fracture

Break in the continuity of a bone, with or without displacement of any fragments. It may be pathological, the result of a relatively mild injury to an already diseased bone (as in osteomalacia and Paget's disease), or, more often, it is the result of an injury to healthy bone.

Types of fracture A clean break that does little damage to the surrounding tissues and leaves the overlying skin intact is known as a simple fracture. An open or compound fracture is one where the skin is broken, exposing the site to the air. A comminuted fracture is one where the bone is broken into more than two pieces, usually the result of a crushing injury. An incomplete break in a long bone of a child is known as a greenstick fracture.

Symptoms Fracture may be recognized by the helpless condition of the limb, the extreme pain on movement of the affected part, and, frequently, a visible deformity. When the signs are present, further investigation must be carried out with the minimum of movement. An unmistakable symptom is crepitus, the grating sensation of the broken pieces passing over each other; this symptom should only be looked for by a doctor.

Treatment Treatment is by reduction (manipulation) to align the broken ends of the bone with or without some form of fixation or traction. Fractures also need to be immobilized, usually by some form of splint such as plaster of Paris. Sometimes fixation of the broken fragments is secured by surgical operation and plating, pinning, or screwing them together. Healing of broken bones is known as union. It depends on the formation of callus that serves as a natural bone cement. When the bone has joined, gradually increasing movement is advocated in order to accustom the muscles and tendons to the resumption of their normal functions.

A genetically engineered protein that triggers the regrowth of bone is now available for use in healing nonunion fractures where the two parts of a broken bone fail to join up.