:
• Either until union or till the operation.
• e.g. Shaft of femur.
14. Cont.
• HOLD.
• Methods:
• Cast/ splint.
• Internal fixation
• wires
• Screws
• Plates and screws
• IM Nail
• External fixation
• Ring and pins.
• Sever soft tissue damage.
• Sever comminuted fracture.
• Pelvic and open fractures.
15.
16.
17.
18. Open fracture
• Bone Fracture with open wound.
• Gastilo classification
• I, less than 1cm, low energy, clean wound.
• II, more than 1cm, medium energy, clean wound.
• III, high energy, extensive soft tissue loss, vascular injury
• IIIA, minimum soft tissue damage
• IIIB, soft tissue damage and periosteal stripping.
• IIIC, vascular injury
• Treatment
• Wound debridement
• Prophylactic antibiotic
• Stabilization of fracture
• Early definitive wound care.
