FRACTURE
Musah Abubakari
INTRODUCTION
• A fracture is a break in the continuity of bone and is defined according
to its type and extent.
• Fracture is a break in any bone in the body.
Causes of fracture
• direct blows
• crushing or indirect forces
• sudden twisting motions
• extreme muscle contractions
• Spontaneous or pathological fractures
Types of fracture
• Complete fracture : a break across the entire cross-section of the
bone.
• An incomplete fracture : the break occurs through only part of the
cross-section of the bone.
• Compound Fracture: A fracture in which the bone is sticking through
the skin.
• Closed fracture: (simple fracture) is one that does not cause a break
in the skin.
• An open fracture (compound, or complex, fracture) is one in which
the skin or mucous membrane wound extends to the fractured bone.
• Greenstick fracture : A fracture in which one side of a bone is broken
while the other is bent (like a green stick).
• Spiral Fracture :A fracture, sometimes called torsion fracture, in
which a bone has been twisted apart.
• Comminuted Fracture :A fracture, in which bone is broken, splintered
or crushed into a number of pieces.
• Transverse Fracture :A fracture, in which the break is across the bone,
at a right angle to the long axis of the bone.
• Compression Fracture A fracture caused by compression, the act of
pressing together. Compression fractures of the vertebrae are
especially common with osteoporosis.
• Avulsion: fracture which occurs when a fragment of bone tears away
from the main mass of bone.
• Depressed: A fracture in which fragments are driven inward (seen
frequently in fractures of skull and facial bones)
Depressed Compression
Avulsion
Clinical manifestations
• pain
• loss of function
• deformity
• shortening
• crepitus
• swelling and
• Discoloration
• Shock in severe fracture
First Aid Management
1. Reassure patient
2. Always control severe bleeding before immobilizing any fractures
3. Place sufficient padding to support fracture site
4. Immobilize fracture sites
5. Do not force bones back into the wound
6. Give proper padding before the patient is shifted to the hospital
7. Apply ice pack on the affected area to reduce pain and control
swelling.
8. Do not apply anything over area of fracture
9.Treat to prevent shock
10. Do not give patient anything orally
11. Transport patient immediately to the hospital
FRACTURE HEALING
• Haematoma formation
• Callus formation
• Callus ossification
• Bone remodelling
FRACTURE HEALING
Haematoma formation:
• Blood from damaged vessels collect between fragments to form
haematoma which hold bone fragments temporally.
• New cells and small blood vessels soon grow into clot and convert
into granulation tissue.
• Callus formation: Bone producing cells invade granulation tissue a
bone like material called callus. It is made up of the Internal callus
which forms between ends of bone fragments and external callus
which forms a collar around the break.
• Callus Ossification: the cartilage in the callus is replaced by woven,
cancellous bone.
Fracture Healing
Bone remodelling:
• osteons from both sides of the break extend across the fracture line
to “peg” the bone fragments together.
• This remodeling process takes time and may not be complete even
after a year.
• As the internal callus is remodelled and becomes stronger, the
external callus is reduced in size by osteoclast activity
Complications of Fractures
• Haemorrhage
• Shock
• Infection
• Tetanus
• Mal-union
• Non –union
• Delayed union
• Deep vein thrombosis
• Pulmonary embolism
• Fat embolus
• Pulmonary thrombosis
• Nerve damage
SPECIFIC FRACTURES
FRACTURE OF THE SKULL
• Fractures relating to bones of the skull
• It is associated with serious injuries related to the brain injuries
• It results in concussion, contusion or compression.
• Victims usually becomes unconscious
• There are 2 fractures affecting the skull namely fracture of the dome
and fracture of the base of the skull
Signs and symptoms
• Vomiting
• Distortion of face
• Speech disorders
• Eye movements
• Bruises
• Blood flow
• Discharge of Cerebrospinal Fluid from nose, ear or mouth
• Bleeding around eyes
First Aid mgt.
• Place patient in supine position
• Elevate head with pillow and turn to one side
• Let patient lie on the opposite side when there is bleeding form ear
• If there is wound on the scalp, trim hair around it and cover the
wound with sterile dressing
Fracture and dislocations of lower jaw
• It involves bones of the mandible(mandible)
• There may be asphyxiation due to loss of control of tongue.
Causes
• Direct blow or trauma
• Dislocations may result from yawing or downward blow on the chin.
Signs and symptoms
• Difficulty in speaking
• Excessive salivation (may be blood stained)
• Irregularity in the line of the teeth
• Airway obstruction
• In dislocations, the mouth may not be able to close
First Aid Mgt.
• Cover wound with clean cloth
• Support broken jaw with a bandage looped under the jaw and over
the top of the head
• Tilt head forward over a bowl as blood and fluid may be falling back
into the throat.
• Keep airway clean
• Put patient in supine position with head turned to one side if
unconscious
• Transport patient the nearest hospital.
SPRAINS, STRAINS AND
DISLOCATION
SPRAINS
• It is a tearing of ligaments of a joint or tissues around the joint
Causes
• Sudden twist
• Slip or wrench
Signs and symptoms
• Bruising at the site of sprain
• Pain (Increases with movement)
• Swelling
Management
• Reassure patient
• Place limb in a comfortable position
• Do not move the limb unnecessarily
• Apply firm bandage to the joint
• Leap the bandage wet with cold water
• Apply ice to the site of sprain
• Transfer to the hospital immediately
STRAINS
• It is the stretching or tearing of muscle and tendon fibres.
Causes
Usually caused by overexertion such as lifting something too heavy or
working a muscle beyond the point of fatigue.
NB: Strains may be distinguished from other musculoskeletal injuries by
their history and location of pain. The history usually indicate an injury
caused by overstretching or movement and will not include a fall or direct
blow.
Signs and symptoms
• Pain located at muscle or tendon
• Swelling
First Aid mgt.
Same as first aid management in strains + ICE for first aid mgt in sprains
Ice or cold pack
Compression
Elevation
DISLOCATION
• An injury which forces bones out of their sockets
• Dislocation is a common sports injury
• It temporarily deforms or immobilizes the joint
• Causes
• Usually caused by a trauma like a fall/blow
• Rheumatoid arthritis also causes dislocation
Symptoms
• Pain
• Tenderness
• Difficulty to move injured part
• Swelling
• Discoloration
First aid management
• Reassure patient
• Do not move the joint or try to place it back
• Place ice to control swelling
• If skin is cut, clean gently and bandage with sterile gauze
• Sling or splint the injury in its original position
• If injury is serious, check for breathing
• If not breathing, provide Cardio pulmonary resuscitation (CPR)
Elevate the feet up to 12 inches
• Cover the patient with a blanket
• Call medical help as soon as possible
