A fracture is a medical condition where the continuity of the bone is broken. When describing a fracture, it is essential to describe the type and severity of the fracture. Adequate description includes providing information about a number of different categories:
Open or closed?
Closed fracture = a broken bone with no open wound
Open fracture = a broken bone with a break in the skin
Simple or comminuted?
Simple = a fracture where the bone is broken into two fragments
Comminuted = bone is splintered or crushed into several pieces
Angle of break?
Transverse = this is when the break is perpendicular to the long axis of the bone
Oblique = bone is broken at an angle across the bone
Spiral = a fracture in which the bone has been twisted apart.
Level of displacement?
Displaced = a fracture where the ends no longer retain their normal alignment
Non-displaced fracture = bone fracture where the ends do retain their normal alignment.
How to Describe Displacement
Type of fracture
Hairline = a stress fracture which causes a very thin break – but bones retain the same shape
Compression = bone becomes fractures due to pressure from other bones, often in the vertebrae
Distal Radius Fracture
This is a fracture of the radius which usually occurs due to a fall on an outstretched hand.
It can be divided into two main types of fractures
Colles’ Fracture
This is a fracture which occurs due to a fall on an outstretched hand.
It is an extra-articular fracture of the distal radius (within 2 centimeters of the joint) which involves dorsal angulation with radial tilt.
It causes a dinner fork deformity, due to dorsal angulation of the distal segment.
Smith’s fracture
This is a fracture which occurs with a fall onto flexed wrists.
It is an extra-articular fracture of the distal radius (within 2 cm of joint) which involves volar displacement of the distal segment and is less common than a Colles’ fracture.
These are inherently unstable and usually require surgical fixation.
![Colles](https://b2470160.smushcdn.com/2470160/wp-content/uploads/2021/04/Colles.png?lossy=0&strip=1&webp=1)
Key tests
Plain film x-ray of the wrist
Management
If not displaced, immobilisation in cast
If displaced or neurovascular compromise, then operative fixation is often required
Supracondylar Fracture
This is a fracture which occurs at the distal end of the humerus, usually due to a fall on an outstretched hand
It can also be due to a direct blow to the lateral elbow (more common in children)
Symptoms
Pain and swelling
Key tests
Elbow X-ray
Complications
Vascular – acute ischaemia due to disruption of the brachial artery
Neurological – damage to the anterior interosseous nerve, median nerve
Volkmann’s ischaemic contracture
Scaphoid Fracture
This is a fracture which occurs across the scaphoid, one of the small hand bones.
It usually occurs due to a fall on an outstretched hand.
The blood supply to the scaphoid is from a nutrient branch of the radial artery which runs from distal to proximal.
Therefore, with a proximal pole scaphoid fracture, there is a high risk of avascular necrosis of the proximal segment.
Symptoms
Hand pain and swelling
Tenderness in the anatomical snuffbox
Pain on longitudinal compression of the thumb and on wrist movement
![scaphoid fracture](https://b2470160.smushcdn.com/2470160/wp-content/uploads/2021/04/scaphoid-fracture.png?lossy=0&strip=1&webp=1)
Key tests
Wrist X-ray. If unclear, MRI is gold standard
Management
Usually conservative in a plaster/splint for 6–8 weeks. If there is a delay in union, then it may require operative fixation.
Neck of femur
This is a hip fracture which is often seen in elderly women, usually secondary to a fall.
It can be categorised according to whether the capsule is affected.
Intracapsular fractures
These are divided into subcapital, transcervical and basicervical.
In these types, there is a high risk of damage to blood vessels causing avascular necrosis of the femoral head.
Therefore, in these types, the femoral head often requires replacement with a hemiarthroplasty or total hip replacement.
Extracapsular fractures
These are divided into intertrochanteric or subtrochanteric.
In these types, is less of a risk of avascular necrosis to the femoral head, which means that it does not have to be replaced as often.
![hip fractures](https://b2470160.smushcdn.com/2470160/wp-content/uploads/2021/04/hip-fractures.png?lossy=0&strip=1&webp=1)
Symptoms
Hip/groin pain
Inability to weight bear
Shortening of the leg due to iliopsoas pull with external rotation
Key tests
Hip X-ray shows disruption of Shenton’s line and discontinuity of the cortex
Management
Intracapsular
If non-displaced – consider internal fixation in situ with screws or a plate
If displaced and patient is unfit/elderly – hemiarthroplasty
If displaced and patient is younger/fit – total hip replacement
Extracapsular
If intertrochanteric – dynamic hip screw or intramedullary nail
If subtrochanteric – intramedullary nail
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