Definition Fracture

The word "break" is commonly used by lay (non-professional) people.

Fractures can occur in any bone of the body.

Among health care professionals, especially bone specialists, such as orthopedic
surgeons, "break" is a much less common term when talking about bones. A crack (not only a
break) in the bone is also known as a fracture. Fractures can occur in any bone in the body. 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.
Most human bones are surprisingly strong and can generally stand up to fairly strong
impacts or forces. However, if that force is too powerful, or there is something wrong with the
bone, it can fracture. The older we get the less force our bones can withstand. Approximately
50% of women and about 20% of men have a fracture after they are 50 years old (Source:
National Health Service, UK). Because children's bones are more elastic, when they do have
fractures they tend to be different. Children also have growth plates at the end of their bones areas of growing bone - which may sometimes be damaged.
A fracture is a broken bone. A bone may be completely fractured or partially fractured in
any number of ways (crosswise, lengthwise, in multiple pieces).

Types of Fractures
Bones are rigid, but they do bend or "give" somewhat when an outside force is applied.
However, if the force is too great, the bones will break, just as a plastic ruler breaks when it is
bent too far. The severity of a fracture usually depends on the force that caused the break. If the
bone's breaking point has been exceeded only slightly, then the bone may crack rather than break
all the way through. If the force is extreme, such as in an automobile crash or a gunshot, the bone
may shatter. If the bone breaks in such a way that bone fragments stick out through the skin, or a
wound penetrates down to the broken bone, the fracture is called an "open" fracture. This type of
fracture is particularly serious because once the skin is broken, infection in both the wound and
the bone can occur.
Common types of fractures include:

Stable fracture. The broken ends of the bone line up and are barely out of place.

Open, compound fracture. The skin may be pierced by the bone or by a blow that
breaks the skin at the time of the fracture. The bone may or may not be visible in the
wound.

Transverse fracture. This type of fracture has a horizontal fracture line.

Oblique fracture. This type of fracture has an angled pattern.

Comminuted fracture. In this type of fracture, the bone shatters into three or more
pieces.

Types of fractures.

Sign and Symptoms of bone fractures

The signs and symptoms of a fracture vary according to which bone is affected, the patient's age
and general health, as well as the severity of the injury. However, they may include some of the
following:

Symptoms of a bone fracture can vary wildly depending on the affected region and severity.

Pain

Swelling

Bruising

Discolored skin around the affected area

Deformity

Angulation - the affected area may be bent at an unusual angle

The patient is unable to put weight on the injured area

The patient cannot move the affected area

The affected bone or joint may have a grating sensation

If it is an open fracture there may be bleeding.

When a large bone is affected, such as the pelvis or femur:

The sufferer may look pale and clammy

There may be dizziness (feeling faint)

Feelings of sickness and nausea.

If possible, do not move a person with a broken bone until a health care professional is present
and can assess the situation and, if required, apply a splint. Obviously, if the patient is in a
dangerous place, such as in the middle of a busy road, one sometimes has to act before the
emergency services arrive.
Pathophysiology
Fractures can heal by two different mechanisms, depending on their position and stability.
Primary or direct healing is possible when an anatomic reduction with compression is
achieved. With primary healing, the modeling occurs internally, and no callus is formed.
Secondary or indirect healing occurs with relative stability when an anatomic reduction is not
achieved or compression is not possible. This type of healing involves the formation of a bony
callus and then subsequent external remodeling to bridge the gap.
The four phases of indirect fracture healing are as follows :

Fracture and inflammatory phase

Granulation tissue/soft callus formation

Hard callus formation, including woven bone creation

Remodeling, including lamellar bone creation

Actual fracture injuries to the bone include insult to the bone marrow, periosteum, and local soft
tissues. The most important stage in fracture healing is the inflammatory phase and subsequent
hematoma formation. It is during this stage that the cellular signaling mechanisms work through
chemotaxis and an inflammatory mechanism to attract the cells necessary to initiate the healing
response.
Within 7 days, the body forms granulation tissue between the fracture fragments. Various
biochemical signaling substances are involved in the formation of the soft callus, which lasts
approximately 2 weeks.
During hard callus formation, cell proliferation and differentiation begin to produce
osteoblasts and chondroblasts in the granulation tissue. The osteoblasts and chondroblasts,
respectively, synthesize the extracellular organic matrices of woven bone and cartilage, and then
the newly formed bone is mineralized. This stage requires 4-16 weeks.
During the fourth stage, the meshlike callus of woven bone is replaced by hard lamellar
bone, which is organized parallel to the axis of the bone. This final stage involves remodeling of
the bone at the site of the healing fracture by various cellular types such as osteoclasts.
Remodeling can take months to years, depending on patient and fracture factors.
Patient factors that influence fracture healing include age, comorbidities, medication use, [social
factors, and nutrition . Other factors that affect fracture healing include the type of fracture,
degree of trauma, systemic and local disease, and infection.
Patients who have poor prognostic factors in terms of fracture healing are at increased risk for
complications of fracture healing such as nonunion (a fracture with no possible chance of
healing), malunion (healing of bone in an unacceptable position in any plane), osteomyelitis, and
chronic pain.
Source :
American Academy of Orthopaedic Surgeons 800/346-AAOS (2267)
http://orthoinfo.aaos.org/topic.cfm?topic=a00139
Nordqvist, C. (2016, April 1). "Fractures: Causes, Symptoms and Diagnosis." Medical News Today.
Retrieved from
http://www.medicalnewstoday.com/articles/173312.php.

Buckley, Richard., 2016. General Principles of Fracture Care. (Online),

http://emedicine.medscape.com/article/1270717-overview#a8