PRINCIPLES OF FRACTURES

A fracture is a break in the structural continuity of bone. If the overlying skin remains intact it is
a closed (simple) fracture; if the skin or one of the body cavities is breached it is and open
(compound) fracture, liable to contamination and infection.

How fractures happen?

Fracture result from:
1. Traumatic incident
Most fractures are caused by sudden and excessive force, which may be direct and indirect.
a. With a direct force the bone breaks at the point of impact. The soft tissue also must be
damaged. A direct blow usually causes a transverse fracture and damage to the overlying
skin; crushing is more likely to cause a comminuted fracture with extensive soft-tissue
damage.
b. With an indirect force the bone breaks at a distance from where the force is applied; soft
tissue damage at the fracture site is not inevitable.
Although most fractures are due to a combination (twisting, compression, bending, tension),
the x-ray pattern may suggest the dominant mechanism:
a. Twisting causes a spiral fracture.
b. Compression causes a short oblique fracture.
c. Bending result in fracture with a triangular butterfly fragment.
d. Tension tends to break the bone transversely; however, in some situations it may simply
result in avulsion of a small fragment of bone at the point of ligament or tendon insertion.
2. Fatigue or repetitive stress fractures
Cracks can occur in bone due to a repetitive stress. This is most often seen in the tibia, fibula,
or metatarsal, especially in athletes, dancers and army recruits who go on long route marches.
3. Pathological fractures
Fracture may occur even with normal stresses if the bone has weakened by a change in its
structure (e.g. in osteoporosis and pagets disease) or the presence of a lytic lesion (e.g. bone
cyst or a metastasis).