Statistics

• Fractures of extremities most common

Fractures and bone healing
• More common in men up to 45 years of
age
• More common in women over 45 years of
age
• Before 75 years wrist fractures (Colles’)
most common
• After 75 years hip fractures most common

Types of fractures Transverse fracture

• Magnitude and direction of force • Usually caused by directly applied force to
• Closed fracture site
– Bone fragments do not pierce skin
• Open/compound
– Bone fragments pierce skin
• Displaced or undisplaced

Spiral or oblique Greenstick

• Caused by violence transmitted through limb from • Occurs in children: bones soft and bend without
a distance (twisting movements) fracturing completely

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Burst fracture
• Occurs in short bones
e.g. vertebra from
strong direct pressure
such as impaction of
disc.
Fracture dislocation/subluxation
• Fracture involves a
joint: results in mal-
alignment of joint
surfaces.
Crush fractures
• Fracture in cancellous bone: result of
compression (osteoporosis)
Avulsion fracture
• Caused by traction,
bony fragment usually
torn off by a tendon or
ligament.
• What muscle group
attaches to this bony
prominence and what
nerve also runs in
close proximity?
• Forearm flexors
(common flexor
origin)
• ulnar nerve
Impacted fracture
• Bone fragments are
impacted into each
other.
2
 Comminuated fracture
• Two or more bone
pieces - high energy
trauma

Comminuated fractures
can require serious
hardware to repair.

Stress fracture Functions of the x-ray

• Abnormal • Localises fracture and number of fragments
stress on • Indicates degree of displacement
normal bone • Evidence of pre-existing disease in bone
(fatigue
fracture) • Foreign bodies or air in tissues
• or normal • May show other fractures
stress on • MRI, CT or ultrasound to reveal soft tissue
abnormal bone damage
(insufficiency
fracture).

Reduction Holding the reduction

• Manipulation • 4-12 weeks
– Usually with anaesthesia • External fixation
• Traction – Plaster of Paris casts
– Fractures or dislocation requiring slow • Internal fixation
reduction
– Intermedually nails, compression plates
• Open reduction
• Frame fixation
– Allows very accurate reduction
– Risk of infection
– Usually when internal fixation is needed

3
External fixation Frame fixation
Allows correction of deformities
by moving the pins in relation to
Used for fractures that are the frame.
too unstable for a cast.
You can shower and use
the hand gently with the
external fixator in place.

Internal fixation

Bone healing after a fracture

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 Bone Healing
Fracture of the • Fracture
second hematoma
– blood from
metatarsal broken vessels
10th April forms a clot.
– 6-8 hours after
2002 injury
– swelling and
8 weeks to the inflammation to
dead bone cells
start of the at fracture site
World Cup

• Fibrocartilaginous callus
(lasts about 3 weeks (up to
1st May))
– new capillaries organise
fracture hematoma into
granulation tissue - ‘procallus’
– Fibroblasts and osteogenic
cells invade procallus.
– Make collagen fibres which
connect ends together
– Chondroblasts begin to
produce fibrocatilage,

• Bony callus (after 3

weeks and lasts
about 3-4 months
(8th May)
– osteoblasts make
woven bone.

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 • Bone remodelling
– Osteoclasts remodel
woven bone into
compact bone and
trabecular bone
– Often no trace of
fracture line on X-
rays.

England v Argentina 7th June

2002

Wayne Rooney – will he make it? Wayne Rooney – Lisfranc fracture

• The facts
• Fractured the right 4th metatarsal proximally
on 29th April 2006 plus other #’s?
• World cup starts 9th June 2006 England's 1st
match on 10th June, then 15th and 20th June
• Exactly 6 weeks from injury to 1st match
• David Beckham had 8 weeks between his
fractured metatarsal and playing in Japan and
was not fit.
• Latest CT scan Wayne not going to make
group stage, additional scan on 7th June.
• Michael Owen broke his metatarsal on 31st
December and has only just come back after
mal-union of the fracture and a misplaced
screw.

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Wayne Rooney – CT scan ?