There are many types of fractures. The main types of
fractures are described as either displaced, non-displaced, open, or closed.
Displaced and non-displaced refer to the way the bone breaks. Incomplete fractures such as a hairline
fracture usually results from a minor trauma and the fracture does not go all
the way through the bone. It is a very small crack in the bone. A Greenstick fracture is an incomplete
fracture in which the bone is bent. This fracture type most often occurs in
children. The Toddler fracture is an incomplete or undisplaced fracture that is
difficult to see. You may need an internal oblique view of the tibia to see
this fracture. Complete fracture means that the bone is completely fractured
through its entire width. Transverse fracture occurs due to tension of the bone
(such as a patellar fracture).
Transverse diaphyseal fracture in children can be successfully treated
by flexible IM nails. Oblique fracture occurs due to compression force. There
is slight obliquity of the fracture. In
a bending fracture pattern, part of the bone is subjected to tension force and
the other part of the bone is subjected to compression force. The part of the
fracture that is subjected to tension force will be transverse. The part of the
fracture that is subjected to compression force will be oblique. You can tell
from which side that the extremity was hit to create this fracture. Another
type of complete fracture is the Butterfly fracture pattern. If the fracture is
subjected to a bending force as well as axial loading, this will create the
butterfly fracture pattern. With the bending force there is a tension force on
one side creating a transverse fracture and a compression force on the other
side creating a short oblique fracture, and the addition of an axial load force
will create another oblique fracture. This is how the butterfly fracture is
created (small transverse fracture and two oblique fracture). Segmental fractures may occur from four point
bending. Segmental open fracture is considered to be a Grade III open fracture
even if the wound is 1 cm. Antibiotic coverage will include Ancef and
Gentamicin. A spiral fracture occurs due to torsion or twisting force. There is
a high association of posterior malleolus fractures with spiral distal tibial fractures
and a CT scan of the ankle may be needed to diagnose and ankle fracture. A
comminuted fracture or explosion fracture occurs due to high energy force. With
this fracture type, there is a concern for the development of compartment
syndrome. Examine the patient carefully for neurovascular deficit. The
treatment of this fracture may be difficult. The skin may be compromised and
the soft tissue is probably badly injured. The blood supply of the bone itself
may be affected which may affect healing of the bone. When the fracture is
comminuted, the most current treatment is to use a bridge plate to bridge the
fragments and not to try to organize them and fit the pieces together because
you may compromise the circulation of these fragments which may lead to nonunion
or infection. The tendency is not to touch these fragments, but to line the
axis of the limb carefully and to check the rotation and use a bridge plate.
Fractures that penetrate the skin are open. Fractures that do not penetrate the
skin are closed. Open fracture are more serious than closed fractures. Open
fractures need an antibiotic immediately once the patient arrives to the
hospital. Adequate debridement of the compromised, contaminated soft tissue
should be done. Open fractures have a higher risk of infection and nonunion
than closed fractures. Open fracture of the tibia can develop compartment
syndrome. Open fracture of the humerus with radial nerve palsy, you have to
explore the nerve because the nerve can be transected. Open fracture and radial
nerve palsy is not a case for observation, it is a case for exploration.
