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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

what is pelvis
Aisha Reply
Complex of bones that connect the trunk and the legs,supports and balance the trunk.
Orpha
What is d most heaviest organ in d body
Abraham Reply
Liver
Akasi
The skin
Akasi
skin
Divya
why skin?
Sam
liver
Anne
water
Mehdi
Heart
Biplob
the brain
lehumo
skin
Emma
skin
jessica
largest internal organ is the liver
jessica
liver is the heaviest organ
Eyyammeh
the liver is the heaviest organs
Khh
What is the meaning? What does it entails to? What are the works of Arthropologists?
Orpha Reply
bones of appendicular skeleton
hemalatha Reply
Fore limbs, hind limbs, pectoral and pelvic girdle
Abraham
Functions of the thoracic cage
Fereh Reply
protect all the organs and tissues from any impact or injury
Javier
It protects the heart other tissues in the chest region
Abraham
why sickle cell carrier people don't get malaria
Boakye Reply
Bcos mosquitoes are not attracted by their blood due to poor oxygen
Abraham
What is the amniotic fluid
bollywood Reply
amniotic fluid is the fluid that is inside the uterus with the baby.
Fati
shielded
Varun
This fluid serves as a cushion for the growing fetus but also serves to facilitate the exchange of nutrients, water, and biochemical products between mother and fetus.
Anne
it also reduces friction during birth as it wets the birth canal during delivery
steve
Amniotic fluid can be taken out by inserting needle to detect birth abnormalities as the foetus cells are present in amniotic fluid. This process is known as amniocentesis.
Biplav
structure of heart and it's function (10 mark )
Priyanka Reply
not possible
Abraham
What is the best book on physiology?
cesar Reply
describe varicocele
malulu
what do you mean by peritoneum
Siba Reply
It is thick covering surrounding the abdomen
Awais
r8
how to become good in Anatomy and physiology
malulu
hi
Milkah
hlo
Wani
What are is the last solution to abdomen pain in pregnant women
Umoru
no it is in kidney
Tantray
Kk
Umoru
structure of heart and it's function
Priyanka
Serous membrane lining the cavity of the abdomen
bollywood
it is four lobs structure and it is triangular in shaped. it 's function pumping the blood
ABDULLAH
explain root of lungs
ABDULLAH
Glomerular pressure -capsule pressure -colloid osmosis pressure
malulu Reply
how to describe mechanism of micturition
malulu
spleen is important?
AKASH Reply
helpful in destruction of rbc
It is imp in storing blood and destruction of microbes and harmful particles
Awais
ty sir
AKASH
K
Umoru
what are the sources of glucose in the body
malulu
describe mechanism of micturition
malulu
Pancreatic hormones with function
mami Reply
Insulin, which helps to regulate our blood sugar levels.
Bb
glucagon which is antagonistic to insulin increase the blood glucose level,. Somatostatin help to regulate the levels of both insulin and glucagon
Ashish
thnks for helping
nimco
thanks
Narendra
what is a lymph node.?
AKASH
lymph nodes are small kidney shaped organs of the lymphatic system.
Trishauna
there are several hundred lymph nodes found mostly throughout the thorax and abdomen of the body with the highest concentrations in the auxiliary (armpit) and inguinal groin regions.
Trishauna
what is life
Yar Reply
life is the existence of an individual human being animal or plant
Furmose
how I join this
Ahmed
meaning
Furmose
to day I am new person and I can't participate questions so to morow I shall participate question sopleas excuse me
Ahmed
I had a debate earlier about nutrition and it didn't get a clear answer on that,can one tell me what the definition of nutrition.?
kelvin
the nutrition is nourish person is feeling an nutrition
Ahmed
I think nutrition is the process of taking food and using it for growth, metabolism and repair.
Methila
life is full of happy and sorrow
Sanamacha
life is achievement
Nandini
life is the nothing but god gave us 1 body. and we all service k in this body. The things which we do for the Survivation for this body I felt that this is called as the life
AKASH
Yes God gave us life but not god who gave us the life. Hope u understood what i meant by God n not god who gave life..... ?
laku
What's the question?
Sherman 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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