COMPLEX FRACTURES

Fractures In Children

Fractures

A fracture is a break, usually in a bone. If the broken bone punctures the skin, it is called an open or compound fracture. Fractures commonly happen because of car accidents, falls, or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Overuse can cause stress fractures, which are very small cracks in the bone.

There are several different ways in which a bone can fracture; for example a clean break to the bone that does not damage surrounding tissue or tear through the skin is known as a closed fracture or a simple fracture.

On the other hand, one that damages surrounding skin or tissue is known as a compound fracture or an open fracture. Compound or open fractures are generally more serious than simple fractures, with a much higher risk of infection.

Symptoms

  • Deformity– the limb looks out of place.
  • Swelling, bruising, or tenderness around the injury.
  • Numbness and tingling.
  • Problems moving a limb.
  • Swelling.
  • Bruising.
  • Discolored skin around the affected area.
  • Angulation – the affected area may be bent at an unusual angle.
  • The patient is unable to put weight on the injured area.
  • The affected bone or joint may have a grating sensation.
  • If it is an open fracture there may be bleeding.
  • Intense pain.

An x-ray can tell if your bone is broken. You may need to wear a cast or splint. Sometimes you need surgery to put in plates, pins or screws to keep the bone in place.

Types Of Fractures

  • Avulsion Fracture – A muscle or ligament pulls on the bone, fracturing it.
  • Comminuted Fracture – The bone is shattered into many pieces.
  • Compression (crush) Fracture – Generally occurs in the spongy bone in the spine. For example, the front portion of a vertebra in the spine may collapse due to osteoporosis.
  • Fracture Dislocation – A joint becomes dislocated, and one of the bones of the joint has a fracture.
  • Hairline Fracture – A partial fracture of the bone. Often this type of fracture is harder to detect.
  • Longitudinal Fracture – The break is along the length of the bone.
  • Oblique Fracture – A fracture that is diagonal to a bone’s long axis.
  • Pathological Fracture – When an underlying disease or condition has already weakened the bone, resulting in a fracture (bone fracture caused by an underlying disease/condition that weakened the bone).
  • Spiral Fracture – A fracture where at least one part of the bone has been twisted.
  • Stress Fracture – More common among athletes. A bone breaks because of repeated stresses and strains.
  • Torus (buckle) Fracture – Bone deforms but does not crack. More common in children. It is painful but stable.

Causes

The majority of fractures are caused by a bad fall or automobile accident. Healthy bones are extremely tough and resilient and can withstand surprisingly powerful impacts. When people enter old age two factors make their risk of fractures greater; weaker bones and a greater risk of falling.

Children, who tend to have more physically active lifestyles than adults, are also prone to fractures.

People with underlying illnesses and conditions that may weaken their bones also have a higher risk of fractures. Examples include osteoporosis, infection, or a tumor. As mentioned earlier, this type of fracture is known as a pathological fracture.

Stress fractures, which result from repeated stresses and strains, commonly found among professional sports people, are also common causes of fractures.

Traumatic incidents such as sporting injuries, vehicle accidents and falls.

Conditions such as osteoporosis and some types of cancer that cause bones to fracture more easily, meaning even minor trauma and falls can become serious.

Treatment

Bone healing is a natural process which in most cases will occur automatically. Fracture treatment is usually aimed at making sure there is the best possible function of the injured part after healing.

For the natural healing process to begin, the ends of the broken bone need to be lined up – this is known as reducing the fracture.

Immobilization – As soon as the bones are aligned they must stay aligned while they heal. This may include:

  • Plaster casts or plastic functional braces – These hold the bone in position until it has healed.
  • Metal plates and screws – Current procedures use minimally invasive techniques.
  • Intra-Medullary Nails – Internal steel rods are placed down the center of long bones. Flexible wires may be used in children.
  • External Fixators – These may be made of metal or carbon fiber; they have steel pins that go into the bone directly through the skin. They are a type of scaffolding outside the body.

Treatment Continued

Physical Therapy – After the bone has healed it may be necessary to restore muscle strength as well as mobility to the affected area. If the fracture occurred near or through a joint there is a risk of permanent stiffness – the individual may not be able to bend that joint as well as before.

Surgery – If there was damage to the skin and soft tissue around the affected bone or joint, plastic surgery may be required.

Ultrasound Therapy – Low-intensity ultrasound is applied daily to the affected area. This has been found to help the fracture to heal. Studies in this area are still ongoing.

Bone Graft – If the fracture does not heal a natural or synthetic bone is transplanted to stimulate the broken bone.

Stem Cell Therapy – Studies are currently underway to see whether stem cells can be used to heal fractures that do not heal.

Complications

Heals in the wrong position – This is known as a malunion; either the fracture heals in the wrong position or it shifts (the fracture itself shifts).

Disruption of bone growth – If a childhood bone fracture affects both ends of bones, there is a risk that the normal development of that bone may be affected, raising the risk of a subsequent deformity.

Persistent bone or bone marrow infection – If there is a break in the skin, as may happen with a compound fracture, bacteria can get in and infect the bone or bone marrow, which can become a persistent infection (osteomyelitis). Patients may need to be hospitalized and treated with antibiotics. Sometimes surgical drainage and curettage is required.

Bone death (avascular necrosis) – If the bone loses its essential supply of blood it may die.

Prevention

Nutrition and sunlight – the human body needs adequate supplies of calcium for healthy bones. Milk, cheese, yogurt and dark green leafy vegetables are good sources of calcium.

Our body needs vitamin D to absorb calcium – exposure to sunlight, as well as eating eggs and oily fish are good ways of getting vitamin D.

Physical activity – the more weight-bearing exercises you do, the stronger and denser your bones will be.

Examples include skipping, walking, running, and dancing – any exercise where the body pulls on the skeleton.

Older age not only results in weaker bones, but often in less physical activity, which further increases the risk of even weaker bones. It is important for people of all ages to stay physically active.

Facts On Fractures

  • Most bone fractures are caused by falls and accidents.
  • Bone fractures caused by disease are referred to as pathological fractures.
  • A compound fracture is one that also causes injury to the overlying skin.
  • Around half of women over 50 years of age will have a fracture.
  • There are a number of different types of fractures, including avulsion, comminuted and hairline fractures.
  • Symptoms of bone fractures include pain, swelling and bruising.
  • Stress fractures resulting from repetitive movements are relatively common.
  • The best way to diagnose a fracture is by X-ray.
  • Bone healing is a natural process, treatment revolves around giving the bone optimum conditions to heal itself.
Fractures In Adults

How does osteoporosis affect my possibility of having a fracture?

It has been estimated that one in every two women and one in four men over age 50 will have an osteoporosis-related fracture. But remember, the upside of osteoporosis is that it is treatable.

What should patients do at home after a hip fracture?

It’s essential to follow your outpatient rehabilitation plan and do your strength and balance training exercises. Building up strength is the key to a successful recovery. A big problem is that  many patients become less active at home because they are afraid of experiencing another fall and fracture.

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