FRACTURE

FRACTURE

Definition

• A fracture is a break in a bone or cartilage caused by a sudden force or stress.

Types of Fractures

• Comminuted fracture: A fracture where the bone breaks into multiple pieces.
• Greenstick fracture: A type of fracture where the bone bends and partially breaks.
• Stress fracture: A hairline fracture caused by repeated stress on the bone.
• Compression fracture: A type of fracture where the bone is compressed, often seen in vertebral fractures.
• Impacted fracture: A type of fracture where the broken bone ends are driven into each other.

Causes of Fractures

• Trauma: A sudden force or impact, such as a fall or a car accident.
• Osteoporosis: A condition where the bones become weak and brittle, making them more susceptible to fractures.
• Tumors: Abnormal growths that can weaken the bone and cause it to break.
• Infections: Infections such as osteomyelitis can cause the bone to weaken and break.
• Metabolic disorders: Conditions such as rickets and osteomalacia can cause the bones to become weak and brittle.

Clinical Features of Fractures

• Pain: The most common symptom of a fracture, especially when the affected area is moved.
• Swelling: The affected area may become swollen and bruised.
• Deformity: The affected area may become deformed or misshapen.
• Limited mobility: The affected area may become stiff and difficult to move.
• Numbness or tingling: If the fracture affects a nerve, numbness or tingling may occur.

Investigations for Fractures

• X-rays: A common diagnostic tool for fractures, used to visualize the bone.
• CT scans: A more detailed diagnostic tool that provides cross-sectional images of the bone.
• MRI scans: A diagnostic tool that provides detailed images of soft tissue and bone.
• Bone scans: A diagnostic tool that uses small amounts of radioactive material to visualize the bone.

Complications of Fractures

• Infection: Bacteria can enter the fracture site and cause a bone infection.
• Nerve damage: The fracture may damage nearby nerves, causing numbness or tingling.
• Vascular damage: The fracture may damage nearby blood vessels, causing bleeding or circulation problems.
• Malunion: The bone may not heal properly, leading to a deformity.
• Nonunion: The bone may not heal at all, leading to chronic pain and disability.

Stages of Fracture Healing

1. Inflammatory phase → step 1
   • Hematoma formation
   • Inflammation
   • Soft callus formation
2. Soft callus phase → step 2
   • Cartilage formation
   • Bony callus formation
3. Hard callus phase → step 3
   • Bony callus formation
   • Remodeling
4. Remodeling phase → step 4
   • Bone density recovery
   • Bone shape recovery

Factors Affecting Fracture Healing

1. Age
2. Nutrition
3. Blood supply
4. Immobilization
5. Smoking
6. Infection

Types of Fractures

1. Stress fracture: A small crack in a bone due to repetitive stress.
2. Avulsion fracture: A small piece of bone is pulled off due to a muscle or ligament.
3. Comminuted fracture: A bone is broken into multiple pieces.
4. Greenstick fracture: A bone is bent and partially broken.
5. Compound fracture: A bone is broken and protrudes through the skin.
6. Incomplete fracture: A bone is broken but not completely.

Principles of Management

1. Immobilization
2. Pain management
3. Infection control
4. Rehabilitation

Signs and Symptoms of a Fracture

1. Severe pain
2. Swelling
3. Deformity
4. Limited mobility
5. Inability to bear weight

Emergency Care

1. Immobilization in a splint or cast
2. Pain management with medication
3. Neurovascular assessment
4. Dressing and cleaning of the wound
5. Transfer to a hospital for further treatment

Imaging

1. X-rays: Used to visualize bones and fractures.
2. CT scans: Used to visualize soft tissues and fractures in detail.
3. MRI: Used to visualize soft tissues and fractures in detail.

Treatment Plans

1. Conservative management: Treatment with immobilization, pain management, and rehabilitation.
2. Surgical management: Treatment with surgery to repair the fracture.

Complications

1. Hemorrhage: Excessive bleeding from the fracture site.
2. Compartment syndrome: Increased pressure in a muscle compartment.
3. Fat embolism: Fat enters the bloodstream and causes a blockage.
4. Infection: Bacterial infection of the fracture site.
5. DVT: Blood clot in the deep veins.
6. ARDS: Acute respiratory distress syndrome.

Management of Complications

1. Hemorrhage: Control bleeding with pressure and surgery.
2. Compartment syndrome: Release the pressure with surgery.
3. Fat embolism: Treat with anticoagulants and oxygen therapy.
4. Infection: Treat with antibiotics and surgical debridement.
5. DVT: Treat with anticoagulants and compression stockings.
6. ARDS: Treat with oxygen therapy and mechanical ventilation.

Late Complications

1. Delayed union: Fracture takes longer than expected to heal.
2. Non-union: Fracture does not heal.
3. Malunion: Fracture heals but in a incorrect position.
4. Joint stiffness: Loss of range of motion in a joint.
5. AVN: Avascular necrosis of a bone.
6. Myositis ossificans: Bone formation in a muscle.
7. Ischemic contracture: Muscle contraction due to lack of blood supply.
8. Post-traumatic osteoarthritis: Joint degeneration due to a fracture.
9. Sudeck's dystrophy: Chronic pain and swelling after a fracture.
10. Growth disturbances: Abnormal growth of a bone after a fracture.

Homoeopathic Therapeutic Approach

1. Arundo donax: For pain and inflammation.
2. Calendula: For wound healing and tissue repair.
3. Hypericum: For nerve pain and inflammation.
4. Belladonna: For inflammation and pain.
5. Arnica: For tissue repair and inflammation.

Compartment Syndrome

1. Definition: Increased pressure in a muscle compartment.
2. Causes: Fractures, crush injuries, burns, and prolonged compression.
3. Symptoms: Pain, swelling, and weakness.
4. Treatment: Release the pressure with surgery.

Sudeck's Dystrophy

1. Definition: Chronic pain and swelling after a fracture.
2. Causes: Fractures, injuries, and surgery.
3. Symptoms: Pain, swelling, and limited mobility.
4. Treatment: Physical therapy, pain management, and medication.

Myositis Ossificans

1. Definition: Bone formation in a muscle.
2. Causes: Trauma, overuse, and infection.
3. Symptoms: Pain, swelling, and limited mobility.
4. Treatment: Physical therapy, pain management, and medication.ypericum 30: Used to treat nerve damage and numbness.

• Rhus toxicodendron 30: Used to treat inflammation and pain.
• Symphytum 30: Used to treat bone fractures and osteoporosis.