Fracture & Trauma

• A fracture is a partial or complete break in the bone. When a fracture occurs, it is classified as either open or closed:

  • Open fracture (compound fracture): occurs when the broken bone breaks through the skin in the leg.
  • Closed fracture (simple fracture): the bone is broken but the skin is still intact.

Signs and symptoms of a fracture include:

• Swelling or bruising over a bone.
• Deformity of an arm or leg.
• Pain in the injured area that gets worse when the area is moved or pressure is applied.
• Loss of function in the injured area.
• In compound fractures, bone protruding from the skin.

• First-aid – Depends on type & location of fracture
• For open fractures -Control bleeding before treatment
• Dress the wound with antiseptic solution
• Check the breathing , pulse, conscious status
• Calm the person
• Examine for other injuries-head, chest , abdominal etc.
• Immobilize the injured limb in splints/ supports to prevent abnormal movements.
• Apply ice to reduce pain / swelling
• Shift patient to nearest hospital & pre-inform that hospital about the arrival of injured patient.

DO NOT 

• Massage the affected area.
• Straighten the broken bone.
• Move without support to broken bone.
• Move joints above / below the fracture.

• Greenstick fracture: A portion of the bone is broken, causing the other side to bend (this resembles what would happen if you tried to break a branch from a tree: it cracks on one side but stays partially intact on the other side).
• Buckle or torus fracture: One side of the bone bends (buckles) upon itself without breaking the other side
• Comminuted fracture: A bone has broken into more than two pieces. Comminuted fractures often require surgery.
• Growth plate fractures: Children have open growth plates (areas from which bone grows) at each end of their long bones. Injuries to these growth plates are common and in rare cases can result in limb length discrepancies or angular deformities Growth plate fractures are unique to pediatric patients.
• Stress (hairline) fracture: Tiny cracks in the bone usually caused by overuse or repetitive stress-bearing motions. These are common in children who take dance or run track.
• Non-displaced: the bone cracks or breaks but stays in place.
• Displaced fracture: ends of the broken bone come out of alignment. In a displaced fracture, surgery is usually needed to realign bones.

A child’s bone differs from adult bone in a variety of ways:

• Flexible bones: A child’s growing bones are bendable and resilient, which means they tend to buckle or bend a lot before breaking. This is the reason for the unique fracture patterns seen in children and not in adults. “Greenstick” and “buckle” fractures are two examples.
• Faster healing: Children’s bones are also surrounded by a thick layer of connective tissue (periosteum) that defends the bone against injury and harm. This tissue also produces blood supply to the area of a fracture. The body uses this supply of blood to replace damaged cells. Periosteum in adults tends to be much thinner, resulting in a slower healing process.
• Vulnerable growth plates:  Children have open growth plates (areas from which bone grows) at each end of their long bones. Injuries to these growth plates are common and in rare cases can result in limb length discrepancies or angular deformities. In performing surgery on broken limbs in children, surgeons must consider and account for these growth plates.

Undisplaced fractures or fractures with least chances of displacement.

Duration of cast treatment varies with the configuration, location and involvement of weight bearing limb .It is generally applied for 3 -6 weeks.