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Bone fractures

Generalities and Causes

By fracture is meant an interruption of the structural integrity of the bone that may be of traumatic or spontaneous (pathological) origin.

In the case of a trauma, the bone fractures when the trauma has such an extent as to overcome the limits of resistance of the bone itself.

Trauma can affect the bone directly or indirectly.

In the first case the bone fractures at the point where the force is applied.

In the case of indirect trauma, the fracture occurs at a certain distance from the point of application of the force, which propagates along the kinetic chain of a limb or vertebral column until it reaches the fracture site.

In both cases the applied forces can be of torsion, of bending, of compression or of tearing. If the bone is undermined by a pathological process (systemic or local), these forces can create a fracture despite being negligible or of modest entity, in these cases we speak of pathological fractures (typical of the elderly, see: OSTEOPOROSIS).

There are also stress fractures or functional overload determined by the repetition of continuous stresses on the bone (a typical example is the marching fracture or of the walkers that affects the second metatarsal).

Fractures can also be caused by an abrupt and violent muscle contraction (avulsion fractures) which results in a bone detachment at the tendon insertion of the muscle itself. This type of fracture is very frequent in young athletes in whom bone mass is not yet well established.

Classification

The classification of fractures is a very vast and complete topic, we will try to summarize in the following points the most frequent and characteristic fractures.

COMPACT FRACTURE (without dislocation of the fragments) / COMPOSITION (with dislocation of the fragments): in relation to the possible displacement of the fractured segments, compound fractures can be distinguished, in which the fracture segments retain their anatomical position, and displaced fractures, in which a fragment shift occurs.

CLOSED / EXPOSED FRACTURE: according to the integrity or not of the skin there are closed fractures (in which the skin remains intact) and exposed fractures with a high risk of infection (in which there is laceration of the skin and external exposure of the bone).

COMPLETE / INCOMPLETE FRACTURE: depending on whether the fracture affects the entire thickness of the bone (complete fracture) or a part of it (incomplete fracture or simple bone infringement).

STABLE / INSTABLE FRACTURE: when deforming forces such as muscle force that prevent mutual contact between the two bone segments take over, this is called an unstable fracture. In these cases the immobility of the fracture with consequent delayed healing will be compromised. Otherwise, in the absence of deforming forces, we speak of a stable fracture.

SIMPLE / MULTIPURPOSE FRACTURES / CURTAIN: based on the number of bone fragments produced. If the fracture creates two distinct bone fragments, it is called simple. If instead it originates numerous fragments it is called pluriframmentale or comminuta fracture (presence of more fracture rhymes).

TRANSVERSE / OBLIQUE / SPIROID / LONGITUDINAL FRACTURES: based on the course and shape of the fracture gap (the fissure separating the two bone fragments) the fractures can be classified into:

  • TRANSVERSE FRACTURES: the fracture gap is placed at right angles to the longitudinal axis of the bone
  • FRATTURE OBLIQUE: the fracture gap forms an angle less than 90 ° with respect to the longitudinal axis of the bone (flute beak fractures)
  • LONGITUDINAL FRACTURES: the fracture gap is parallel to the longitudinal axis of the bone
  • SPIROID FRACTURES: the fracture gap takes a spiral course along the bone segment, wrapping around it.

As we have seen for displaced fractures, fracture-related injuries can be of a muscle, tendon, ligament, vascular, nervous, visceral or cutaneous nature

Symptoms

Fracture symptomatology is characterized by:

  • pain (stimulation of the periosteum sensory endings)
  • reduced motility (more or less broad depending on the site of the fracture and the anatomical position of the single bone)
  • functional impotence (pain and lack of lever arm for muscles)
  • hematoma

Phases of Healing

Healing from a traumatic event that has been fractured proceeds according to the following steps:

  1. hematoma reduction (7-14 days), fracture stabilization, cellular stimulus for the production of new bone structures
  2. temporary production of a soft healing tissue ("granulation tissue"). This phenomenon occurs in a period of time generally between 4 and 16 weeks.
  3. replacement of this tissue with another hard but temporary tissue called "ossification callus"
  4. substitution of the "callus" with a well oriented lamellar bone tissue
  5. the concomitant remodeling phenomenon through which the bone recovers its original shape (1 or more years).

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