Bone fracture Classification and external resources
Internal and external views of an arm with a compound fracture, both before and after surgery
ICD-10	T14.2
ICD-9	829
DiseasesDB	4939
MeSH	D050723

A bone fracture (sometimes abbreviated # or Fx or F_x) is a medical condition in which a bone is cracked or broken. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings S00-T14 - Injury (S00-S09 Head ( Superficial Injury of head ( Superficial injury of The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Bones are rigid organs that form part of the Endoskeleton of Vertebrates They function to move support and protect the various organs of the body produce It is a break in the continuity of the bone. While many fractures are the result of high force impact or stress, bone fracture can also occur as a result of certain medical conditions that weaken the bones, such as osteoporosis, certain types of cancer or osteogenesis imperfecta. An impact force is a high Force or shock applied over a short time period This article is about stress fractures in bones For stress fractures in engineering see Fracture and Fatigue (material. Osteoporosis is a Disease of Bone that leads to an increased risk of fracture. Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled Osteogenesis imperfecta ( OI and sometimes known as Brittle Bone Disease) is a genetic bone disorder Although fractures are commonly referred to as bone breaks, the word break is not part of formal orthopaedic terminology.

Classification systems

Orthopedic

In orthopedic medicine, fractures are classified as closed or open (compound) and simple or multi-fragmentary (formerly comminuted). Orthopedic surgery or orthopedics (also spelled orthopaedics) is the branch of Surgery concerned with injuries to or conditions involving the Medicine is the art and science of healing It encompasses a range of Health care practices evolved to maintain and restore Human Health by the

• Closed fractures are those in which the skin is intact, while open (compound) fractures involve wounds that communicate with the fracture and may expose bone to contamination. Open injuries carry an elevated risk of infection; they require antibiotic treatment and usually urgent surgical treatment (debridement). An infection is the detrimental Colonization of a host Organism by a foreign Species. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa Debridement is a medical term referring to the removal of Dead, damaged or Infected tissue to improve the healing potential of the remaining This involves removal of all dirt, contamination, and dead tissue.

• Simple fractures are fractures that only occur along one line, splitting the bone into two pieces, while multi-fragmentary fractures involve the bone splitting into multiple pieces. A simple, closed fracture is much easier to treat and has a much better prognosis than an open, contaminated fracture. Prognosis (older Greek πρόγνωσις modern Greek πρόγνωση - literally fore-knowing foreseeing) is a medical term denoting the Other considerations in fracture care are displacement (fracture gap) and angulation. If angulation or displacement is large, reduction (manipulation) of the bone may be required and, in adults, frequently requires surgical care. These injuries may take longer to heal than injuries without displacement or angulation.

Another type of bone fracture is a compression fracture. An example of a compression fracture is when the front portion of a vertebra in the spine collapses due to osteoporosis, a medical condition which causes bones to become brittle and susceptible to fracture (with or without trauma). A vertebra (plural vertebrae) is an individual Irregular bone in the spinal or Vertebral column ( aka ischis a flexuous and flexible column Osteoporosis is a Disease of Bone that leads to an increased risk of fracture.

Other types of fracture are:

• Complete Fracture- A fracture in which bone fragments separate completely.
• Incomplete Fracture- A fracture in which the bone fragments are still partially joined.
• Linear Fracture- A fracture that is parallel to the bone's long axis.
• Transverse Fracture- A fracture that is at a right angle to the bone's long axis.
• Oblique Fracture- A fracture that is diagonal to a bone's long axis.
• Compression Fracture-A fracture that usually occurs in the vertebrae.
• Spiral Fracture- A fracture where at least one part of the bone has been twisted.
• Comminuted Fracture- A fracture which results in several fragments.
• Compacted Fracture- A fracture caused when bone fragments are driven into each other.
• Open Fracture- A fracture when the bone is in contact with air either by piercing the skin or by severe tissue injury.

OTA classification

The Orthopaedic Trauma Association, an association for Orthopaedic surgeons, devised an elaborate classification system to describe the injury accurately and guide treatment. Orthopedic surgery or orthopedics (also spelled orthopaedics) is the branch of Surgery concerned with injuries to or conditions involving the ^[1][2] There are five parts to the code:

• Bone: Description of a fracture starts by naming the bone
  • (1) Humerus
  • (2) Radius/Ulna
  • (3) Femur
  • (4) Tibia/Fibula
  • (5) Spine
  • (6) Pelvis
  • (24) Carpus
  • (25) Metacarpals
  • (26) Phalanx (Hand);
  • (72) Talus
  • (73) Calcaneus
  • (74) Navicular
  • (75) Cuneiform
  • (76) Cuboid
  • (80) LisFranc
  • (81) Metatarsals
  • (82) Phalanx (Foot);
  • (45) Patella
  • (06) Clavicle
  • (09) Scapula
• Location: the part of the bone involved (e. The humerus is a Long bone in the Arm or Forelimb that runs from the Shoulder to the Elbow. The radius is the Bone of the Forearm that extends from the lateral side of the elbow to the Thumb side of the Wrist. The ulna ( elbow bone) is a long bone prismatic in form placed at the medial side of the Forearm, parallel with the radius. The femur is the thigh bone In Humans, it is the longest, most voluminous and strongest Bone. The tibia, shinbone, or shankbone is the larger and stronger of the two Bones in the Leg below the Knee in vertebrates and connects For other uses see Fibula (disambiguation The fibula or calf bone is a Bone located on the lateral side of the Tibia In Human anatomy, the vertebral column ( backbone or spine) is a column of 34 Vertebrae the Sacrum, Intervertebral The pelvis (pl pelvises or pelves) or pelvic girdle is the irregular bony structure located at the base of the spine (properly known In Tetrapods the carpus is the sole cluster of the Bones in the Wrist between the radius and Ulna and the Metacarpus The metacarpus is the intermediate part of the Hand Skeleton that is located between the Phalanges (bones of the fingers Distally and the The name Phalanx (plural phalanges) is commonly given to the Bones that form Fingers and Toes In Primates such as Humans See Talus for other meanings of the word The talus bone or astragalus of the Ankle joint connects the leg to the foot The calcaneus, or the heel bone is the largest bone of the Human foot. The navicular bone occurs in human and horse anatomy Human anatomy The navicular bone is one of the tarsal bones, found in the Foot. There are three cuneiform Bones in the Human Foot: the Medial cuneiform the Intermediate The cuboid Bone is one of seven tarsal bones Articulations Distally, the Cuboid articulates with the fourth and Fifth The metatarsus consists of the five long Bones of the Foot, which are numbered from the medial side ( ossa metatarsalia I The name Phalanx (plural phalanges) is commonly given to the Bones that form Fingers and Toes In Primates such as Humans The patella or kneecap is a thick triangular Bone which articulates with the Femur and covers and protects the knee joint In Anatomy, the scapula, omo, or shoulder blade, is the Bone that connects the Humerus (arm bone with the Clavicle (collar g. shaft of the femur). The femur is the thigh bone In Humans, it is the longest, most voluminous and strongest Bone.
  • 1) proximal
  • 2) diaphyseal
  • 3) distal
• Type: It is important to note whether the fracture is simple or multifragmentary and whether it is closed or open. In fields of Anatomy, anatomical terms of location are descriptive terms to help identify relative positions or directions within a species The diaphysis is the main or mid section (shaft of a long bone. In fields of Anatomy, anatomical terms of location are descriptive terms to help identify relative positions or directions within a species
  • A=simple fracture
  • B=wedge fracture
  • C=complex fracture
• Group: The geometry of the fracture is also described by terms such as transverse, oblique, spiral, or segmental. A spiral fracture (also called a torsion fracture is a Bone fracture in which the bone has been twisted apart
• Subgroup: Other features of the fracture are described in terms of displacement, angulation and shortening. A stable fracture is one which is likely to stay in a good (functional) position while it heals; an unstable one is likely to shorten, angulate or rotate before healing and lead to poor function in the long term.

Other classification systems

There are other systems used to classify different types of bone fractures:

• "Neer classification": humerus^[3][4]

• "Denis classification": spine^[5]

• "Seinsheimer's Classification": femur^[6]

• "frykmann's classification":radius and ulna

Bone healing

Main article: Bone healing

The natural process of healing a fracture starts when the injured bone and surrounding tissues bleed. The humerus is a Long bone in the Arm or Forelimb that runs from the Shoulder to the Elbow. In Human anatomy, the vertebral column ( backbone or spine) is a column of 34 Vertebrae the Sacrum, Intervertebral The femur is the thigh bone In Humans, it is the longest, most voluminous and strongest Bone. The forearm is the structure on the Upper limb, between the elbow and the Wrist. Bone healing or fracture healing is a proliferative Physiological process in which the body facilitates repair of Bone fractures Physiology The blood coagulates to form a blood clot situated between the broken fragments. Coagulation is a complex process by which Blood forms Clots It is an important part of Hemostasis (the cessation of blood loss from a damaged vessel whereby A thrombus, or blood clot, is the final product of the Blood coagulation step in Hemostasis. Within a few days blood vessels grow into the jelly-like matrix of the blood clot. Angiogenesis is a physiological process involving the growth of new Blood vessels from pre-existing vessels The new blood vessels bring white blood cells to the area, which gradually remove the non-viable material. The blood vessels also bring fibroblasts in the walls of the vessels and these multiply and produce collagen fibres. A fibroblast is a type of cell that synthesizes and maintains the Extracellular matrix of many Animal tissues Collagen is the main Protein of Connective tissue in Animals and the most abundant protein in Mammals making up about 50% of the whole-body protein In this way the blood clot is replaced by a matrix of collagen. Collagen's rubbery consistency allows bone fragments to move only a small amount unless severe or persistent force is applied.

At this stage, some of the fibroblasts begin to lay down bone matrix (calcium hydroxyapatite) in the form of insoluble crystals. The osteon, or Haversian system is the fundamental functional unit of compact bone. Hydroxylapatite, also called hydroxyapatite, is a Mineral. It is a naturally occurring form of calcium Apatite with the formula Ca5(PO43(OH In Materials science, a crystal is a Solid in which the constituent Atoms Molecules or Ions are packed in a regularly ordered repeating This mineralization of the collagen matrix stiffens it and transforms it into bone. In fact, bone is a mineralized collagen matrix; if the mineral is dissolved out of bone, it becomes rubbery. Healing bone callus is on average sufficiently mineralized to show up on X-ray within 6 weeks in adults and less in children. A fibrocartilage callus is a temporary formation of Fibroblasts and Chondroblasts which forms at the area of a Bone fracture as the Bone attempts X-radiation (composed of X-rays) is a form of Electromagnetic radiation. This initial "woven" bone does not have the strong mechanical properties of mature bone. By a process of remodeling, the woven bone is replaced by mature "lamellar" bone. The whole process can take up to 18 months, but in adults the strength of the healing bone is usually 80% of normal by 3 months after the injury.

Several factors can help or hinder the bone healing process. Bone healing or fracture healing is a proliferative Physiological process in which the body facilitates repair of Bone fractures Physiology For example, any form of nicotine hinders the process of bone healing, and adequate nutrition (including calcium intake) will help the bone healing process. Nicotine is an Alkaloid found in the Nightshade family of plants ( Solanaceae) which constitutes approximately 0 Calcium (ˈkælsiəm is the Chemical element with the symbol Ca and Atomic number 20 Weight-bearing stress on bone, after the bone has healed sufficiently to bear the weight, also builds bone strength.

Treatment

X-ray showing a the proximal portion of a fractured tibia with an intramedular nail. The tibia, shinbone, or shankbone is the larger and stronger of the two Bones in the Leg below the Knee in vertebrates and connects

X-ray showing the distal portion of a fractured tibia and intramedular nail.

First aid for fractures includes stabilizing the break with a splint in order to prevent movement of the injured part, which could sever blood vessels and cause further tissue damage. A splint is a medical device for the immobilization of limbs or of the spine. The blood vessels are part of the Circulatory system and function to transport Blood throughout the body Tissue is a cellular organizational level intermediate between cells and a complete organism Waxed cardboard splints are inexpensive, lightweight, waterproof and strong. Compound fractures are treated as open wounds in addition to fractures.

At the hospital, closed fractures are diagnosed by taking an X-ray photograph of the injury. X-radiation (composed of X-rays) is a form of Electromagnetic radiation.

Since bone healing is a natural process which will most often occur, fracture treatment aims to ensure the best possible function of the injured part after healing. Bone healing or fracture healing is a proliferative Physiological process in which the body facilitates repair of Bone fractures Physiology Bone fractures are typically treated by restoring the fractured pieces of bone to their natural positions (if necessary), and maintaining those positions while the bone heals. To put them back into the natural positions, the doctor often "snaps" the bones back into place. This process is extremely painful without anesthesia, about as painful as breaking the bone itself. To this end, a fractured limb is usually immobilized with a plaster or fiberglass cast which holds the bones in position and immobilizes the joints above and below the fracture. The term plaster can refer to plaster of Paris Lime plaster, or Cement plaster. Glass-reinforced plastic ( GRP) is a Composite material or Fiber-reinforced plastic made of a Plastic reinforced by fine fibers An orthopedic cast is a shell frequently made from Plaster, encasing a limb (or in some cases large portions of the body to hold a broken Bone If being treated with surgery, surgical nails, screws, plates and wires are used to hold the fractured bone together more directly. Alternatively, fractured bones may be treated by the Ilizarov method which is a form of external fixator. The Ilizarov apparatus is used in a surgical procedure that can be used to lengthen or reshape limb bones

Occasionally smaller bones, such as toes, may be treated without the cast, by buddy wrapping them, which serves a similar function to making a cast. Toes are the digits of the Foot of an animal Many animal species such as Cats walk on their toes and are described as being Digitigrade Buddy wrapping or buddy taping is the act of bandaging a damaged (particularly a Fractured finger or toe together with a healthy one By allowing only limited movement, fixation helps preserve anatomical alignment while enabling callus formation, towards the target of achieving union. A fibrocartilage callus is a temporary formation of Fibroblasts and Chondroblasts which forms at the area of a Bone fracture as the Bone attempts

Surgical methods of treating fractures have their own risks and benefits, but usually surgery is done only if conservative treatment has failed or is very likely to fail. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental With some fractures such as hip fractures (usually caused by osteoporosis or Osteogenesis Imperfecta), surgery is offered routinely, because the complications of non-operative treatment include deep vein thrombosis (DVT) and pulmonary embolism, which are more dangerous than surgery. A hip fracture is a fracture in the Proximal end of the Femur (the long bone running through the Thigh) near the hip joint. Osteoporosis is a Disease of Bone that leads to an increased risk of fracture. Osteogenesis imperfecta ( OI and sometimes known as Brittle Bone Disease) is a genetic bone disorder In Medicine, deep vein thrombosis (also known as deep-vein thrombosis or deep venous thrombosis and usually abbreviated as DVT) is the formation Pulmonary embolism (PE is a blockage of the Pulmonary artery or one of its branches usually occurring when a venous Thrombus (blood clot from a vein When a joint surface is damaged by a fracture, surgery is also commonly recommended to make an accurate anatomical reduction and restore the smoothness of the joint. Infection is especially dangerous in bones, due to their limited blood flow. An infection is the detrimental Colonization of a host Organism by a foreign Species. Bone tissue is predominantly extracellular matrix, rather than living cells, and the few blood vessels needed to support this low metabolism are only able to bring a limited number of immune cells to an injury to fight infection. In Biology, the extracellular matrix ( ECM) is the Extracellular part of animal tissue that usually provides structural support to the cells For this reason, open fractures and osteotomies call for very careful antiseptic procedures and prophylactic antibiotics. Antiseptics (from Greek αντί - anti, '"against" + σηπτικός - septikos, "putrefactive" are antimicrobial Prophylaxis ( Greek "προφυλάσσω" to guard or prevent beforehand) is any medical or Public health procedure whose purpose

Sometimes bones are reinforced with metal, but these fracture implants must be designed and installed with care. Stress shielding occurs when plates or screws carry too large of a portion of the bone's load, causing atrophy. Stress shielding refers to the reduction in Bone density ( Osteopenia) as a result of removal of normal stress from the bone by an implant (for instance the femoral Atrophy is the partial or complete Wasting away of a part of the Body. This problem is reduced, but not eliminated, by the use of low-modulus materials, including titanium and its alloys. In Solid mechanics, Young's modulus (E is a measure of the Stiffness of an isotropic elastic material Titanium (taɪˈteɪniəm is a Chemical element with the symbol Ti and Atomic number 22 The heat generated by the friction of installing hardware can easily accumulate and damage bone tissue, reducing the strength of the connections. If dissimilar metals are installed in contact with one another (i. e. , a titanium plate with cobalt-chromium alloy or stainless steel screws), galvanic corrosion will result. Cobalt (ˈkoʊbɒlt is a hard lustrous silver-grey Metal, a Chemical element with symbol Co. Chromium (ˈkroʊmiəm is a Chemical element which has the symbol Cr and Atomic number 24 In Metallurgy, stainless steel is defined as a Steel Alloy with a minimum of 11 Corrosion means the breaking down of essential properties in a material due to Chemical reactions with its surroundings The metal ions produced can damage the bone locally and may cause systemic effects as well. An ion is an Atom or Molecule which has lost or gained one or more Valence electrons giving it a positive or negative electrical charge

In children

In children, whose bones are still developing, there are risks of either a growth plate injury or a greenstick fracture. Almost exclusively occurs during infancy and childhoodThe bending of a bone with incomplete fracture involving the convex side only

• A greenstick fracture occurs because the bone is not as brittle as it would be in an adult, and thus does not completely fracture, but rather exhibits bowing without complete disruption of the bone's cortex. In Anatomy and Zoology the cortex ( Latin: "bark" "rind" "shell" or "husk" is the outermost (or "superficial"
• Growth plate injuries, as in Salter-Harris fractures, require careful treatment and accurate reduction to make sure that the bone continues to grow normally. Salter-Harris Fractures: Descriptive terms for fractures affecting the Growth plate of a bone
• Plastic deformation of the bone, in which the bone permanently bends but does not break, is also possible in children. These injuries may require an osteotomy (bone cut) to realign the bone if it is fixed and cannot be realigned by closed methods. An osteotomy is a surgical operation whereby a Bone is cut to shorten lengthen or change its alignment

See also

• Fibrocartilage callus
• Distraction osteogenesis
• Rickets
• Catagmatic
• Greenstick Fracture

References

External links

• First Aid for Fractures - From Wildernessmanuals. com
• Fracture and Dislocation Compendium of the Orthopaedic Trauma Association
• Bone fractures
• Bone fracture Videos
• Long bone fracture and healing