FRACTURE

DR.D.VISHNUGURUBARAN
ASSISTANT PROFESSOR
DEPT. OF VSR
FRACTURE
A complete / incomplete break in the continuity of the
bone or cartilage or both is called fracture
Causes
 Trauma
 Direct fracture
 Indirect fracture
 Pathology – bone diseases
 Stress
 CLASSIFICATION OF FRACTURE
Fracture may be broadly classified into three typer viz. simple, compound
and complicated fractures

 Simple fracture (Closed fracture) a fracture which does not

communicate with outside i.e., there is no wound on the skin leading to
the fracture site

 Compound fracture (Open fracture) a fracture which is

communicating with an open wound on the skin

 Complicated fracture a closed fracture in which there is considerable

injury to important neighboring vessels or nerves or is accompanied by
A fracture may be complete or incomplete

An incomplete fracture – It is a fracture which does not extend through complete thickness
of the bone

 Greenstick fracture: fracture in which the bone is partially broken like a bent green stick
and occurs in young animal

 Partial or splintered fracture: when splinters of bone are separated from the main bone
as a result of direct violence as may be caused by firearms

 Fissured fracture: there is a fissure (Crack) extending through the bone without causing
any displacement of fragments. The fissure in the bone may be longitudinal, transverse or
oblique

 Sub-periosteal (Intra-periosteal) fracture: A fracture of the cortical bone without

rupture of the periosteum

 Deferred fracture is an incomplete fracture in which separation of fragments occur only

after a varying period after the incidence due to subsequent violence, strain or concussion
A complete fracture – it is a fracture in which the bone is broken completely
through its thickness

 Single fracture

 Double fracture

 Multiple fracture (Comminuted fracture)

Based on the portion of the bone involved, fractures may be classified as

 Diapysary fracture: A fracture involving the diaphysis (shaft) of a long bone

 Epiphysary fracture: Fracture at the junction of the epiphysis and shaft of the bone

 Supracondylar fracture: A fracture above the condyle

 Condyloid fracture (Condylar fracture): A fracture in which small fragments including the condyle is separated from the bone

 Transcondylar fracture: A fracture of humerus or femur in which the line of fracture is at the level of condyles

 Intercondylar fracture: A fracture between the condyles of the humerus

 Pertrochantric fracture: Fracture of femur passing through the great trochanter

 Transcervical fracture: Fracture through the neck of the femur

 Periarticular fracture: When bone is fractured close to its articular extremity without extending into the joint, periarticular
fracture results.

 Articular fracture (joint fracture): Fracture involving the articular surface of the bone

 Extracapsular fracture: a fracture near a joint but not entering within the joint capsule.

 Intercapsular fracture: A fracture within the joint capsule.

Depending on the direction of the fracture, a fracture may be classified as:

Transverse fracture: A fracture at right angles to the axis of the bone

Longitudinal fracture: A fracture extending in a longitudinal direction,

e.g., “split pastern” in the horse, wherein there is a longitudinal fracture of
the os-suffragins.

Oblique fracture: A break in a bone extending in an oblique direction

Spiral fracture: A fracture which is in a spiral direction.

 Depending on relationship between the fragments in the fracture:

Torsion fracture: A fracture in which one of the fragments has been twisted and
separated

Impacted fracture: Fracture in which one fragment firmly driven into another or one bone
is driven into the fracture site of another, e.g., head of femur driven into a fractures
acetabulum.

Dentate fracture: A fracture in which the ends of the fragments are toothed or interlocked

Riding fracture (Over-riding fracture) A fracture in which the fragments lie side side,
causing shortening of the limb.

Distracted fracture: A fracture in which the fractured fragments are separated by

muscular pull
 A fracture could be

Compression fracture: A fracture produced by compression, causing apparent

reduction in the size of the bone due to pressure.

Depressed fracture: A fracture of skull in which a fragment is depressed blow the

surface

Colle’s fracture: Fracture of distal end of radius. Abduction of paw is noticed in colle’s
fracture.

Pathological fracture(spontaneous fracture; Secondary fracture) A fracture

occurring due to weakening of bone by disease and not due to trauma.

Congenital (Intra-uterine) fracture: fracture of bone of a foetus in the uterus.

FRACTURE HEALING

The healing of a fracture may be described in four stages

I. Formation of haematoma

II. Formation of soft callus

III. Formation of primary bone callus

IV. Formation of secondary bone callus

FORMATION OF HAEMATOMA

Fracture causes injury to blood

vessels and surronding soft
tissue

Haemorrhage around the seat

od the fracture

Haematoma
(Within about 24 hours)
FORMATION OF SOFT CALLUS

Innergrowth of fibroblasts and capillaries

(Periosteum, endosteum, Haversian canals and
bone marrow)

Macrophages enters the blood clot to remove the

extravasated RBC and debris

The clote contains fibrins, fibroblasts and newly

formed blood vessels and resembles like
granulation tissue

SOFT CALLUS OR FIBROUS CALLUS OR

TEMPORARY CALLUS
(within one or two weeks)
FORMATION OF PRIMARY BONE CALLUS

Clot is acidic due to cellular debris consisting of damaged

tissues and haemorrhage

this acidity favours mobilization of calcium from the

bone fragment as calcium phosphate and from blood

Enzyme phosphatase released from osteoclasts also

cause release of calcium phosphate

Supersaturation of calcium in the haematoma at the

fractured site

calcium starts depositing and the reaction slowly turns

towards alkaline - PRIMARY BONE CALLUS forms
Osteoblasts derived from the bone fragments invade the
callus(OSteoblast are more in the periosteum and endosteum and
extremely few in compact bones)

Calcium deposited in the intercellular space

Mineralisation is more at the periphery and central

zone of the callus and meagre in the intermediate zone

Afford temporary union and immobilises the fractured

fragments

within about four to eigh weeks depends upon the size

of the bone and age, clinical union set to be happen
FORMATION OF SECONDARY BONE CALLUS AND
FUNCTIONAL RECONSTRUCTION OF THE HEALING BONE
(FORMATION OF MATURE BONE)

Develops from four to eight weeks

primary callus organised by a process of

consolidation and ossification

excessive connective tissue, cells and debris

are removed by osteoclasts and new bone
formation is brought about by osteoblasts

contraction and organisation of the callus

takes pace and excess thickness over the
periphery disappears (Resorption)
 GENERAL PRINCIPLE OF FRACTURE REPAIR

General principle of fracture treatment includes

1. Reduction of the fracture fragments

2. Retention of the fracture fragments

3. Immobilization
 The first consideration is preserving the patient’s life; repair of tissues and restoration of function are secondary.
Treatment for shock, hemorrhage, and wounds of the soft tissues, if present, should be instituted immediately,

and the patient should be made as comfortable as possible.

 Examination of an animal with a fracture or suspected fracture should include the following:

1. Assessment of the animal’s general health.

2. Determination of whether tissues or organs adjacent to the fracture or other parts of the body have been damaged

and, if so, to what extent.

3. Examination to ascertain whether fractures, ligamentous instability, or dislocations are present in other parts of the

body.

4. Precise evaluation of the fracture or fractures.

Clinical signs

1. Pain or localized tenderness

2. Deformity or change in angulation

3. Abnormal mobility

4. Local swelling (This may appear almost immediately or not until several
hours or a day after the accident. It usually persists for 7 to 10 days because
of the disturbed flow of blood and lymph.)

5. Loss of function

6. Crepitus
DIAGNOSIS

 History and clinical signs

 Radiography
 CT and MRI
REDUCTION OF THE FRACTURED
FRAGMENTS
 Hold the upper segment and adjust or move the lower one
 Over riding – General anaesthesia
 Traction and counter traction combined with local manipulation
 Open reduction
RETENTION AND IMMOBILIZATION

 To stabilize the fragments and to prevent displacement,

angulation, and rotation.

Ideally, the fixation method used should

(1) accomplish uninterrupted stabilization at the time of the

original surgery,

(2) permit early ambulation, and

(3) permit the use of as many joints as possible during the healing
period.
METHODS OF FIXATION

1. Limb splintage (coaptation splints, casts, modified Thomas splint)

2. Bone splintage (intramedullary pin, external skeletal fixator, bone

plate)

3. Compression (lag screw, cerclage/interfragmentary wire, tension

band wire, tension band/compression plate)
 Coaptation splints and casts are very commonly used for
fracture immobilization. The commonly used coaptation splints
and casts are listed below:
Mason meta splints
 Gum bandage Suturing bone fragments

 Starch Applying bone plates

bandage
Applying bone pins
 Splints and bandages
External pinning
 Plaster of Paris and gutters
Intra-medullary pinning
 Poroplastic felt
 Thomas splints
FORCES ACTING ON
BONES