FRACTURE

DANIELLE G. DEVILLERES, PTRP

DEFINITION
Any

break in the continuity of the

bone
Used interchangeably with the
term broken bone

CLASSIFICATION
ACCORDING TO SOFT TISSUE
INVOLVEMENT
OPEN

(COMPOUND) FRACTURE

Fracture with communication to outside

environment
CLOSED

FRACTURE

Fracture without communication to

outside environment

CLASSIFICATION
ACCORDING TO MECHANISM
PATHOLOGIC

FRACTURE

Fracture caused by pre-existing

illness
STRESS

FRACTURE

Fracture caused by repeated,

unaccustomed loading and
inadequate muscular support

CLASSIFICATION
ACCORDING TO MECHANISM
TRAUMATIC

FRACTURE

Fx caused by sustained trauma

CLASSIFICATION
ACCORDING TO PATTERN
TRANSVERSE

FRACTURES

Fracture caused by simple

angulatory forces
SPIRAL

FRACTURES

Fracture caused by torsion

CLASSIFICATION
ACCORDING TO PATTERN
OBLIQUE

FRACTURES

Fracture that is diagonal to a bones

long axis
LINEAR

FRACTURES

Fracture that is parallel to the bones

long axis

CLASSIFICATION
ACCORDING TO PATTERN
COMPRESSION/

WEDGE

FRACTURES
Usually in vertebrae
Front portion collapses due to
osteoporosis

CLASSIFICATION
ACCORDING TO PATTERN
IMPACTED

FRACTURE

Fracture caused when bone

fragments are driven into each other
AVULSION

FRACTURE

Fracture where a fragment of bone is

separated from the main mass

CLASSIFICATION
ACCORDING TO FRAGMENTS
INCOMPLETE

Bone fragments are still partially joined

Crack does not completely traverse the
width of bone
COMPLETE

Bone fragments separates completely

CLASSIFICATION
ACCORDING TO FRAGMENTS
COMMINUTED

FRACTURES

Fracture where bone is broken into 3

or more fragments

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Skull

Fracture

Mandibular Fx
Nasal Fx
Basilar Skull Fx

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Spinal

Fracture

Jeffersons Fx
Fracture of C1

Hangmans Fx
Fracture of C2

CLASSIFICATION
ACCORDING TO ANATOMICAL LOCATION
Spinal

Fracture

Flexion Teardrop Fx
Fx of the anteroinferior aspect of a cervical
vertebrae

Clayshovelers Fx
Fx through the spinous process of a vertebra
occuring at any lower cervical or upper thoracic

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Spinal

Fracture

Chance Fx
Compression injury to the anterior portion
of the verbetral body with concomitant
distraction injury to posterior elements

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Spinal

Fracture

Dens (Odontoid) Fx
Type I avulsion fx at tip of dens at site of
alar ligaments
Type II fx at base of dens without
extension to body of C2
Type III fx at body of C2 not involving the
dens

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Rib

Fracture
Sternal Fracture
Shoulder Fracture
Clavicular Fx
Scapular Fx

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Arm

Fracture

Humerus
Supracondylar Fx

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Arm

Fracture

Forearm
Ulnar
Monteggia Fx
Fx of the proximal third of the ulna
With dislocation of the head of the radius

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Arm

Fracture

Forearm
Radius
Galeazzi Fx
Fx of the radius
Dislocation of the distal radioulnar joint

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Arm

Fracture

Forearm
Radius
Colles Fx
Distal fx of the radius
Dorsal (posterior) displacement of the wrist
and hand

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Arm

Fracture

Forearm
Radius
Smiths Fx
Distal fx of the radius
Volar (ventral) displacement of the wrist and
hand

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Arm

Fracture

Forearm
Radius
Bartons Fx
Intra articular fx of the distal radius
Dislocation of the radiocarpal joint

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Arm

Fracture

Hand
Scaphoid Fx
Rolando Fx
Comminuted intra articular fx through the base
of the 1st MC bone

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Arm

Fracture

Hand
Bennetts Fx
Fx of the base of the 1st MC bone with extends
into the CMC joint

Boxers Fx
Fracture at the neck of a metacarpal

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Pelvic

Fracture

Hip bone
Duverney Fx
Isolated pelvic fx involving the iliac wing

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Femoral

Fracture

Hip fracture ( femur bone and not

the hip )

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Patella

Fracture

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Crus

Fracture

Tibia
Bumper Fx
Fx of the lateral tibial plateau
Caused by forced valgus applied to the knee

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Crus

Fracture

Tibia
Segond Fx
Avulsion fx of the lateral tibial condyle
Gosselin Fx
Fractures of the tibial plateau into anterior and
posterior fragments

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Crus

Fracture

Tibia
Toddlers Fx
Undisplaced and spiral fracture of the distal
third to distal half of tibia

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Crus

Fracture

Fibula
Maisonneuve Fx
Spiral fx of the proximal third of the fibula
Asso. With a tear of the distal tibiofibular
syndesmosis and the interosseous membrane

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Combined

Tibia and Fibula

Fracture
Trimalleolar Fx
Involving lateral malleolus, medial
malleolus and the distal posterior aspect
of tiba

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Combined

Tibia and Fibula

Fracture
Bimalleolar Fx
Involving lateral malleolus and medial
malleolus

Potts Fx

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Foot

Fracture

Lisfranc Fx
One or all MT are displaced from tarsus

Jones Fx
Fx of the proximal end of the 5th MT

CLASSIFICATION
ACCORDING TO ANATOMICAL
LOCATION
Foot

Fracture

March Fx
Fx of the distal 3rd of one of the MT due to
recurrent stress

Calcaneal Fx

CLASSIFICATION
PEDIATRIC CLASSIFICATION
Greenstick (Torus)
Incomplete
Occurs on flexible bones
Bends and fractures only outer edge
Epiphyseal

Fx located at site of epiphysis

Sometimes with associated
dislocation

GUSTILO ANDERSON
CLASSIFICATION (OPEN FX)
TYPE

Wound : <1cm
No contamination
Minimal soft tissue injury
TYPE

II

Wound : 1-10 cm
Mild contamination
Extensive soft tissue damage
Minimal to moderate crushing component

GUSTILO ANDERSON
CLASSIFICATION (OPEN FX)
TYPE

III A

Wound : >10cm
Severe contamination
Severe crushing component
TYPE

III B

Wound : >10cm
Severe contamination
Severe loss of tissues

GUSTILO ANDERSON
CLASSIFICATION (OPEN FX)
TYPE

III C

Wound : >10cm
Severe contamination
Neurovascular injury

SALTER AND HARRIS CLASSIFICATION

(EPIPHYSEAL PLATE FRACTURE IN
CHILDREN
TYPE

Fx only on the cartilage plate

TYPE

II

Plate + triangular segment of the

metaphysis
TYPE

III

Fx traverses the bony epiphysis and

involves the cartilage plate

SALTER AND HARRIS CLASSIFICATION

(EPIPHYSEAL PLATE FRACTURE IN
CHILDREN
TYPE

IV

Epiphysis + growth plate +

metaphysis
Often causes growth arrest
TYPE

Not apparent on xray

Crushing of part of growth plate

DIAGNOSIS
HISTORY

Details of accident
to know type of forces involved

Time and place of injury

Age of patient
History of pain or deformity preceding Fx
In OPEN Fractures
Check for immunization to tetanus

History of recent respiratory infection or

of cardiac and renal difficulties

DIAGNOSIS
PHYSICAL

EXAMINATION

Severely injured patients

Respiratory difficulties
Obstruction produced by edema from soft tissue
injury about the face and neck
Foreign bodies
Accumulated secretions in respiratory tract

DIAGNOSIS
PHYSICAL

EXAMINATION

Severely injured patients

Acute hemorrhage
Obvious if external
Venous bleeding can usually be controlled by
direct pressure through a sterile dressing placed
in wound
Mild arterial bleeding can be controlled in same
manner
Larger arterial bleeding needs clamping in the
ER

DIAGNOSIS
PHYSICAL

EXAMINATION

Severely injured patients

Shock

Manifested by cold and clammy skin

Rapid and thready pulse
Lowered blood pressure
Result of blood loss
Also a result of burns, crush injury,
overwhelming bacterial infection, and toxic
conditions

DIAGNOSIS
PHYSICAL

EXAMINATION

(Detailed)
1st step

Observation
Lacerations
Abrasions
Swelling
Deformity

DIAGNOSIS
PHYSICAL

EXAMINATION

(Detailed)
2nd step

Palpation
Tenderness
Induration
Deformity
Skull and jaw cervical spine clavicles
SC and AC joint shoulder humerus
elbow wrist and hand

DIAGNOSIS
PHYSICAL

EXAMINATION

(Detailed)
2nd step
Rib cage and sternum thoracic and
lumbar spine sacrum and SI joints
ischial tuberosities
Iliac crests trochanters pubis
thigh patella knee tibia ankle
and foot toes

DIAGNOSIS
PHYSICAL

EXAMINATION

(Detailed)
2nd step
Circulation is evaluated
Temperature
Color changes
Pulse

Cranial nerve function

Mouth
Eyes
Ears

DIAGNOSIS
PHYSICAL

EXAMINATION

(Detailed)
2nd step
Auscultation of chest
Palpation of abdomen

DIAGNOSIS
PHYSICAL

EXAMINATION

(Detailed)
3rd step
Focus on injured area
Swelling
Deformities
Angulation
Shortening
Rotation

Check circulation distal to Fx site

BONE HEALING
Proliferative

physiological
process in which the body
facilitates the repair of a bone
fracture

BONE HEALING
Reactive

Phase

Inflammatory phase
Presence of blood cells within the tissues
adjacent to injury

Granulation tissue formation

Blood vessels constrict
Hematoma or blood clot is formed (cells
within the blood clot and cells adjacent to the
injury site dies)
Fibroblasts survive and replicate = forms the
granulation tissue

BONE HEALING
Reparative

Phase

Cartilage callus formation

Cells of periosteum replicate and transform
Periosteal cells proximal to the fracture gap
develop into chondroblasts (form hyaline
cartilage)
Periosteal cells distal to the fracture gap
develop into osteoblasts (develop woven
bone)
Fibroblasts within granulation tissue
develop into chondroblasts

BONE HEALING
Reparative

Phase

Cartilage callus formation

These 2 new tissues grow until they unite
with their counterparts from other parts
of the fracture
Formation of FRACTURE CALLUS

BONE HEALING
Reparative

Phase

Lamellar bone deposition

Replacement of hyaline and woven bone
into lamellar bone
Woven bone = Bony substitution
Hyaline cartilage = Endochondral
ossification
Begins soon after the collagen matrix of
either tissue becomes mineralized
Mineralized matrix is penetrated by
channels, each containing a microvessel and
numerous osteoblasts

BONE HEALING
Reparative

Phase

Lamellar bone deposition

Osteoblasts form new lamellar bone in
the form of trabecullar bone
Eventually all of the woven bone and
cartilage becomes trabecullar bone

BONE HEALING
Remodelling

Phase

Substitutes the trabecullar bone with

compact bone
Takes 3 to 5 years depending on
many factors

BONE HEALING
Complications

of Wound Healing

Delayed union
3-4 months after injury
Poor blood supply or infection

Non-union
>6 months after injury
Bone loss or wound contamination

Malunion
Improper immobilization

FACTORS THAT INFLUENCE

HEALING

Factor
s
Age,
years

Ideal

Problematic

Youth

Advanced age (>40 y)

Comorbid
None
ities

Multiple medical comorbidities (eg,

diabetes)

Medicatio
ns

None

Nonsteroidal anti-inflammatory drugs

(NSAIDs), corticosteroids

Social
factor

Nonsmoker

Smoker

Nutrition

Well nourished

Poor nutrition

Fracture
type

Closed fracture,
neurovascularly
intact

Open fracture with poor blood supply

Trauma

Single limb

Multiple traumatic injuries

Local
factors

No infection

Local infection

PRINCIPLES OF FRACTURE
TREATMENT
REDUCTION
MAINTENANCE

OF REDUCTION
PRESERVATOIN/ RESTORATION OF
FXN

PRINCIPLES OF FRACTURE
TREATMENT
REDUCTION

By manipulation
MC

By traction
Applied over a period of several hours or
days
Commonly applied for femoral shaft fx
and cervical spine injuries

PRINCIPLES OF FRACTURE
TREATMENT
REDUCTION

By surgery
Fragments caught in soft tissue
Internal fixation is anticipated

PRINCIPLES OF FRACTURE
TREATMENT
MAINTENANCE

OF REDUCTION

By external fixation
Casts
Splints = MC is POP

By traction
Skin traction
<5/6 lbs. pull required
BUCKS EXTENSION
RUSSELLS TRACTION children with femoral
shaft fx

PRINCIPLES OF FRACTURE
TREATMENT
MAINTENANCE

OF REDUCTION

By traction
Skeletal traction

20-30 lbs. pull

Drilling pin/wire
STEINMANN PIN
KIRSCHNER WIRE
HALO BRACE - cervical

PRINCIPLES OF FRACTURE
TREATMENT
MAINTENANCE

OF REDUCTION

By internal fixation
Metal plates
Rods/screws
TRANSFIXION SCREW oblique fx tibial
shaft
BONE PLATE fastened by screws
INTERMEDULLARY ROD/NAIL

PRINCIPLES OF FRACTURE
TREATMENT
PRESERVATION/RESTORATION

OF

FX
Physical Therapy techniques
PHYSIOTHERAPY MANAGEMENT fx.pp
tx