hello all i am excited to discuss with you one of the fan favorite topic topics in this session
which are fractures you have likely had some experience one way or another regarding fractures
either you personally had a fracture or someone you know or even watching a sporting event where
a fracture occurs so it's something that is a something that you have some familiarity with
and so now we're going to talk about the specific ones
so we will discuss the main types of fractures and additionally talk
a little bit about how fractures repair it's a little on the amazing side of how
quickly the body starts trying to heal itself after a fracture
and lastly we will discuss or be discussing the two major types of treatments for fractures
okay fractures can be described as either open sometimes referred to as compound or closed aka
simple and in the most concise terms an open fracture will have the broken ends of the bone
protruding or at least one of those broken ends protruding through the skin
whereas a closed fracture will not break the plane in terms of skin now while you can have
some very very serious closed fractures typically the open fractures are more emergent situations
a community fracture are sometimes colloquially referred to as shattered bone or a shattered bone
with a portion of the bone being broken into many much smaller bony fragments lying between the two
major uh bone fragments so say this is one of your major ones your second major bone fragment
and then kind of in the middle you will literally have a shattering of bone where you have multiple
multiple small portions of the bone and these are typically much slower to heal as it's hard
for all those bony parts to properly align sometimes some of that bone has to be removed
an impacted fracture will typically have one of the fractured ends of a bone being driven
forcefully into the other end of the bone
a green stick fracture i think is one of the more interesting types of fractures
where you'll have an incomplete transverse fracture with the other side kind of bending
and this fracture is so named it's it's named green stick because of the similarity with say
a newish green twig so say you're you pick up a green twig and you're trying to break it you'll
usually have a break on one end but the other side will just bend so it'll be remain unbroken
this type of fracture only occurs in juveniles as juvenile bones are not fully formed or calcified
and contain more organic than the hardened inorganic material so
that's why you get that bending because you have that increase of flexibility
now as soon as a fracture occurs the bone and surrounding area almost immediately tries to
heal itself and it does so in a relatively typical process so these are kind of the
the four major steps now because blood vessels are typically associated with the fracture site
because remember with bone the blood supply is prolific so it's very hard not to also
cut or damage a vessel in that area so what will typically happen is you'll have the release of
blood because of the the torn vessel and this will form what is called a fracture hematoma
or a collection of blood that will form around the fracture site and this hematoma can can start
forming immediately and it's usually almost complete around six hours after the fracture
now because the blood supply has been affected and and so you have kind of a stop to blood
coming into this region and all you have is the the blood that's escaped from the blood vessels
this affects the bone cells because they're not getting that sufficient supply of oxygen
and other nutrients so those bone cells around this area will die in this region now cells from
the periosteal region called fibroblasts will move into the fracture site and create this really cool
area called the fibrocartilaginous or the soft callus so it's going to be kind of the soft area
that is going to be the intermediate over time that fibrocartilaginous callus will be replaced
by a bony callus so it will replace the cartilage the bone will replace the cartilage in that area
and you're left with a relatively large bony callus which will be remodeled over time in order
to repair the bone to as close as the original shape and size if all factors are right however
typically you'll still have a thickened area of bone over the once fractured site
and it's typically impossible to get the bone to exactly where it was pre-fracture so that area is
often detectable as a healed fracture but it gets pretty close and it's pretty amazing how this can
kind of go from you know this area where you have a lot of this escaped blood it's kind of getting
it stays in there because the periosteum is in that region unless you have an open fracture where
you could have periosteum um also being torn to a stage of fibrocartilage being replaced by
bone and then basically those osteoblasts and osteoclasts kind of work together
in order to get the bone to as close as the the previous shape as possible
now the treatment of a fracture depends on numerous factors including the type of fracture
so is it one of the more severe fractures or is it less so age bones involved these will all affect
the treatment for fractures but the ultimate goal of treatment is to realign the fractured
components as much as possible which often involves immobilization to prevent refracturing
or misalignment but the process of aligning the bony fragments to as close to one another
as possible is called reduction oftentimes we hear this referred to as setting a fracture
now this can be done through manual manipulation so kind of moving it through
kind of on the outside of the skin and moving the bones to as close
to each other as possible with the skin intact this is called a closed reduction
so keys here is manual manipulation and we're not having to make any incisions into the skin
if this is not possible surgery is necessary and this is referred to as an open reduction and you
can have some type of hardware that could play a role in terms of getting these bones aligned
in certain situations all right that was a lot of fracture fun but i don't
want to stop talking about fractures so let's work through a question together
all right question you receive a report from the radiologist concluding that you
have a shattered mid shaft oh this question i shouldn't have that v there so you have a
shattered mid shaft of your right femur what type of fracture have you most likely suffered is it A.
community B. green stick or C. impacted and really the main clue in this question stem is the word
shattered and hopefully if you see that you should be making your way towards a the community
which is the correct answer impacted can have some shattering but it is really more characterized by
one fractured end being really forcefully driven into the other fractured in and green stick is not
correct either it is an incomplete fracture which includes bending of that non-fractured portion
and remember green stick is going to be specific to juvenile bones or juvenile bones and that will
be a specific fracture for those individuals all right make sure to review these concepts on your
own and please reach out with any questions thank you for your time and attention here