This document provides an introduction to bone fractures, including definitions, types, and treatment principles. It defines a bone fracture as a break in the structural continuity of bone. There are different types of fractures including complete, incomplete, stress, compression, and physeal fractures. The key principles of fracture treatment are to reduce the fracture by realigning the bone fragments, hold the fragments in place using various immobilization methods like casting or internal/external fixation, and exercise the area as appropriate for healing. Proper treatment helps the bone heal through either callus formation or direct healing of the bone edges.

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.

9. Cont.
• Without-callus (primary healing):
• Cutting cone mechanism.

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.

13. Cont.
3. Open reduction, indications:
• Fail of closed reduction.
• Articular fracture.
• Avulsion fracture.
• Neurovascular injury.
• Pathological fracture.
• Unstable fracture.
• Multiple fractures.
• Poor healing potential.

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.

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.

20. Thank you