A fracture is a complete or incomplete disruption in the continuity of bone structure

and is defined according to its type and extent. Fractures occur when the bone is
subjected to stress greater than it can absorb. Fractures may be caused by direct
blows, crushing forces, sudden twisting motions, and extreme muscle contractions.
When the bone is broken, adjacent structures are also affected, resulting in soft
tissue edema, hemorrhage into the muscles and joints, joint dislocations, ruptured
tendons, severed nerves, and damaged blood vessels. Body organs may be injured
by the force that caused the fracture or by fracture fragments.

incomplete fracture
complete fracture
comminuted fracture
closed fracture
Types of Fractures
A complete fracture involves a break across the entire cross section of the bone and
is frequently displaced (removed from its normal position). An incomplete fracture
(eg, greenstick fracture) involves a break through only part of the cross-section of
the bone. A comminuted fracture is one that produces several bone fragments. A
closed fracture (simple fracture) is one that does not cause a break in the skin. An
open fracture (compound, or complex, fracture) is one in which the skin or mucous
membrane wound extends to the fractured bone.

An intra-articular fracture extends into the joint surface of a bone. Because each
end of a long bone is cartilaginous, if the fracture is nondisplaced, x-rays will not
always reveal the fracture because cartilage is non radiopaque. An MRI or
arthroscopy will identify the fracture and confirm the diagnosis. The joint is
stabilized and immobilized with a splint or cast and no weight bearing is allowed
until the fracture has healed. Intra-articular fractures often lead to posttraumatic
arthritis.
Clinical Manifestations
The clinical signs and symptoms of a fracture include acute pain, loss of function,
deformity, shortening of the extremity, crepitus, and localized edema and
ecchymosis. Not all of these are present in every fracture (Whiteing, 2008).
Pain
The pain is continuous and increases in severity until the bone fragments are
immobilized. The muscle spasms that accompany a fracture begin within 20
minutes after the injury and result in more intense pain than the patient reports at
the time of injury. The muscle spasms can minimize further movement of the
fracture fragments or can result in further bony fragmentation or malalignment.

Loss of Function
After a fracture, the extremity cannot function properly because normal function of
the muscles depends on the integrity of the bones to which they are attached. Pain
contributes to the loss of function. In addition, abnormal movement (false motion)
may be present.
Deformity
Displacement, angulation, or rotation of the fragments in a fracture of the arm or
leg causes a deformity that is detectable when the limb is compared with the
uninjured extremity.

Shortening In fractures of long bones, there is actual shortening of the extremity

because of the compression of the fractured bone. Sometimes muscle spasms can
cause the distal and proximal site of the fracture to overlap, causing the extremity
to shorten.
Crepitus When the extremity is gently palpated, a crumbling sensation, called
crepitus, can be felt. It is caused by the rubbing of the bone fragments against each
other.

Localized Edema and Ecchymosis

Localized edema and ecchymosis occur after a fracture as a result of trauma and
bleeding into the tissues. These signs may not develop for several hours after the
injury or may develop within an hour, depending on the severity of the fracture.

Emergency Management
Immediately after injury, if a fracture is suspected, it is important to immobilize the
body part before the patient is moved. Adequate splinting is essential. Joints
proximal and distal to the fracture must be immobilized to prevent movement of
fracture fragments. Immobilization of the long bones of the lower extremities may
be accomplished by bandaging the legs together, with the unaffected extremity

Rapid Review
Types of Fractures
incomplete fracture
complete fracture

comminuted fracture
closed fracture
Clinical manifestations of fractures
Pain
Loss of Function
Deformity
Shortening
Crepitus
Localized Edema and Ecchymosis

Emergency Management
Before the patient is moved immobilize the body part.
The joints above and below the fracture must be immobilized to prevent movement
of fracture fragments.

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