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Fracture

A bone is not a stagnant organ. It is the body's reservoir of calcium and is always undergoing change under the influence of hormones. The parathyroid hormone, parathormone, increases blood calcium levels by leeching calcium from bones, while calcitonin has the opposite effect, allowing bones to accept calcium from the blood. It allows the body to be supported against gravity and to move. Any breakage in the continuity of the bone is known as a fracture.

Classification:
1.Based upon etiology-
    a. Fragility fracture- it occurs spontaneously or as the result of relative minor trauma;
        they are typical of osteoporosis.
    b. Pathological fracture- it occurs in bone that is structurally abnormal, such as paget's
        disease, osteomalacia, bone metastases and parathyroid bone diseases. Like fragility
        fractures, they can occur spontaneously or follow minor trauma.
    c. High-energy fracture- it results from major trauma like car crash, fall from height
        and can effect normal bones.
    d. Stress fracture- it is also known as fatigue fracture. Oft- repeated trauma loads
        applied to the skeleton at the same site may cause fracture. This is commonest in the
        metatarsals, particularly the second in its neck due to prolonged marching. Hence it
        is also called MARCH FRACTURE. 

2. Based upon orthopaedic medicine-
    a. Simple or closed fractures- those in which the fracture surface does not
        communicate with the exterior through skin or mucus membrane.
    b. Compound or open fractures- those in which there is a communication between the
         fracture and the exterior through the skin or the mucus membrane.

3. Based upon number-
    a. Single
    b. Multiple

4. Fractures may be-
    a. Complete- where the whole thickness of the bone is discontinued.
    b. Incomplete- in this type of fracture it does not involve whole breath of a shaft and
        portion remains intact.

Fractures in children:
Children can break bones and yet have normal x-rays. Fractures appear as clear lines through the bone on an x-ray through the bone. If calcium hasn't yet accumulated in the repairing bone, the break may not be apparent. This lack of calcification happens in two ways.
1.Bones mature at different times in a child's development and while the bony structure is there, it may have more cartilage than calcium.
2.The second situation is associated with growth plates. Each bone has an area where cell activity is maximal and where the bone grows. These areas appear as lucent lines on x-ray. It may be one of the weaker points in the bone as well, and a fracture through the growth plate may not be seen.
The doctor needs to match the history and physical exam with what is seen on x-ray to make to a diagnosis. Sometimes, the child is placed in a cast for a period of time to protect the broken limb. As fractures heal, the body lays down extra calcium as building material and then remodels it to normal shape. After 7-10 days, there may be evidence on x-ray of the healing calcium to confirm the fracture.
Growth plate fractures are classified by Salter-Harris category. When a break occurs through the growth plate, it can involve different parts of the bone on each side of the plate. It is important that these fractures are aligned properly so that the bone grows properly as the child ages.
Children are more flexible than adults until the calcium completely solidifies their bone. If you think of an arm or leg bone as tubular, sometimes only one side of the bone breaks, just like an immature branch on a tree. This is referred to as a greenstick fracture, and may need to be "set" so that it heals properly. Sometimes the bones can bend but not break because they are so pliable. This is called a plastic deformity and again will need to be set or aligned to allow proper healing.

Symptoms:
Although bone tissue itself contains no nociceptors, bone fracture is very painful for several reasons-

  • Breaking in the continuity of the periosteum, with or without similar discontinuity in endosteum, as both contain multiple nociceptors.
  • Edema of nearby soft tissues caused by bleeding of torn periosteal blood vessels evokes pressure pain.
  • Muscle spasms trying to hold bone fragments in place.
Local Examination:
1.Inspection-
a.Abnormal swelling and deformity
b.Shortening- a little amount of shortening is almost always expected in fractures dut to overlapping of segments.
c.Overlying skin- to detect the communication between the fracture site and exterior environment.
2.Palpation-
a.Tenderness- Local bony tenderness in valuable sign.
b.Bony irregularity
c.Abnormal movement
d.repitus- it is a sensation of grating which may be felt or heard, when the bones ends are moved against each other.
e.Absence of transmitted movements.
f.Swelling
g.Wound

Diagnosis:
1.Complete history of patient with the history of trauma or any pathological disorder one is suffering..
2.Clinical examination
3.X- ray- it help in diagnosing the fracture and its proper site and type.

Healing process:
The natural process of healing a fracture starts when the injured bone and surrounding tissues bleed, forming what's called fracture Hematoma. The blood coagulates to form a blood clot situated between the broken fragments. Within a few days blood vessels grow into the jelly-like matrix of the blood clot. The new blood vessels bring phagocytes to the area, which gradually remove the non-viable material. The blood vessels also bring fibroblasts in the walls of the vessels and these multiply and produce collagen fibres. In this way the blood clot is replaced by a matrix of collagen. Collagen's rubbery consistency allows bone fragments to move only a small amount unless severe or persistent force is applied.
At this stage, some of the fibroblasts begin to lay down bone matrix (calcium hydroxyapatite) in the form of insoluble crystals. This mineralization of the collagen matrix stiffens it and transforms it into bone. In fact, bone is a mineralized collagen matrix; if the mineral is dissolved out of bone, it becomes rubbery. Healing bone callus is on average sufficiently mineralized to show up on X-ray within 6 weeks in adults and less in children. This initial "woven" bone does not have the strong mechanical properties of mature bone. By a process of remodeling, the woven bone is replaced by mature "lamellar" bone. The whole process can take up to 18 months, but in adults the strength of the healing bone is usually 80% of normal by 3 months after the injury.
Several factors can help or hinder the bone healing process. For example, any form of nicotine hinders the process of bone healing, and adequate nutrition (including calcium intake) will help the bone healing process. Weight-bearing stress on bone, after the bone has healed sufficiently to bear the weight, also builds bone strength. The bone shards can also embed in the muscle causing great pain.

Treatment:
Initial treatment for fractures of the arms, legs, hands and feet in the field include splinting the extremity in the position it is found, elevation and ice. Immobilization will be very helpful with initial pain control. For injuries of the neck and back, many times, first responders or paramedics may choose to place the injured person on a long board and in a neck collar to protect the spinal cord from potential injury.
Once the fracture has been diagnosed, the initial treatment for most limb fractures is a splint. The joints above and below the injury are immobilized to prevent movement at the fracture site. This initial splint does not go completely around the limb. After a few days, the splint is removed and replaced by a circumferential cast. Circumferential casting does not occur initially because fractures swell (edema). This swelling would cause a build up of pressure under the cast, yielding increased pain and the potential for damage to the tissues under the cast.

Surgery
Surgery on fractures are very much dependent on what bone is broken, where it is broken, and whether the orthopedic surgeon believes that the break is at risk (for staying where it is) once the bone fragments have been aligned. If the surgeon is concerned that the bones will heal improperly, an operation will be needed. Sometimes bones that appear to be aligned normally are splinted, and at a recheck appointment, are found to be unstable and require surgery.
Surgery can include closed reduction and casting, where under anesthesia, the bones are manipulated so that alignment is restored and a cast is placed to hold the bones in that alignment. Sometimes, the bones are broken in such a way that they need to have metal hardware inserted to hold them in place. Open reduction means that, in the operating room, the skin is cut open and pins, plates, or rods are inserted into the bone to hold it in place until healing occurs. Depending on the fracture, some of these pieces of metal are permanent (never removed), and some are temporary until the healing of the bone is complete and surgically removed at a later time.
Homoeopathic Management:
Homeopathy provides many significant medicines in treating people who suffer from accidents and injuries. When these medicines are used in combination with conventional procedures, the risk of long-term damage from an injury can be significantly decreased and the healing process can be noticeably improved. Homeopathic medicines will help in speed up healing over the fractured site by enhancing circulation, can also be used as an antiseptic to avoid infections in case of open fractures. Patients treated homeopathically experience less pain, have fewer side effects, and recover faster. The goal of this Homeopathic approach is to enliven the body's natural healing and self-repair ability to not only help recover from your fracture, but also create the highest state of health and well-being.

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