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FRACTURE A bone fracture (sometimes abbreviated FRX or Fx, Fx, or #) is a medical condition in which there is a break in the continuity of the bone. A bone fracture can be the result of high force impact or stress, or trivial injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, bone cancer, orosteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture. Although broken bone and bone break are common colloquialisms for a bone f
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  FRACTURE A bone fracture (sometimes abbreviated FRX or Fx , F x , or # ) is a medical condition in whichthere is a break in the continuity of thebone.A bone fracture can be the result of highforceimpactorstress,or trivial injury as a result of certain medical conditions that weaken the bones, such asosteoporosis,bone cancer,orosteogenesis imperfecta,where the fracture is then properly termed apathologic fracture. Although broken bone and bone break are common colloquialisms for a bone fracture, break  isnot a formalorthopedicterm.Bone is the strong tissue that forms the basis of your skeleton. It is a living tissue, made up of bone-forming cells, which produce the mineral compound (matrix) that makes your bones strongand hard.Your bones can usually tolerate external forces (for example, knocking a bone as a result of a fallor injury) but if the force is very big or your bones are weak, they may crack or break intofragments. TYPES OF FRACTURE Inorthopedicmedicine,fractures are classified in various ways. Historically they are named after the doctor who first described the fracture conditions. However, there are more systematicclassifications in place currently. All fractures can be broadly described as:    Closed (simple) fractures are those in which the skin is intact    Open (compound) fractures involve wounds that communicate with the fracture, orwhere fracturehematomais exposed, and may thus expose bone tocontamination.Open injuries carry a higher risk of infection. Other considerations in fracture care are displacement (fracture gap) and angulation. If angulation ordisplacementis large, reduction (manipulation) of the bone may be required and, inadults, frequently requires surgical care. These injuries may take longer tohealthan injurieswithoutdisplacementor angulation.    Compression fractures usually occur in the vertebrae, for example when the frontportion of avertebrain the spine collapses due toosteoporosis(a medical condition which causes bones to become brittle and susceptible to fracture, with or without trauma).  Other types of fracture are:    Complete fracture :A fracture in which bone fragments separate completely.    Incomplete fracture : A fracture in which the bone fragments are still partially joined. Insuch cases, there is a crack in the osseous tissue that does not completely traverse thewidth of the bone.    Linear fracture : A fracture that is parallel to the bone's long axis.    Transverse fracture : A fracture that is at a right angle to the bone's long axis.    Oblique fracture : A fracture that is diagonal to a bone's long axis.    Spiral fracture :A fracture where at least one part of the bone has been twisted.    Comminuted fracture : A fracture in which the bone has broken into a number of pieces.    Impacted fracture : A fracture caused when bone fragments are driven into each other. INDICATIONS OF PRESENCE First know what happened. If the victim thinks he has a broken bone, or if he was unconsciousafter an accident try to find out. Signs and symptoms Although bone tissue itself contains nonociceptors,bone fracture is very painful for severalreasons:    Breaking in the continuity of theperiosteum,with or without similar discontinuityinendosteum,as both contain multiplenociceptors.     Edemaof nearbysoft tissuescaused by bleeding of torn periosteal blood vessels evokes pressure pain.    Muscle spasmstrying to hold bone fragments in placeDamage to adjacent structures such as nerves or vessels, spinal cord and nerve roots (for spinefractures), or cranial contents (for skull fractures) can cause other specific signs and symptoms.At the site of the fracture you may also notice:    swelling    bruising    the bone sticking out or bending    a grating feeling or sound     pain upon moving the area above the injured part    dislocation    tendernessYou may also become pale and clammy, and feel sick or light-headed due to the pain. If youthink you have a fracture, you should go to your nearest accident and emergency department orcall for an ambulance if you are unable to move. PATHOPHYSIOLOGY The natural process of healing a fracture starts when the injured bone and surrounding tissuesbleed, forming a fracture Hematoma . Theblood coagulatesto form a bloodclotsituated between the broken fragments. Within a few daysblood vessels growinto the jelly-like matrix of the blood clot. The new blood vessels bringphagocytesto the area, which gradually remove thenon-viable material. The blood vessels also bringfibroblastsin the walls of the vessels and thesemultiply and producecollagenfibers. In this way the blood clot is replaced by a matrix of collagen. Collagen's rubbery consistency allows bone fragments to move only a small amountunless severe or persistent force is applied.At this stage, some of the fibroblasts begin to lay downbone matrix(calcium hydroxyapatite)in the form of insolublecrystals.This mineralization of the collagen matrix stiffens it andtransforms it into bone. In fact, bone is a mineralized collagen matrix; if the mineral is dissolvedout of bone, it becomes rubbery. Healing bonecallusis on average sufficiently mineralized toshow up onX-raywithin 6 weeks in adults and less in children. This initial woven bone doesnot have the strong mechanical properties of mature bone. By a process of remodeling, thewoven bone is replaced by mature lamellar bone. The whole process can take up to 18 months,but in adults the strength of the healing bone is usually 80% of normal by 3 months after theinjury.Several factors can help or hinder thebone healingprocess. For example, any formof nicotinehinders the process of bone healing, and adequate nutrition (includingcalciumintake) will help the bone healing process. Weight-bearing stress on bone, after the bone has healedsufficiently to bear the weight, also builds bone strength. Although there are theoretical concernsaboutNSAIDsslowing the rate of healing, there is not enough evidence to warrant withholdingthe use of this type analgesic in simple fractures. COMPLICATIONS Fractures can sometimes cause a number of additional problems. Your fracture may damagesurrounding structures, such as your nerves or a blood vessel. You may need special treatment if this happens.Your fracture may become infected. This is more common if you have an open fracture or if youneed surgery to fix it. If your fracture becomes infected, it may take longer to heal and there is achance that your bone will become infected. This is called osteomyelitis - see Related topics formore information  CAUSES Fractures usually occur if you hit your bone or if you twist or bend awkwardly. This can happenas a result of a fall or a collision. Fractures are more common in young children because theytend to have more falls and accidents, partly because they are less aware of hazards.You may fracture a bone without an obvious trauma. For example, athletes are more at risk of getting stress fractures, as these can happen with repeated stress over time. You're also morelikely to break a bone as you get older or if you have a disease that weakens your bones. DIAGNOSIS At the hospital, your doctor will ask about your symptoms and examine you for signs of afracture, such as swelling or if your bones are held in an unusual position.He or she will usually use X-rays to diagnose your fracture. However, if a fracture doesn't showup clearly on the X-ray, your doctor may request an MRI (magnetic resonance imaging) or CT(computerized tomography) scan to look at it more closely. Your doctor may also ask you tohave some blood tests to check for conditions that can weaken your bones. TREATMENT You should always seek medical attention if you think you may have broken a bone. However,there are some things you can do to reduce your pain and prevent further injury until you see adoctor. First aid If you break your arm, you can secure the bone with a sling or a splint to help reduce the painand prevent further injury, until you receive medical help.You can also take painkillers to ease the pain. Always read the patient information leaflet thatcomes with the medicine and ask your pharmacist or doctor for advice. Pain management In arm fractures in children,ibuprofenhas been found to be equally effective as the combinationof acetaminophenandcodeine.  Immobilization Sincebone healingis a natural process which will most often occur, fracture treatment aims toensure the best possible  function of the injured part after healing. Bone fractures are typicallytreated by restoring the fractured pieces of bone to their natural positions (if necessary), andmaintaining those positions while the bone heals. Often, aligning the bone, calledreduction,ingood position and verifying the improved alignment with an X-ray is all that is needed. Thisprocess is extremely painful without anesthesia, about as painful as breaking the bone itself. Tothis end, a fractured limb is usually immobilized with aplasterorfiberglasscastor splint which holds the bones in position and immobilizes the joints above and below the fracture. When theinitial post-fracture edema or swelling goes down, the fracture may be placed in a removable
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