}]]}]}]}] 2f:T871d,

### Fracture: Definition & Classification - **Definition:** A break in the continuity of a bone. - **Classification:** - #### Etiological - **Traumatic:** Due to sudden impact. - **Pathological:** Fracture through bone weakened by disease (e.g., tumors, osteoporosis). - **Stress:** Repeated microtrauma, often in athletes. - #### Completeness - **Complete:** Bone fragments are separated. - **Incomplete (Greenstick):** Partial break, bone is still connected (common in children). - #### Displacement - **Displaced:** Bone fragments are not in anatomical alignment. - **Undisplaced:** Fragments remain in alignment. - #### Relationship with external environment - **Closed (Simple):** Skin and soft tissues are intact. - **Open (Compound):** Skin and soft tissues are breached, exposing the fracture site. - **Gustilo-Anderson Classification for Open Fractures:** - **Type I:** Wound < 1 cm, minimal soft tissue damage, clean. - **Type II:** Wound > 1 cm, moderate soft tissue damage, moderate comminution. - **Type III:** Extensive soft tissue damage, high-energy trauma, severe comminution. - **IIIA:** Adequate soft tissue coverage despite extensive laceration. - **IIIB:** Extensive soft tissue loss, periosteal stripping, requires flap coverage. - **IIIC:** Arterial injury requiring repair. - #### Pattern - **Transverse:** Perpendicular to the long axis of the bone. - **Oblique:** Angled break. - **Spiral:** Twisting force, often seen in long bones. - **Comminuted:** Bone shattered into multiple fragments. - **Impacted:** Bone fragments driven into each other. - **Avulsion:** Ligament or tendon pulls off a piece of bone. ### Stages of Fracture Healing 1. **Inflammatory Phase (Hematoma Formation):** - Immediately after fracture, blood vessels rupture, forming a hematoma. - Inflammatory cells migrate, clearing debris and initiating repair. 2. **Reparative Phase:** - #### Soft Callus Formation: - Fibroblasts and chondroblasts proliferate from periosteum and endosteum. - Granulation tissue forms, followed by cartilage (soft callus) bridging the gap. - #### Hard Callus Formation (Ossification): - Osteoblasts replace cartilage with woven bone, forming a hard callus. - Callus is visible on X-ray, providing initial stability. 3. **Remodeling Phase:** - Woven bone is gradually replaced by lamellar bone. - Excess callus is resorbed, and the bone reshapes itself according to Wolff's Law (bone remodels in response to stress). - Medullary canal is re-established. This phase can last months to years. ### Pathological Fracture - **Definition:** A fracture that occurs through bone weakened by an underlying disease process, often with minimal or no trauma. - **Causes:** - **Metabolic Bone Diseases:** Osteoporosis, osteomalacia, hyperparathyroidism. - **Neoplasms:** Primary bone tumors (e.g., osteosarcoma, Ewing's sarcoma), metastatic lesions (common from breast, lung, prostate, kidney, thyroid). - **Infections:** Osteomyelitis. - **Genetic/Developmental:** Osteogenesis imperfecta, Paget's disease. - **Other:** Radiation osteitis, fibrous dysplasia. - **Diagnosis:** - **Clinical History:** Minimal trauma for fracture, history of underlying disease. - **Radiography (X-ray):** Shows fracture and often the underlying