Table of contents · 7 sections
Fractures represent a complete or partial disruption of bone integrity and are among the most common reasons for presentation to trauma departments. Proper classification, diagnosis, and provision of first aid determine the treatment outcome. This article provides a comprehensive overview for medical students and primary care physicians.
Fracture classification
| Criterion | Types | Description |
|---|---|---|
| By skin integrity | Closed | Skin is intact |
| Open | Wound in the fracture area, bone contact with the external environment → risk of infection | |
| By fracture line | Transverse | Line is perpendicular to the bone axis |
| Oblique | At an angle to the axis | |
| Spiral | Line wraps around the bone (rotational trauma) | |
| Comminuted | More than 2 fragments | |
| By displacement | Non-displaced | Fragments maintain anatomical position |
| Displaced | Transverse, longitudinal, angular, rotational | |
| By completeness | Complete | Through the entire thickness of the bone |
| Incomplete (fissure/crack) | Only part of the cortical layer | |
| Special types | Pathological | Through an area of pathologically altered bone (metastases, osteoporosis) |
| Stress (fatigue) | Micro-injuries from repetitive loading (runners, military personnel) | |
| Greenstick | In children — the bone breaks incompletely (periosteum remains intact on one side) |
Clinical diagnostics
Absolute (definite) signs of a fracture
- Pathological mobility — movement in a place where there should be none
- Crepitus — grinding of bone fragments (do not check intentionally!)
- Limb deformity — shortening, axis deviation
- Visible bone fragments (in open fractures)
Relative (probable) signs
- Pain upon axial loading
- Edema, hematoma
- Impaired limb function
- Forced posture
Instrumental diagnostics
| Method | Indications | What it reveals |
|---|---|---|
| Radiography | First-line imaging for any suspicion | Fracture line, displacement, impaction. The two-projection rule! |
| CT | Complex fractures (intra-articular, spine, pelvis) | Precise fragment anatomy, surgical planning |
| MRI | Stress fractures, soft tissue injury | Bone marrow edema (early sign), ligaments, menisci |
Radiography rule: always 2 views, including 2 adjacent joints.
First aid for fractures
- Assessment — ABC (airway, breathing, circulation). Life-threatening conditions take priority
- Bleeding control — for open fractures: sterile dressing. For arterial bleeding — tourniquet (must record the time!)
- Immobilization — splinting in the position the limb is found. Include 2 adjacent joints. Do not reduce fragments!
- Pain management — analgesics (ketorolac, narcotics for severe pain)
- Cold therapy — for 15-20 minutes through a cloth (reduces edema)
- Transportation — on a stretcher, in a gentle position
Principles of treatment
| Method | Indications | Examples |
|---|---|---|
| Conservative | Closed fractures without significant displacement | Plaster cast, fiberglass cast, orthosis |
| Skeletal traction | Femoral fractures (temporary), preoperative preparation | Pin through the tibial tuberosity |
| Surgical (osteosynthesis) | Displaced, intra-articular, open, unstable | Plates, screws, intramedullary nails, Ilizarov apparatus |
Fracture complications
Early
- Traumatic shock — blood loss up to 1-1.5 L in femoral fractures, up to 3 L in pelvic fractures
- Fat embolism — 24-72 hours after long bone fractures (dyspnea, petechiae, confusion). Pathognomonic triad!
- Compartment syndrome — increasing edema in a closed fascial space → ischemia → muscle necrosis. Pain out of proportion to the injury, pain on passive stretch → emergency fasciotomy
- Vascular and nerve injury — check pulse and sensation distal to the fracture!
Late
- Delayed union — healing >6 months
- Nonunion (pseudarthrosis) — lack of healing → formation of a false joint
- Malunion — with deformity, shortening
- Volkmann's contracture — ischemic contracture of forearm muscles (outcome of compartment syndrome)
- Post-traumatic osteoarthritis — in intra-articular fractures
Frequently asked questions
How to distinguish a fracture from a dislocation?
Fracture: abnormal mobility, crepitus, deformity along the bone axis. Dislocation: "springy fixation" (upon attempting passive movement, the limb returns to its forced position), joint deformity, "empty" joint cavity on palpation. Definitive diagnosis — radiography.
Why is it forbidden to try to reduce fracture fragments on site?
Unprofessional manipulation can: damage nearby vessels and nerves; convert a closed fracture into an open one; increase bleeding; trigger fat embolism. Reduction is performed only in a hospital setting, under anesthesia, with fluoroscopic control.
Study traumatology through interactive lessons on the platform. Related topics: muscles of the upper extremity, acute abdomen, chest X-ray. Use clinical calculators for traumatology scales.