<< 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

what is oesophagus?
Bhavani Reply
oesophagus also known as food pip
ABDULLAH
What is the meaning of dissection
Beryl Reply
what's the meaning of polar?
Jackson Reply
Sign of anaemia or whitish color or Hgb luck
Kassahn
Are you talking of Polar anaemia or what, because the word polar doesnt have one meaning
Kingsley
what are the three types of adrenocorticoids hormones
Lubega Reply
glucocorticoids mineralocorticoid and catecholamines
Kartik
what is polar and non-polar
Jackson Reply
polar unequal share of electron while non polar is equal share
Quran
why are phosphate molecules negatively charged?
Jackson Reply
Bocz of unpaired elections
Javid
because of unpaired electrons
ABDULLAH
what are amphipathic molecules?
Jackson Reply
Amphipathic molecules are molecules with both polar and non polar regions
Mohammed
How does the male organ develop
MADUBULA Reply
Hw does the male organ develop
MADUBULA
Review your questions madam
Aliyu
what is anaphylaxis?
Rugut Reply
it is an imagency condition resulting from abnormal and immediate alagic response to a substance to which the body has become intensively sensitized
Lubega
different between drug and medicine
ado Reply
drugs have no medical application (cocaine, heroin, crystal meth). medicine have medical purpose (fentanyl, albuterol, aspirin, ect ect)
Jordan
medicine is a substance or preparation used in treating disease,drug is chemical compound medicine are drugs but all drugs are not medicines
Wafa
assalam o alaikum
Sidra
what happen to ECF and ICF regarding to OEDEMA
Zwanga Reply
what are the smooth muscles of the heart
Sintung Reply
stomach
Sidra
identify external features of kidney
saba Reply
kidney weight on males?
saba
and female ?
saba
Sle full name & treatment
Samim
Syplymic lupw erythematous
Samim
blood supply to spleen ?
saba
g..
saba
ya 135 g females
saba
130 on male
saba
130g on male
saba
g samim
saba
no 130grms on male
saba
mbbs
saba
good saba khan
Shahab
Tom kya krti ho st?
saba
your name?
saba
ok
saba
tum kya krti ho? muskan
saba
ok
saba
good muskan
Shahab
ok bye I m studying
saba
Define cranial nerves with oder
Javid
O-olfactory O-optic O-occumulator T-trochlear T-trigemenal A-abducent F-facial A-auditory G-glossopharyngeal V-vagus A-acessory
Aniee
opd mean?
Shahab
out patient department
mahesh
thnxx
Shahab
Ty Aniee singh
Javid
Ap sb us book s parhte h
Areeej
Read KD Tripathi book of Pharmacology.
mayank
Hello
mayank
CT Scan means
Sintung
what's health?
Sintung
hello
Philip
hi
Sintung
CT means - computerized tomography
Vivek
connective tissue
Dee
they link some body organs
Sintung
Difference between drug and medicine
Javid
hiii muskan
saba
what is tomography?
Gideon
tomography ☝
shahid
yes
Gideon
how hemolytic anemia cause due to gas gangrene?
Huma Reply
what's gangrene?
Sidra
why retro abdominal region called or named "flank "?
Huma Reply

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