1.4

• Fracture


  A break or disruption in the continuity of a bone

  
• Types of bones


  • Long bones
  • Short bones
  • Flat bones
  • Irregular bones
  • Sesamoid bones
  • Apophysis

  
• Diaphysis


  The shaft or middle portion of a long bone

  
• Metaphysis


  The region between the diaphysis and epiphysis of a long bone

  
• Epiphysis


  The end portion of a long bone

  
• Physis


  The growth plate between the epiphysis and metaphysis
• Loading forces on the body

  • Tension
  • Compression
  • Bending
  • Torsion
• Fractures


  Linked to each of the loading forces
• Tension fracture


  Pulls the bones apart (usually from tendon or ligament)
• Compression fracture


  Bones "squashed" together

  
• Bending fracture


  Bone undergoes angulation

  
• Torsion fracture


  Rotational (twisting) load
• Fracture documentation should contain

  • Name of bone
  • Location
  • Orientation
  • Condition of overlying tissue
  • Description

  
• Transverse fracture


  Perpendicular to long axis of the bone, results from tension force or bending force

  
• Oblique fracture


  Oblique to long axis of a bone, results from twisting force

  
• Spiral fracture


  Results from torsion force
• Longitudinal fracture


  May be described as fracture pattern in reference to long axis, results from axial compression
• Comminuted fracture


  Various names: butterfly fracture, segmental fracture, less common in children
• Closed fracture


  Skin and soft tissues intact
• Open fracture


  Skin is broken, high risk of infection or complications
• Pathologic fracture


  Occur secondary to underlying pathology or disease process
• Avulsion fracture


  Ligament or tendon remains intact with the bone but failure occurs at the bone rather than the soft tissue

  
• Stress fracture


  Occur after repetitive trauma, repeated loading of bone results in ongoing attempted healing response
• Intra-articular fracture


  Fracture that involves the joint surface

  
• Impaction fracture


  Long bone fracture that occurs when bones or fragments driven into each other

  
• Depression fracture


  Type of impaction fracture
• Compression fracture


  Impaction fracture seen in vertebrae

  
• Displacement


  Loss of position
• Angulation


  Loss of alignment, requires minimum 2 views to determine direction
• Non-displaced fracture


  Contact with fracture fragments

  
• Displaced fracture


  Loss of contact between fracture fragments
• Dislocation


  A loss of position by articulating bones when no contact between articulating surfaces
• Subluxation


  Partial contact has been maintained between articulating bones

  
• Anatomical differences in pediatric fractures

  • Growth plates and apophyses in long bones often confused with fractures
  • Increased flexibility of long bones
  • Increased vascularity
  • Thicker periosteum with greater osteoblastic potential

  
• Greenstick fracture


  Breaks the cortex on one side, causes plastic deformation (bending) on opposite side - an incomplete fracture
• Torus (Buckle) fracture


  Bony cortex in the metaphysis is compressed and bulges resulting in a buckling deformity - an incomplete fracture

  
• Epiphyseal/physeal plate fracture


  Disruption or separation of the epiphysis or epiphyseal plate, can cause premature closing of the growth plate and growth abnormalities
• Salter-Harris Classification System


  • Type I - complete separation of epiphyseal plate without a fracture
  • Type II - separation of the epiphysis with a fracture of the metaphysis
  • Type III - fracture of epiphysis extending from the epiphyseal plate through the articular surface
  • Type IV - fracture extending through the joint surface, epiphysis, epiphyseal plate and metaphysis
  • Type V - crushing of the epiphyseal plate
• Primary fracture healing


  Direct bone-to-bone healing without callus formation
• Secondary fracture healing


  Formation of a bony callus and bone remodeling, involves micromotion between fracture fragments to stimulate osteogenesis