<< Chapter < Page Chapter >> Page >
By the end of this section, you will be able to:
  • Differentiate among the different types of fractures
  • Describe the steps involved in bone repair

A fracture    is a broken bone. It will heal whether or not a physician resets it in its anatomical position. If the bone is not reset correctly, the healing process will keep the bone in its deformed position.

When a broken bone is manipulated and set into its natural position without surgery, the procedure is called a closed reduction    . Open reduction requires surgery to expose the fracture and reset the bone. While some fractures can be minor, others are quite severe and result in grave complications. For example, a fractured diaphysis of the femur has the potential to release fat globules into the bloodstream. These can become lodged in the capillary beds of the lungs, leading to respiratory distress and if not treated quickly, death.

Types of fractures

Fractures are classified by their complexity, location, and other features ( [link] ). [link] outlines common types of fractures. Some fractures may be described using more than one term because it may have the features of more than one type (e.g., an open transverse fracture).

Types of fractures

In this illustration, each type of fracture is shown on the right femur from an anterior view. In the closed fracture, the femur is broken in the middle of the shaft with the upper and lower halves of the bone completely separated. However, the two halves of the bones are still aligned in that the broken edges are still facing each other. In an open fracture, the femur is broken in the middle of the shaft with the upper and lower halves of the bone completely separated. Unlike the closed fracture, in the open fracture, the two bone halves are misaligned. The lower half is turned laterally and it has protruded through the skin of the thigh. The broken ends no longer line up with each other. In a transverse fracture, the bone has a crack entirely through its width, however, the broken ends are not separated. The crack is perpendicular to the long axis of the bone. Arrows indicate that this is usually caused by compression of the bone in a superior-inferior direction. A spiral fracture travels diagonally through the diameter of the bone. In a comminuted fracture, the bone has several connecting cracks at its middle. It is possible that the bone could splinter into several small pieces at the site of the comminuted fracture. In an impacted fracture, the crack zig zags throughout the width of the bone like a lightning bolt. An arrow indicates that these are usually caused by an impact that pushes the femur up into the body. A greenstick fracture is a small crack that does not extend through the entire width of the bone. The oblique fracture shown here is travelling diagonally through the shaft of the femur at about a thirty degree angle.
Compare healthy bone with different types of fractures: (a) closed fracture, (b) open fracture, (c) transverse fracture, (d) spiral fracture, (e) comminuted fracture, (f) impacted fracture, (g) greenstick fracture, and (h) oblique fracture.
Types of Fractures
Type of fracture Description
Transverse Occurs straight across the long axis of the bone
Oblique Occurs at an angle that is not 90 degrees
Spiral Bone segments are pulled apart as a result of a twisting motion
Comminuted Several breaks result in many small pieces between two large segments
Impacted One fragment is driven into the other, usually as a result of compression
Greenstick A partial fracture in which only one side of the bone is broken
Open (or compound) A fracture in which at least one end of the broken bone tears through the skin; carries a high risk of infection
Closed (or simple) A fracture in which the skin remains intact

Bone repair

When a bone breaks, blood flows from any vessel torn by the fracture. These vessels could be in the periosteum, osteons, and/or medullary cavity. The blood begins to clot, and about six to eight hours after the fracture, the clotting blood has formed a fracture hematoma    ( [link] a ). The disruption of blood flow to the bone results in the death of bone cells around the fracture.

Stages in fracture repair

This illustration shows a left to right progression of bone repair. The break is shown in the leftmost image, where the femur has an oblique, closed fracture in the middle of its shaft. The next image magnifies the break, showing that blood has filled the area between the broken bones. Blood has also filled in around the lateral and medial sides of the break. The influx of blood causes the broken area to swell, creating a hematoma. In the next image, the hematoma has been replaced with an external callus between the two broken ends. Within the internal callus, the blood vessels have reconnected and some spongy bone has regenerated in the gap between the two bone halves. In the next image, spongy bone has completely regenerated, connecting the two broken ends, referred to as the bony callus. The external callus still remains on the lateral and medial sides of the break, as the compact bone has not yet regenerated. In the final image, the compact bone has fully regenerated, encapsulating the bony callus and completely reconnecting the two bone halves. The bone has a slight bulge at the location of the healed fracture, which is clearly shown in the final image, which shows a zoomed out image of the completely healed femur.
The healing of a bone fracture follows a series of progressive steps: (a) A fracture hematoma forms. (b) Internal and external calli form. (c) Cartilage of the calli is replaced by trabecular bone. (d) Remodeling occurs.

Within about 48 hours after the fracture, chondrocytes from the endosteum have created an internal callus    (plural = calli) by secreting a fibrocartilaginous matrix between the two ends of the broken bone, while the periosteal chondrocytes and osteoblasts create an external callus    of hyaline cartilage and bone, respectively, around the outside of the break ( [link] b ). This stabilizes the fracture.

Over the next several weeks, osteoclasts resorb the dead bone; osteogenic cells become active, divide, and differentiate into osteoblasts. The cartilage in the calli is replaced by trabecular bone via endochondral ossification ( [link] c ).

Eventually, the internal and external calli unite, compact bone replaces spongy bone at the outer margins of the fracture, and healing is complete. A slight swelling may remain on the outer surface of the bone, but quite often, that region undergoes remodeling ( [link] d ), and no external evidence of the fracture remains.

Visit this website to review different types of fractures and then take a short self-assessment quiz.

Chapter review

Fractured bones may be repaired by closed reduction or open reduction. Fractures are classified by their complexity, location, and other features. Common types of fractures are transverse, oblique, spiral, comminuted, impacted, greenstick, open (or compound), and closed (or simple). Healing of fractures begins with the formation of a hematoma, followed by internal and external calli. Osteoclasts resorb dead bone, while osteoblasts create new bone that replaces the cartilage in the calli. The calli eventually unite, remodeling occurs, and healing is complete.

Questions & Answers

Card 5 / 12: For whom would an appreciation of the structural characteristics of the human heart come more easily: an alien who lands on Earth, abducts a human, and dissects his heart, or an anatomy and physiology student performing a dissection of the heart on her very first day of class? Why?
Gelowe Reply
what are regular shaped cells with granules in the cytoplasam
Kabita Reply
PMNL
Dinu
I need sylubuss of clinical officers book
Omary Reply
cholesterol normal value is
BISWANATH Reply
less than 200mg/dl
Ashis
100 to159mg/dL
Dinu
Early this wk. I had some "A & P" questions & answers unfortunately didn't save them, Is there any way I can have them back ,so as 2 save them?. Thnx.
Kechi
what are the functions of the female reproductive system
Lister Reply
it produces the female egg necessary for reproduction, called the Ova or Oocytes. The system is designed to transport the Ova to the site of fertilization.
Kechi
Female reproductive system was mainly functioned to produce ova(ovum) (female eggs) Into which will be fertilized by male gamete to produce zygote
Omary
absolutely right
nimco
wa qalad nimco rage iska hubi
Khaliil
waxwalba ka fikirbay ubaahantahay
Ahmed
ha wayo jawabtoda wa qabyo nimco wey ku raacdat
Khaliil
ha wayo jawabtoda wa qabyo nimco wey ku raacday
Khaliil
wxayaabaha qaarkood waaa in aan u feejignaano
Ahmed
asc if I try female reproductive system has two function the first is to produce egg cell and the second is to protact and nourish the offspring until birth
Muriidi
what is stercobilinogen
Hancerich Reply
fecal urobilinogen. Created by bacteria in the gut. a chemical that gives feces brown color.
Blayne
next question pls.
Kechi
The rate of diffusion increases if the
stella
What's the answer?
Kechi
it's a breaking down of haemoglobin and it's a chemical made by bacteria
Dev
Thnx Dev Raj.
Kechi
yup so any more
Dev
yes I sure do need more "Questions" & "Answers". I'm learning whole lot. Thnx.
Kechi
what is the greatest muscle of the body
Lungu Reply
gluteus maximus
ABDULLAH
pls!!! more "A&P" questions & answers. Thnx.
Kechi
Gluteus maximus
THE
Describe anatomy of cardiovascular system?
cardiovascular system is a group of organs coming together to perform the circulation of blood. The organs invoked are the heart and the blood vessels with blood being the tissue. The heart is a pump and it pumps oxygenated blood through the systemic circuit and deoxygenated blood through the pulmon
bernard
pulmonary circuit.
bernard
more A&P questions pls. Thnx.
Kechi
If an ANOVA yields a significant F value, you could rely on ________ to test significant differences between group means.
Dane Reply
what's ANOVA
Cassandra
analysis of variance
Blayne
plz what you mean with "ANOVA" first
Fatima
anova means analysis of variance, a statistical method in which the variation in a set of observations is divided into distinct components.
Blayne
M value ot test
ABDULLAH
What does it mean by M value ot test?
Orpha
formation of red blood cells
Biketi Reply
explain why... lower back pain in ovarian cancer
Srijoni Reply
we says that protoplasm is the living part of us How?
Muzamil Reply
is the leaving part of our cellular structure.
Eric
it is the leaving part of our blood cellular structure also
ABDULLAH
what is receptor?
Preity Reply
an organ or cell able to respond to light, heat, or other external stimulus and transmit a signal to a sensory nerve.
Jessi
Has anyone taken the first exam?
Sandra
yes
yahye
yes
Allan
hey what is the process after your food is swallowed? how long does it take to get to the stomache until it is released as waste?
Fednise Reply
that is such a broad question. as you begin to swallow its various doses down the alimentary canal that brings the food into your stomach.then depending on whether it's a protein carbohydrate fat that dictates what function takes place in your stomach. these are all steps of digestion.
Joseph
typo sorry it's peristalsis , wave-like projections that push food down your alimentary canal etc. digestion starts in your mouth ends in your large intestines (colon anus)
Joseph
some of the many processes of digestion include hydrolysis dehydration synthesis denaturation of proteins etc. you have to be more specific.
Joseph
there's many different contributing factors the how long it takes food to convert into waste. remember fats, triglycerides proteins and carbohydrates all breakdown two different monomers and structures. you should be looking up metabolic processes.
Joseph
depending how much fiber you have in your diet dictates how much water is brought to your intestines that has to do with excretion whether fiber is insoluble or soluble. this is an anatomy and physiology app. to simply say the stomach will empty its contents in 2 to 3 hours would do you a disservice
Joseph
can the study of anatomy relate to medical technologies
Lean Reply
yes
Khh
absolutely
Jessi
yes...
Sherif
how can I understand micro biology and anatomy better.
Cassandra
yes
Kevin
someone to help me understand glycogeneogenesis
abel
what are the major branches of the aorta?
Kevin
look youtube video
Jessi

Get the best Anatomy & Physiology course in your pocket!





Source:  OpenStax, Anatomy & Physiology. OpenStax CNX. Feb 04, 2016 Download for free at http://legacy.cnx.org/content/col11496/1.8
Google Play and the Google Play logo are trademarks of Google Inc.

Notification Switch

Would you like to follow the 'Anatomy & Physiology' conversation and receive update notifications?

Ask