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At risk groups Runners, ballet dancers—fibula, tibia; soldiers—metatarsal bones; jackhammer/pneumatic drill operators—metacarpal bones; office workers—coccyx
fatigue fractureInsufficiency fracture, stress fracture Sports medicine A stress fracture affecting the feet of formerly fit foot soldiers, caused by repeated, relatively 'trivial' trauma to normal bone, resulting in local bone resorption. Cf Flat feet.
fa·tigue frac·ture(fă-tēg' frak'shŭr)
Synonym(s): stress fracture.
fracture(frak'chur) [L. fractura, a break]
Fractures may be due to pathology, direct violence, indirect violence, or muscular contraction. In a pathological fracture, bones break, spontaneously and without trauma, due to certain diseases and conditions like cancer, osteomalacia, syphilis, and osteomyelitis, In a fracture due to direct violence, the bone breaks at the spot where the force was applied, as in fracture of a crushed tibia. In a fracture due to indirect violence, the bone is fractured by a force applied at a distance from the site of fracture and transmitted to the fractured bone, as a fracture of the clavicle by a fall on an outstretched hand. In a fracture due to muscular contraction, the bone breaks from a sudden, violent contraction of the muscles.
Signs include loss of the power of movement, pain with acute tenderness over the site of fracture, swelling and bruising, deformity and possible shortening, unnatural mobility, and crepitus or grating heard when the ends of the bone rub together.
Immediate first aid includes splinting of the fracture site and joints above and below it to limit further movement and displacement. Applying a cold pack to the fracture site and elevating it above the level of the heart may limit pain and swelling. Radiography should be used to identify the fracture and the exact position of the bone fragments.
The physician reduces the fracture. The bone is kept in position by a cast or splint until union has taken place. Afterwards the limb is restored to complete function by physical therapy and exercise.
In open or compound fractures, bleeding must be arrested before the fracture is treated. Initially, the open fracture should be covered with a clean or sterile dressing and the fracture site immobilized. Open reduction may be required. The wound is then washed and cleaned with sterile saline. If the area is grossly contaminated, mild soap solution may be used provided it is thoroughly washed away with generous amounts of sterile saline. When the wound is clean, a sterile dressing is secured by a bandage. The bone may then be immobilized by external fixation until the wound heals.
Skeletal traction may be used instead of a cast or external fixator for certain fractures, such as femoral shaft fractures. Pins are placed in the bone, and the bone ends are held in place by pulleys and weights until union occurs.
If the bone does not heal, a weak electric current applied to the bone ends (bone stimulation) may promote healing. Hip fractures require gentle handling and immobilization to prevent displacement of the fracture, aggravation of bleeding, or disruption of a pelvic hematoma. Open reduction with internal fixation may be required and is performed when the patient is judged to be hemodynamically stable.
CAUTION!First aid for fractures of the spine requires extreme care in moving the patient. Unnecessary or improper movement may injure or even transect the spinal cord. Stabilizing the patient on a rigid board, with full spinal protection, is necessary until x-ray studies reveal the spine is stable.
Vascular and neurological status of the limb distal to the fracture site are monitored before and after immobilization with traction, casting, or fixation devices. Pain is assessed and managed with prescribed analgesics and noninvasive measures. All procedures and related sensations are explained, and reassurance given.
The patient is evaluated for fat embolism after long bone fractures, for infection in open fractures, for excessive blood loss and hypovolemic shock, and for delayed union or nonunion during healing and follow-up. The patient should report signs of impaired circulation (skin coldness, numbness, tingling, discoloration, and changes in mobility) and is taught how to care for the cast or splint and the correct use of assistive devices (slings, crutches, walker). ; illustration
bend fracturePlastic deformation of bone.
Bennett fractureSee: Bennett fracture
blow-out fractureSee: orbital blow-out fracture
buckle fractureTorus fracture.
childhood accidental spiral tibial fractureAbbreviation: CAST
fracture of clavicle
Symptoms include swelling, pain, and protuberance with a sharp depression over the injured bone. Palpable deformity and crepitus are commonly present.
If indicated, an emergency care physician or an orthopedist will reduce the fracture. This usually is done by elevating the arm and lateral fragment so they line up with the medial fragment. The position is maintained by a clavicle strap, spica cast, immobilizing sling, or figure-of-eight wrap between the shoulders and over the back. Healing takes from about 6 to 8 weeks.
A ball of cloth or one or two handkerchiefs are tightly rolled and placed under the armpit. An arm sling is applied and the elbow bandaged to the side, with the hand and forearm extending across the chest. Alternatively, the patient may lie on his or her back on the floor with a rolled-up blanket under the shoulders until medical aid arrives. This position keeps the shoulders back and prevents the broken ends of the bone from rubbing.
clay shoveler's fracture
Colle fractureSee: Colles, Abraham
Dupuytren fractureSee: Dupuytren, Baron Guillaume
Duverney fractureSee: Duverney, Joseph G.
fatigue fractureStress fracture.
Osteoporosis predisposes an elderly person to hip fracture.
Pain in the knee or groin is the classic presenting sign of a hip fracture. If the femur is displaced, shortening and rotation of the leg may be present.
Preoperatively, Buck's traction may be used in the short term to alleviate muscle spasms. An open reduction is the preferred surgical treatment. A femoral prosthesis may be used for femoral neck or head fractures. The bone takes 6 to 12 weeks to heal in an elderly patient.
During hospitalization, general patient care concerns apply. The patient is prepared physically and emotionally for surgery according to the orthopedic surgeon's protocol, and postsurgical care and pain control (epidural or intravenous patient-controlled analgesia [PCA]) is discussed. Neurovascular status of the affected limb is assessed according to protocol and compared to the unaffected limb. The patient is referred for physical and occupational therapy and uses a walker until the bone is completely healed. Prevention and relief of pain and monitoring of postoperative complications, including infection, hip dislocation, and deep venous thrombosis or pulmonary embolism, are primary concerns. Use of an incentive spirometer is encouraged to prevent atelectasis and respiratory complications. Prophylactic antibiotics and anticoagulants are administered as prescribed, and hip precautions are implemented to prevent dislocation. These precautions include having the patient avoid hip adduction (usually by an abductor wedge), rotation, and flexion greater than 90° during transfer and ambulation activities, and by using a raised toilet seat and semi-reclining chair. The patient is typically hospitalized for 2 to 4 days and then discharged to a nursing home, subacute unit, transitional care unit, rehabilitation center, or home for rehabilitation for several weeks.
fracture of humerus
In a fracture of the shaft and lower end of the humerus, the limb is put in a cast in a position midway between pronation and supination with the humerus at right angles to the forearm. Movement of the shoulder, wrist, and finger is allowed.
Jefferson fractureSee: Jefferson fracture
Jones fractureSee: Jones fracture
lead pipe fracture
mid-face fractureLeFort fracture
Monteggia fractureSee: Monteggia fracture
nonunion of fractureSee: nonunion
open fractureCompound fracture.
orbital blow-out fracture
The limbs and joints of at-risk patients are gently and carefully supported when repositioning, exercising, or mobilizing. If such patients fall or are injured, and report limb, pelvic, or back pain or inability to bear weight, the patient and the affected limb should be stabilized and - diagnostic imaging obtained.
Pott fractureSee: Pott, John Percivall
Rolando fractureSee: Rolando fracture
fracture of skull, fractured skull
Smith fractureSee: Smith fracture
fracture of the spine
The patient is carefully assessed for evidence of neuromuscular compromise and other internal injuries. To prevent complications and promote healing, vests, casts, or halo devices may be used, depending on the location of the fracture. A program of supervised physical therapy may be needed during recovery.
Prognosis depends on the type of spinal fracture and associated spinal cord involvement.
vertebral fractureFracture of the spine.
Wagstaffe fractureSee: Wagstaffe fractureillustration
fracturebreakage of bone or cartilage; all fractures are treated by the same principles of rest and immobilization (e.g. internal fixation and/or casting) and pain control (e.g. non-steroidal anti-inflammatory drugs) Table 1
avulsion fracture due to joint capsule, ligament or muscle pulling away from bone, e.g. as in sprain, dislocation or excess muscle contraction; pathological traction of involved soft tissues causes separation of a small area (flake or fleck) of cortical bone
closed fracture bone ends do not penetrate through overlying soft tissues or skin
Colles fracture fracture and dorsal displacement of distal radius
comminuted fracture bone is broken into more than two pieces
compound fracture open fracture
fatigue fracture march fracture
flake fracture avulsion fracture
fleck fracture avulsion fracture
greenstick fracture bending rather than bone breakage, with minimal fracture on outer curve of the bone; typical of a young bone
hairline fracture a very fine fracture line, without fragment separation
longitudinal fracture line of fracture is parallel to long axis of bone
march fracture; stress fracture fracture due to repeated low-grade trauma, classically affecting shaft of second, third or fourth metatarsal; usually begins as a hairline fracture from medial aspect of bone shaft, at a point one-third from head and two-thirds from base of affected metatarsal; tendency to stress fracture is exacerbated by existing bone pathology (e.g. Paget's disease) and/or osteopenia/osteoporosis (i.e. osteopenia of disuse, menopausal osteoporosis, Charcot neuropathy), unaccustomed or strenuous exercise, or subsequent to revascularization of an ischaemic limb (see stress; stress fracture hypothesis; stress fracture symptoms)
neuropathic fracture feature of foot with profound sensory neuropathy and loss of pain response; autonomic dysfunction causes opening of arteriovenous anastomoses (shunts) leading to osteopenia, and imbalance of osteoblast/osteoclast function; presents as a hairline, march/stress fracture; contributes to Charcot joint formation
open fracture bone ends perforate through overlying tissues and skin, creating an open wound, and almost certain subsequent osteomyelitis
osteoporotic fracture fracture of osteoporotic or osteopenic bone
simple fracture closed fracture without bone displacement
spiral fracture fracture line follows a spiral track across bone shaft; caused by longitudinal twist to bone
stress fracture see march fracture
transverse fracture fracture line is at right angles to longitudinal bone axis
|Simple||The affected bone is broken into two (or occasionally more) segments by transverse breaks, e.g. metatarsal fracture|
|Spiral||The fracture line follows a spiral across the bone shaft, e.g. of the distal fibula, in association with a severe inversion injury of the ankle|
|Comminuted||The affected bone is broken into several/many irregular segments, e.g. the calcaneum after a fall from a height|
|Impacted||The bone at the fracture site is compressed together by the jamming force of the impact, e.g. the neck of the fibula after a fall from a height|
|Open/compound||The bone at the fracture site is so displaced as to penetrate through the overlying soft tissue and skin, so that the end of the bone is exposed|
|Complicated||Deep soft tissues/nerves/blood vessels are traumatized by the sharp end of the fractured bone|
|Avulsion||The traumatic force causes local soft-tissue structures (muscle origins, tendon insertions, ligaments, joint capsule) to pull off a section of the cortex to which they are attached, e.g. avulsion fracture of the tuberosity of the fifth metatarsal|
|Stress/overuse||The repeated application of low-level trauma causes eventual fracture of cortical bone, e.g. march fracture of the metatarsal (stress fractures may also affect the sesamoids, styloid process of the fifth metatarsal, calcaneum or tibia)|
|Pathological||The bone fractures due to an underlying pathology, e.g. Ewing's sarcoma, Paget's disease or von Recklinghausen's disease affecting the tibia|
|Greenstick||Incomplete fracture through the affected bone; commonly affecting children|
fa·tigue frac·ture(fă-tēg' frak'shŭr)
Synonym(s): stress fracture.