Types of fractures

FRACTURES

>According to severity of injury to the soft tissue

Open Fracture (compound) – occurs when an open wound extends to the site of the fracture or when a fragment of bone protrudes through the skin.

Closed Fracture (simple) – type of fracture where the skin is not perforated.

Complicated Fracture – The soft tissues around a closed fracture are damaged.

Incomplete Fracture – fracture does not extend completely across the bone.

–          Greenstick – occurs on the convex side of the curve of the bone.

–          Hairline – two sections of bone do not separate (common in skull fractures).

Complete Fracture – the bone is broken into at least two fragments.

–          Comminuted – the bone breaks into more than two pieces, usually two major fragments and a smaller fragment.

–          Impacted – one fragment is driven into the cancellous portion of the other fragment.

>According to direction

Linear Fracture – run parallel to the long axis of the bone.

Transverse Fracture – runs at right angles to the long axis.

Spiral Fracture – helical course around the bone.

Oblique Fracture – run obliquely in relation to the long axis.

Dentate Fracture – rough, toothed, broken ends.

Stellate Fracture – breakage lines radiating from a central point.

CASTS

Short Arm Cast – Extend from elbow to the proximal palmar crease.

Gauntlet Cast – Extend from below the elbow to the proximal palmar crease including the thumb.

Long-arm Cast – Extend from upper level of axillary fold to proximal palmar crease; elbow usually immobilized at right angle.

Short-leg Cast – Extends from below knee to base of toes.

Long-leg Cast – Extend from upper thigh to the base of toes; foot is at an angle in a neutral position.

Body Cast – Encircles the trunk stabilizing the spine.

Spica Cast – Incorporates the trunk and extremity.

FRACTURE HEALING STAGES

  1. When bone fractures, there is bleeding at the site and a hematoma forms between two bone ends.
  2. An inflammatory reaction sets in. Macrophages collect in the region and gradually remove clotted blood and bone fragments. Granulation tissue consisting of new capillaries and fibroblasts is formed.
  3. Osteoblasts multiply and lay down new bone, that joins the bone ends. This new bone is temporary and is called callus. The union is at first weak but gradually increases in strength.
  4. Activity of the osteoblasts and osteoclasts gradually replaces the callus with normal bone

CARE OF CLIENTS WITH AN EXTERNAL FIXATOR

–          Observe for altered neurovascular status

–          Give patients a full explanation and support in managing the external fixator, ensuring thay are aware of benefits such as early assisted mobilization.

–          Concordance to treatment is essential in the use of external fixator. Patients will require a lot of reassurance and support to help them accept the unsightly external fixator frame, which may significantly alter their body image.

–          The patient with external fixator is at high risk of developing a pin-site infection. This may be  superficial and can be treated with antibiotics; however, if not treated, the infection can progress along the pin tract to the bone, which can have devastating effects. Pin-site care should be carried out at least daily and patients should be encouraged, where possible, to undertake this themselves to help with acceptance with the fixator. Clear instructions should be given to the patient on discharge, with a contact number if they have any questions.

 

 

 

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