A bone is not a stagnant organ. It is the
body's reservoir of calcium and is always undergoing change under the
influence of hormones. The parathyroid hormone, parathormone, increases blood calcium
levels by leeching calcium from bones, while calcitonin has the opposite
effect, allowing bones to accept calcium from the blood. It allows the
body to be supported against gravity and to move. Any breakage in the
continuity of the bone is known as a fracture.
1.Based upon etiology-
a. Fragility fracture- it occurs
spontaneously or as the result of relative minor trauma;
they are typical of osteoporosis.
b. Pathological fracture- it occurs in
bone that is structurally abnormal, such as paget's
disease, osteomalacia, bone metastases and parathyroid bone diseases.
fractures, they can occur spontaneously or follow minor trauma.
c. High-energy fracture- it results from
major trauma like car crash, fall from height
and can effect normal bones.
d. Stress fracture- it is also known as
fatigue fracture. Oft- repeated trauma loads
applied to the skeleton at the same site may cause fracture. This is
commonest in the
metatarsals, particularly the second in its neck due to prolonged
marching. Hence it
is also called MARCH FRACTURE.
2. Based upon orthopaedic medicine-
a. Simple or closed fractures- those in
which the fracture surface does not
communicate with the exterior through skin or mucus membrane.
b. Compound or open fractures- those in
which there is a communication between the
fracture and the exterior through the skin or the mucus membrane.
3. Based upon number-
4. Fractures may be-
a. Complete- where the whole thickness
of the bone is discontinued.
b. Incomplete- in this type of fracture
it does not involve whole breath of a shaft and
portion remains intact.
Fractures in children:
Children can break bones and yet have normal x-rays. Fractures appear
as clear lines through the bone on an x-ray through the bone. If
calcium hasn't yet accumulated in the repairing bone, the break may not
be apparent. This lack of calcification happens in two ways.
1.Bones mature at different times in a child's development and while
the bony structure is there, it may have more cartilage than calcium.
2.The second situation is associated with growth plates. Each bone has
an area where cell activity is maximal and where the bone grows. These
areas appear as lucent lines on x-ray. It may be one of the weaker
points in the bone as well, and a fracture through the growth plate may
not be seen.
The doctor needs to match the history and physical exam with what is
seen on x-ray to make to a diagnosis. Sometimes, the child is placed in
a cast for a period of time to protect the broken limb. As fractures
heal, the body lays down extra calcium as building material and then
remodels it to normal shape. After 7-10 days, there may be evidence on
x-ray of the healing calcium to confirm the fracture.
Growth plate fractures are classified by Salter-Harris category. When a
break occurs through the growth plate, it can involve different parts
of the bone on each side of the plate. It is important that these
fractures are aligned properly so that the bone grows properly as the
Children are more flexible than adults until the calcium completely
solidifies their bone. If you think of an arm or leg bone as tubular,
sometimes only one side of the bone breaks, just like an immature
branch on a tree. This is referred to as a greenstick fracture, and may
need to be "set" so that it heals properly. Sometimes the bones can
bend but not break because they are so pliable. This is called a
plastic deformity and again will need to be set or aligned to allow
Although bone tissue itself contains no nociceptors, bone fracture is
very painful for several reasons-
- Breakage in the continuity of the periosteum, with or
without similar discontinuity in endosteum, as both contain multiple
- Edema of nearby soft tissues caused by bleeding of torn
periosteal blood vessels which evokes pressure pain.
- Muscle spasms trying to hold bone fragments in place.
a.Abnormal swelling and deformity
b.Shortening- a little amount of shortening is almost always expected
in fractures dut to overlapping of segments.
c.Overlying skin- to detect the communication between the fracture site
and exterior environment.
a.Tenderness- Local bony tenderness in valuable sign.
d.repitus- it is a sensation of grating which may be felt or heard,
when the bones ends are moved against each other.
e.Absence of transmitted movements.
1.Complete history of patient with the history of trauma or any
pathological disorder one is suffering..
3.X- ray- it help in diagnosing the fracture and its proper site and
The natural process of healing a fracture starts when the injured bone
and surrounding tissues bleed, forming what's called fracture Hematoma.
The blood coagulates to form a blood clot situated between the broken
fragments. Within a few days blood vessels grow into the jelly-like
matrix of the blood clot. The new blood vessels bring phagocytes 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. 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
At this stage, some of the fibroblasts begin to lay down bone matrix
(calcium hydroxyapatite) in the form of insoluble crystals. 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. 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. For
example, any form of nicotine hinders the process of bone healing, and
adequate nutrition (including calcium intake) will help the bone
healing process. Weight-bearing stress on bone, after the bone has
healed sufficiently to bear the weight, also builds bone strength. The
bone shards can also embed in the muscle causing great pain.
Initial treatment for fractures of the arms, legs, hands and feet in
the field include splinting the extremity in the position it is found,
elevation and ice. Immobilization will be very helpful with initial
pain control. For injuries of the neck and back, many times, first
responders or paramedics may choose to place the injured person on a
long board and in a neck collar to protect the spinal cord from
Once the fracture has been diagnosed, the initial treatment for most
limb fractures is a splint. The joints above and below the injury are
immobilized to prevent movement at the fracture site. This initial
splint does not go completely around the limb. After a few days, the
splint is removed and replaced by a circumferential cast.
Circumferential casting does not occur initially because fractures
swell (edema). This swelling would cause a build up of pressure under
the cast, yielding increased pain and the potential for damage to the
tissues under the cast.
Surgery on fractures are very much dependent on what bone
is broken, where it is broken, and whether the orthopedic surgeon
believes that the break is at risk (for staying where it is) once the
bone fragments have been aligned. If the surgeon is concerned that the
bones will heal improperly, an operation will be needed. Sometimes
bones that appear to be aligned normally are splinted, and at a recheck
appointment, are found to be unstable and require surgery.
Surgery can include closed reduction and casting, where under
anesthesia, the bones are manipulated so that alignment is restored and
a cast is placed to hold the bones in that alignment. Sometimes, the
bones are broken in such a way that they need to have metal hardware
inserted to hold them in place. Open reduction means that, in the
operating room, the skin is cut open and pins, plates, or rods are
inserted into the bone to hold it in place until healing occurs.
Depending on the fracture, some of these pieces of metal are permanent
(never removed), and some are temporary until the healing of the bone
is complete and surgically removed at a later time.
Homeopathy provides many significant medicines in treating people who
suffer from accidents and injuries. When these medicines are used in
combination with conventional procedures, the risk of long-term damage
from an injury can be significantly decreased and the healing process
can be noticeably improved. Homeopathic medicines will help in speed up
healing over the fractured site by enhancing circulation, can also be
used as an antiseptic to avoid infections in case of open fractures.
Patients treated homeopathically experience less pain, have fewer side
effects, and recover faster. The goal of this Homeopathic approach is
to enliven the body's natural healing and self-repair ability to not
only help recover from your fracture, but also create the highest state of
health and well-being.
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