Diagnosis

Fracture

Etiology

Cause

• Usually trauma

• Pathologic fracture: when inadequate trauma

  • Osteoporosis

  • Carcinoma (primary or metastatic)

  • Cyst

  • Enchondroma

  • Giant cell tumor

  • Osteomalacia

  • Osteogenesis imperfecta

  • Scurvy

  • Rickets

  • Pagets disease

Pathophysiology [bzc]

1. Traumatic injury

2. Bones and soft tissue absorb the imposed energy

3. When the absorption of energy exceeds the threshold of the bone --> fracture

4. The bone fragments are usually not attached to any anchoring structures --> displaced --> risk of soft tissue and neurovascular structure damage

5. Foreign material can be deposited into deep intramuscular and bone cortex --> osteomyelitis

Classification

• Anatomical location

• Direction of fracture line (transverse, oblique, spiral)

• Simple or comminuted

• Open or closed.

Complications [bzc]

• Infection

• Failure to heal

• Non-union

Epidemiology

Incidence per 100.000 [ng7][s6y]

Approach

• Arterial blood gas: hemoglobin, hematocrit, platelet count, metabolic panel, serum lactate, and toxicology screens

• X-ray

• CT

• MRI

Treatment

1. Treatment goals:

   • Prevent infection

   • Allow the fracture to heal

   • Restore function in the injured limb

2. Considerations:

   • Unstable (open) fracture: not maintained in a reduced position

   • Displaced intra-articular fractures

   • Fractures known to heal poorly (femoral neck fracture)

   • Disrupted ligamentous function (patella fracture)

   • Pathologic fractures

   • Multiple traumatic fractures

   • Individuals who poorly tolerate prolonged immobilization

   • Fractures in growth areas --> risk for growth arrest

3. Contraindication for surgery:

   • Active infection: local, systemic, osteomyelitis

   • Compromised soft tissue overlying fracture (injury, burns, infection)

   • Medical conditions

4. Treatment:

   1. Nonoperative Therapy:

      • Control hemorrhage

      • Pain relief

      • Prevent ischemia injury

      • Remove contamination (foreign body and nonviable tissues)

   2. Reduce fracture and maintain reduction with immobilisation (splints, plaster cast, traction)

   3. Surgery:

      • External fixation

      • Open Reduction and Internal Fixation (ORIF):

        • Kirschner wires

        • Plates and screws

        • Intramedullary nails

Differential diagnoses

Acute extremity ischemia, Compartment syndrome, Deep venous thrombosis, Erysipelas, Gout, Pseudogout, Rheumatoid arthritis, Septic arthritis, Thrombophlebitis