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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

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Fatima Reply
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Sentamu
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Sentamu
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Shubham
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Sentamu
icant undrestand plz
zahruuzh Reply
try to read I hop you will understand
state and explain 20 radiology uses
ILYAS Reply
what are chemicals in anatomy and physiology?
Mike Reply
what can I do to find it easy for me in anatomy and physiology course
Mike
study up on the basics of the periodic chart, learn bones and muscles attachments, and learn muscles. Those take the longest to memorize. After that it should be a little easier.
Toni
what are the two types of body cells
Jennifer Reply
what is malnutrition
Claire
malnutrition refers to faulty nutrition resulting from malabsorption,poor diet or overeating. Sometimes too these food do not contain all the six food nutrients in their right proportion.
Yakubu
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Claire
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Will u be malnourished?
Baigwa
gud
Budumari
What's the difference between radiology and radiology
gabriel
Nothing! Radiology it means the study or using of radiation in medical science it can be 1.diagnose or treatment diagnosed radiology! x- ray. ultrasound. ct-scan. mammogram. MRI. 2. treatmen- radiation oncology, like Cobalt 60. and nuclear medicine
Larry
what is X-ray?
Nissar
X-ray is type of light that make it possible to see inside any object. as human body
KUNDAN
How the nervous system develops
ayiesher Reply
From the cells at the back of an embryo
Mma
breifly explain anatomy of thorax
Hadiza Reply
How many region the rib is divided
Konneh
how many bon of human being
Nura
206
John
how to study for the skeletal system
ryaisha
and anatomy
ryaisha
I really need sources immediately
ryaisha
I printed out all the different bones. Put them in the see through protective sheaths and got dry erase markers. I could right on them and erase to help me learn to spell the names of markings and bones.
Toni
Or go to a book store, Barnes and Noble(doesn't have to be this) and they have coloring books for anatomy. $16. Really helpful.
Toni
okay thanks and are what study tools you use to study the materials and get a better understanding
ryaisha
*what are
ryaisha
hiii
Roopa
I prefer diagrams, pictures that lay out each step with the information in each step. For Example: how action potential creates muscles to move. A pictured diagram gives me a better understanding of how each piece plays a role in each step of the process.
Toni
Also for basics, such as memorizing vocab. Flash cards are great. Don't become discouraged if you don't get them all right the first times through. The more you go through them, your brain will remember pieces of information from each and help you to pull out the information 😉
Toni
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ryaisha
what is the functions of the lips in human
Momboi Reply
could I say sensation?
Sovilace
kissing
Obrian
for protection
Omar
Lips assist in speech and eating
Cindy
Too many easy questions. Which bones are the axial and appendicular? What are the abbreviations for TEE, TTE, AED, A-Mode, B-Mode, and LTH? What is the difference between hypothalamus and thalamus? Where is the parathyroid located? How many True Ribs do we have?
Sovilace Reply
Transesophageal echocardiography Transthoracic Echocardiography automated external defibrillator brightnees mode Los Hermanos Taverna
Inam
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okello Reply
anatomy is scientific study of body structures and how they relate to each other
Skeater
Are there other functions of the nucleolus apart from synthesis of RNA and formation of ribosomes
Peninah Reply
plays a role in cell response to stress
airiz
what is angle of auscultation
Bryan Reply
Anatomy which is the study of the human body structure has a couple of reasons it is been studied It helps to discover genetic disease cytology And histology which is the study of tissues Physiology is the study of function of the human cells It helps to know how the different body part works Its helps to know how part of the brain works And lastly It gives the essential to understand more about anatomy
Stephen Reply
describe the external features of a spinal cord
okoche Reply
Spinal nerves emerge in pairs, one from each side of the spinal cord along its length. The cervical nerves form a plexus (a complex interwoven network of nerves—nerves converge and branch). The cervical enlargement is a widening in the upper part of the spinal cord (C 4–T 1). Nerves that extend in
Inam
Hormones regulate certain target cell responses. These can include which of the following?
Nazareth Reply
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Source:  OpenStax, Anatomy & Physiology. OpenStax CNX. Feb 04, 2016 Download for free at http://legacy.cnx.org/content/col11496/1.8
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